Evaluation of students' physical examination skills during their surgery clerkship.

BACKGROUND: Faculty often presume that students possess adequate physical examination skills upon graduation. Yet assessments of their performance with these skills often reveal deficiencies. This study was designed to determine if students' physical examination skills improved during their clerkship year. METHODS: Sixty-six students performed four specific physical examinations on patients during the first and last week of their surgery clerkship. Four consecutive clerkship rotations were examined. Encounters were videotaped and evaluated by faculty members. RESULTS: Posttest mean percent correct scores significantly improved for three examinations (P <0.01). Analysis of variance found no significant differences between clerkship mean percent correct scores. CONCLUSIONS: Students' physical examination skills improved slightly during their clerkship, however, no relationship was found between clerkship rotation and performance. These findings suggest unsupervised experiences during the third year do not positively influence student performance with physical examination skill proficiency.

The learning needs of first-year surgical residents in the intensive care unit.

BACKGROUND: Residents are more likely to learn from educational experiences when properly prepared from the start of instruction and expectations are clear and consistent. The purpose of this study was to examine what first year residents need to know and be able to perform before starting their rotation in the intensive care unit (ICU). METHODS: The sample included surgical faculty, first through fifth year general surgery residents, and ICU nurses. A survey was developed that listed 110 knowledge and skill items felt to be possible prerequisite learning objectives. Respondents were asked to evaluate the required level of knowledge or skill on a 5-point Likert-type scale. RESULTS: Items were divided into knowledge or skill categories and then ranked in descending order by their mean ratings. Four knowledge and 10 skill items were ranked highly by all 3 groups of respondents. Kruskall-Wallis analyses found 58 items with statistically significant differences in mean ratings between groups of respondents. CONCLUSION: With this information a self assessment tool was developed to determine the level of performance on these identified learning objectives. A course of instruction can now be developed to assist residents in meeting these objectives before they assume patient care responsibilities in the ICU.

Patients' attitudes toward the involvement of medical students in their care.

BACKGROUND: Research has shown that medical students are generally accepted by patients, but specific details that elucidate patient perceptions of the advantages and disadvantages to student involvement have not been documented. This study was designed to determine variables that influence patient satisfaction with students. PATIENTS AND METHODS: Patients were interviewed by one of two faculty members using a questionnaire-style format that covered 12 variables regarding patient care. Patients were asked to rate the extent to which medical students helped or hindered their hospital stay, with regard to the 12 variables. RESULTS: Patients' attitudes were favorable regardless of the students' extent of clinical experience or clinical abilities or the patients' age or length of hospital stay. Patients reported that students spent time with them and answered their questions. Most patients stated that they would allow students to participate in their future hospital care. CONCLUSION: Positive patient-student interactions can have important effects on patients' expectations and their acceptance of future encounters with students. This fact is becoming increasingly important due to the changes in health care and the decreasing incidence of inpatient surgical encounters.