Council on Medical Student Education in Pediatrics

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COMSEP 2010 Albuquerque Meeting

FEEDBACK ON CLINICAL SKILLS (FCS): A CENTRALIZED, FORMATIVE ASSESSMENT OF MEDICAL STUDENTS' ADVANCED CLINCAL SKILLS

Authors:
Jennifer G. Christner, MD, Pediatrics; Carrie K. Bernat, MSW, MA; Joel Purkiss, PhD, Casey B. White, PhD, Medical School, University of Michigan, Ann Arbor, MI

Background:  A wealth of literature questions the quality of direct observation of medical students coupled with proper feedback and assessment in clinical clerkships.  At our institution, students asked for more direct feedback of their clinical interactions. We implemented a centralized program for providing students with formative feedback on the development of their clinical competence. Objective:  To design a multi-step experience, addressing the limited direct observation in clinical clerkships, that provides formative feedback to third year medical students regarding their advanced cognitive, clinical and communication skills. Methods:  Each student completes 2 FCS encounters during their third year.  In one encounter (focused), students direct their efforts on a chief complaint while the second encounter (full) mimics a new patient encounter.  Students conduct a history and physical examination with a standardized patient(SP)  (with real-time video observation by a faculty preceptor), order diagnostic tests, synthesize evidence for a treatment plan and present the patient to the preceptor.  SPs provide feedback on communication skills, and preceptors provide  feedback about the entire exercise.  Students develop learning plans based on self-reflection, self-assessment, and feedback received. Results: Paired-sample t-test results show that between the first and second exercises, students’ scores increase for: SPI assessment and students’ self-assessment of communication skills (p=0.000), verbal presentation (p=0.001), and final (overall) faculty evaluation (p=0.007).  Differences in performance, especially related to history and physical exam domains, do exist between cohorts who did a full case first, versus second. There is a significant decline in history taking (p=0.000) and physical examination (p=0.0000) between focused first and full second and a significant improvement in history taking (p=0.001) and physical examination (p=0.032) between full first and focused second.  Discussion:  We hypothesize that students have a lower performance on the full physical exam to the fact that they rarely do a full physical examination on clerkships and if done, are rarely observed or provided with feedback.  FCS allows us to measure the global impact of the clinical curriculum on learning while providing formative feedback with direct observations. Student evaluation of this program has also been remarkably high