Procedural and interpretive skills of medical students: experiences and attitudes of fourth-year students.

BACKGROUND: Recent data do not exist regarding fourth-year medical students' performance of and attitudes toward procedural and interpretive skills, and how these differ from third-year students'. METHOD: Cross-sectional survey conducted in February 2006 of 122 fourth-year students from seven U.S. medical schools, compared with their responses in summer 2005. Students estimated their cumulative performance of 22 skills and reported self-confidence and perceived importance using a five-point Likert-type scale. RESULTS: The response rate was 79% (96/122). A majority reported never having performed cardioversion, thoracentesis, cardiopulmonary resuscitation, blood culture, purified protein derivative placement, or paracentesis. One fifth of students had never performed peripheral intravenous catheter insertion, phlebotomy, or arterial blood sampling. Students reported increased cumulative performance of 17 skills, increased self-confidence in five skills, and decreased perceived importance in three skills (two-sided P < .05). CONCLUSIONS: A majority of fourth-year medical students still have never performed important procedures, and a substantial minority have not performed basic procedures.

Feasibility, reliability and user satisfaction with a PDA-based mini-CEX to evaluate the clinical skills of third-year medical students.

BACKGROUND: The mini-clinical evaluation exercise (mini-CEX) has been used to assess clinical skills of 3rd-year medical schools. However a PDA-based mini-CEX has not been developed or evaluated before. Our objective was to determine the feasibility, implementation, and user satisfaction with a PDA-based mini-CEX. DESCRIPTION: Third-year medical students at the Medical College of Wisconsin who rotated on their core clinical clerkship in internal medicine during the period of July 2004 to April 2005 (n = 177) were required to complete two PDA-based mini-CEXs that were supervised by a faculty member or senior resident. Descriptive statistics and sample t test with equal variances were performed to analyze PDA-based mini-CEX completion rates, satisfaction scores by overall user and by evaluator type. EVALUATION: During the 10-month study period, 354 PDA-based mini-CEX forms were collected (100% completion rate). Seventy-five percent (n = 267) of mini-CEXs occurred in the inpatient setting and 24% (n = 87) in the outpatient clinics. Students reported receiving feedback from their evaluator in 96% of these exercises. The most frequently evaluated competencies were humanism (90%), physical examination (90%), and overall clinical competence (90%). Third-year students were evaluated by residents in 58% (n = 205) of encounters and by faculty in 42% (n = 149). Residents rated students significantly higher than faculty (overall M = 7.6 vs. 7.1, respectively) in all clinical domains of the PDA-based form (p < .05). Satisfaction with the PDA based mini-CEX was high (scale = 1-9) for residents (8.1; SD = 1.5), faculty (7.4; SD = 1.5), and students (8.0; SD = 1.7). CONCLUSIONS: A PDA-based mini-CEX is a feasible tool to facilitate the direct observation of students' clinical skills. The PDA-based mini-CEX was highly rated by students and evaluators as a valuable technology-based tool to document direct supervision of clinical skills.

Procedural and interpretive skills of medical students: experiences and attitudes of third-year students.

BACKGROUND: Recent data do not exist on medical students' performance of and attitudes toward procedural and interpretive skills deemed important by medical educators. METHOD: A total of 171 medical students at seven medical schools were surveyed regarding frequency of performance, self-confidence, and perceived importance of 21 procedural and interpretive skills. RESULTS: Of the 122 responding students (71% response rate), a majority had never performed lumbar puncture, thoracentesis, paracentesis, or blood culture, and students reported lowest self-confidence in these skills. At least one-quarter of students had never performed phlebotomy, peripheral intravenous catheter insertion, or arterial blood sampling. Students perceived all 21 skills as important to learn and perform during medical school. CONCLUSION: Through the third year of medical school, a majority of students had never performed important procedures, and a substantial minority had not performed basic procedures. Students had low self-confidence in skills they rarely performed, but perceived all skills surveyed as important.

Learning Activities and Third-Year Medical Student Ratings of High Quality Teaching Across Different Clerkships.

OBJECTIVE: To identify and compare learning activities that students associate with high quality teaching across clerkships. METHODS: For six months, 110 third year medical students recorded data on learning activities and teaching quality using personal digital assistants (PDAs) during five different required clinical clerkships. Univariate and multivariate analyses were performed to assess the association between learning activities and student ratings of high teaching quality. RESULTS: 11,450 teaching interactions were recorded. Univariate analysis revealed that feedback was associated with perceptions of high quality teaching in all clerkships. Proposing a plan, formulating an assessment and giving an oral case presentation were associated with high quality teaching in 80% of the clerkships (p < 0.01). Multivariate analysis demonstrated that receiving high quality feedback was an independent predictor of student ratings of high quality teaching for all clerkships. CONCLUSION: Receiving high quality feedback is the learning activity most strongly associated with students' ratings of high quality teaching across four different clerkships.

Learning/feedback activities and high-quality teaching: perceptions of third-year medical students during an inpatient rotation.

PURPOSE: To identify specific learning activities (and teaching methods) that students associate with high-quality teaching in the inpatient setting. METHOD: For ten months in 2003-04, 170 third-year medical students recorded data on learning/feedback activities and teaching quality via personal digital assistants during the inpatient portion of a required two-month medicine clerkship at four sites affiliated with the Medical College of Wisconsin. Univariate and multivariate analyses were performed to assess the association between learning/feedback activities and students' perceptions of high-quality teaching. RESULTS: A total of 2,671 teaching encounters were rated by 170 students during their required inpatient medicine rotations. Bedside teaching was reported in almost two-thirds of teaching/learning encounters. Feedback on case presentation and differential diagnosis were the inpatient feedback activities most often provided by faculty. The univariate analysis revealed that students' perceptions of high-quality teaching was associated with receiving mini-lectures, developing short presentations on relevant inpatient topics, bedside teaching, case-based conferences, learning electrocardiogram and chest X-ray interpretation, teaching with other team members present (p <. 001), and receiving feedback on history and physical examination, on case presentation, at the bedside, on differential diagnosis, and on daily progress notes. Results from the regression analysis revealed that giving mini-lectures on inpatient topics, teaching electrocardiogram and chest X-ray interpretation, providing feedback on case presentation, and at the bedside were predictors of overall high-quality teaching. CONCLUSIONS: Aspects of feedback, giving mini-lectures, and learning test-interpretation skills were the learning and feedback activities associated with students' perceptions of high-quality teaching. In an increasingly time-pressured inpatient environment, clinical educators should understand which activities students value.

An Assessment of the Impact of Multimedia, Technology-Based Learning Tools on the Cardiac Auscultation Skills of Third-Year Medical Students.

BACKGROUND: Previous studies have shown that medical students and post-graduate trainees need to improve their proficiency in cardiac auscultation. Technologic advances have created new learner-centered opportunities to enhance proficiency in this important physical examination skill. OBJECTIVES: We sought to determine if technology-based, self-directed learning tools improved the cardiac auscultation skills of third-year medical students. METHODS: Sixteen (16) third-year medical (M3) students were exposed to three educational inter-ventions: a one-hour cardiac auscultation lecture that featured computer-generated heart sounds, a PDA-based heart sounds/murmur form and a web-based cardiac auscultation program. Thirteen (13) internal medicine (IM) residents who served as a comparison group attended a cardiac auscultation lecture identical in content and format to the student lecture. At the end of the study period, we evaluated the ability of both groups to accurately identify heart sounds and cardiac murmurs via a twelve-item performance-based examination utilizing computer-generated heart sounds. RESULTS: Following our teaching interventions, findingsM3 students correctly identified 80% of the computer-simulated heart sounds/murmurs while the comparison group of IM residents accurately detected 60% of the same cardiac findings (p<. 005). CONCLUSIONS: The combination of traditional lecture and multi-media, technology-based, self-directed learning tools appears to be an effective and efficient strategy for teaching and reinforcing cardiac auscultation skills to third year medical students.

Learning activities and high-quality teaching: perceptions of third-year IM clerkship students.

PURPOSE: To identify learning activities that students associate with high-quality teaching on a clinical rotation. METHOD: From July to December 2001, data on patient encounters, learning activities, and teaching quality were collected via personal hand-held computers from 82 medical students during a required third-year internal medicine (IM) clerkship at the Medical College of Wisconsin, Milwaukee. Univariate (chi-square test) and multivariate analysis (stepwise multiple logistic regression) were performed to assess the association between learning activities and students' perceptions of teaching quality during this rotation. RESULTS: A total of 1,839 patient encounters were recorded: 62% of these occurred in the inpatient setting and 38% in outpatient clinics. In 80% of all encounters, students reported that they gave an oral case presentation and proposed a plan; they reported receiving high-quality feedback after 64% of these presentations. Univariate analysis demonstrated that the students' perception of high-quality teaching was associated with being on an inpatient rotation, formulating an assessment, proposing a plan, presenting to the attending physician with other members of the team present, giving an oral case presentation, and receiving high-quality feedback (p <.01). Multivariate analysis demonstrated that receiving high-quality feedback (odds ratio [OR] 4.5; 95% CI 3.57-6.25) and proposing a plan (OR 2.3; 95% CI 1.4-3.9) were the two strongest predictors of high, overall teaching quality. CONCLUSION: Receiving high-quality feedback from faculty and proposing a plan were the learning activities most strongly associated with students' perception of high-quality teaching on a required third-year IM clerkship.