Kelsey E. Ward,University of Colorado,Denver,CO,Jennifer B. Soep,University of Colorado,Aurora,CO
Background: In 2013, the USMLE Step 2 Clinical Skills (CS) changed the format of the Integrated Clinical Encounter, including the note. US students have historically had the lowest performance in this section. Students require exposure to this new format to prepare for the exam.
Objectives: Assess the impact of exposure to the new CS note format during the pediatric clerkship on student performance on the end-of-third-year Clinical Practice Exam (CPE) and student-reported readiness for CS.
Methods: During 2013-2014, pediatric clerkship students participated in a group session using the CS note to reason through a case. Sample notes were provided and key aspects of the note were highlighted. The end-of-clerkship (EOC) quiz included a paper case that required completion of a CS note. Notes were given a total score (0-6 points) assigned using similar criteria to CS notes, including subscores (0-2 points each) for differential diagnosis, diagnosis justification and diagnostic testing. Students completed 9 CS-style notes for the CPE. Students were surveyed during the quiz and CPE to assess their attitudes about their CS preparation.
Results: One-hundred-fifty-five students completed the pediatric clerkship and 115 responded to the CPE survey. Percent of students achieving each score on the quiz note: 6 (19%), 5 (26%), 4 (41%), 3 (9%), 2 (4%), 1 (1%), with most points missed in the differential diagnosis section. Preliminary analysis of the first group of CPE notes showed a failure rate of 9%, with the diagnostic study section scoring lower on multiple cases. Eighty-six percent agreed/strongly agreed that the case during the clerkship using the CS note-format and 72% agreed/strongly agreed that the quiz note helped them prepare for the CPE notes and 18% commented that they wanted more exposure to the CS note.
Discussion: Practice with the CS note during the clerkship helped students prepare for the CPE and CS exam. Another survey will be sent to students after all have taken CS. By March 2015, we will compare performance on the EOC quiz notes to the CPE notes and explore areas for further development, such as more instruction on the differential diagnosis and diagnostic study sections.