PURPOSE: To report the experience of OSCE performed as a summative assessment of the medical students in year 4 at Ewha Womans University. METHODS: Ninety-eight students took the twenty stations including 3 pairs of linked stations. We conducted duplicated OSCEs and each station runs 4 minutes 30 seconds. We analyzed the validity of stations, the reliability of duplicated OSCEs and the difference of scores according to the OSCE tools and categories. RESULTS: Mean OSCE score was 64.45+/-5.49 and Cronbach-alpha of total stations was 0.74. The scores between duplicated examinee groups and between duplicated evaluator groups were not different: the score of preceding examinee group was 63.3 and the later 65.7 (p=0.13), and the score of the first evaluator group was 64.6 and the second was 63.6 (p=0.16). However according to the individual analysis, 9 stations showed statistically discrepancies (p< 0.05) between duplicated evaluator groups. Regarding OSCE tools and categories, physical examination and skill categories did not show statistically significant differences between duplicated evaluator groups. OSCE scores showed moderate correlation with the cummulative performance grade in general (r=0.53, p< 0.01). CONCLUSIONs: OSCE could be regarded as a reasonable evaluating tool for the summative assessment after two years of clinical clerkship of the fourth year medical students. Analysis of the OSCE stations which was done individually and according to OSCE tools/categories helps to improve the OSCE more complete and the duplicated stations more coincident.
Clinical Clerkship* ; Female ; Humans ; Physical Examination ; Schools, Medical* ; Students, Medical

PURPOSE: Evaluation of clinical skills and attitude including development of dynamic patient-doctor relationship is important in board examination (BE). Korean Neurological Association (KNA) has introduced clinical performance examination (CPX) utilizing standardized patients (SP) to BE in 2007. In this study, the authors describe the 3-year experience of CPX in BE through 2009. METHODS: To implement CPX session in BE, KNA developed CPX workshop for BE attendees and members of grading committee. CPX sessions in BE consisted of two model scenarios mimicking neurological patients in clinical practice. The total score and itemized scores of CPX sessions were compared with other areas of BE, and scores from each year were also compared. RESULTS: Scores from CPX sessions were significantly correlated with BE step II. Among the itemized scores of CPX sessions, clinical items including history taking and physical examination were significantly correlated with scores from other areas of BE. However, scores from global assessment from SP were strongly associated with patient-doctor relationship, history taking, and patient education. CONCLUSION: Our experiences suggest that CPX utilizing SP is a useful tool to assess the clinical skills in BE. In order to produce clinically well qualified neurologists, more efforts should be made to develop cases and to improve assessment tools for CPX.
Clinical Competence ; Educational Measurement ; Humans ; Licensure ; Patient Simulation ; Physical Examination

PURPOSE: To determine whether disclosure of scoring rubric for objective basic clinical skills can improve the scores on the objective structured clinical examination (OSCE) in medical students. METHODS: Clinical performance score results of one university medical students (study group, n=345) were compared to those of another university (control group, n=1,847). Both groups took identical OSCE exam. OSCE rubric was not revealed to the study group until they were in the last 2 years of medical school. RESULTS: There was no significant difference between before and after disclosure of rubric. However, history taking and physical examination scores of the study group were lower than those of the control group before the disclosure of rubric. After disclosure of rubric, the scores were either unchanged or slightly increased in the control group. Trend analysis of scores demonstrated that history taking and physical examination scores after the disclosure were significantly increased in the study group for 2 years. CONCLUSION: This study revealed that disclosure of basic clinical skills rubric to medical students could enhance their clinical performance, particularly in history taking and physical examination scores.
Clinical Competence* ; Disclosure* ; Humans ; Physical Examination ; Schools, Medical ; Students, Medical

If large-scale testing programs are being used, OSCE stations may be duplicated into two or more sites. There are a few studies on the reliability of OSCE with duplicated stations in Korea. The purpose of this study was to investigate the effect of duplication on the reliability of OSCE. At Hanyang university college of medicine, an OSCE is given to all senior medical students(91 per class) upon completion of all clinical clerkship rotations. The examination consisted of twenty one stations and eighteen cases that represented commonly encountered problems in primary care. Each station required seven minutes for its administration, with 6 to 6.5 minutes for the student-SP or model encounter, during which the students performs a complete focused history and/or physical examination and/or procedure and/or management, and another 0.5 to 1 minutes for the evaluator to feedback case-related comments. We analysed the reliability of duplication by comparing total OSCE scores and case scores between two exam sites. We also evaluated the reliability of duplicated stations from student's and professor's subjective response to the OSCE. All 91 fourth-year students attended the OSCE. Standardized Cronbach coefficient of the OSCE was 0.67. The station scores and OSCE total scores were different between two duplication sites. The total OSCE score of one site was slight higher than that of the other site(p=0.03). Of total 19 stations in which students were evaluated by staff evaluator, six stations are more advantageous to one part compared with counterpart stations, other six stations are vice CONCLUSIONS: OSCE reliability can be affected by duplication of examination sites and inter-rater reliability is the most important determining factor. The results demonstrate a need for caution in the interpretation of scores obtained from OSCE with duplicated stations.
Clinical Clerkship ; Humans ; Korea ; Physical Examination ; Primary Health Care

The Medical Council of Canada Qualifying Examination Part II(MCCQE alpha) is a 20 station, multi-center, large scale OSCE offered for licensure purposes in Canada since 1992. The MCCQE Part I is a 2 day, 4 section, paper an d pencil examination. The content of the OSCE stations, identified as belonging to one of the 4 skill set:history taking, physical examination, management of an acute patient problem, and communications. In addition, the result of the 10 written stations assessing problem solving, and data management ability were grouped together to form a 5th skill set. MCCQEII is a criterion referenced assessment of the minimal clinical competence. The last 5 years result have been entirely satisfactory. The mean score across the 11 test centers have varied slightly, mostly due to variable representation of first time Canadian takers. The failure rates have varied from 13% to 17% for all the examinees and from 6% to 7% for the first time Canadian takers. The reliability estimates, determined by a Cronbach's alpha range from .72 to .81, and by generalizability analysis(GA) from .61 to .78. The dependability indices at the out off score were .99 for all administrations. The Canadian experience has demonstrated the feasibility of testing clinical competence using an OSCE at a licensure level. This report will describe the administrations of the MCCQEII.
Canada* ; Clinical Competence ; Humans ; Licensure ; Physical Examination ; Problem Solving

We reviewed the cases of breast cancer that had not been detected by physical examination (PE), ultrasound (US) and mammography (MMG). Of 90 cases that were diagnosed as breast cancer definitely on pathological assay, 13 cases had gone unnoticed by PE, seven by US, and 15 by MMG. Thus, the detection rate worked out at 85.6%, 92.2% and 83.3%, respectively. When the diagnoses wee made by any combination of one with another, the detection rate for joint PE/US, PE/MMG and US/MMG came to95.6%, 97.8% and 98.9%, indicating that the combined use of US and MMG was most efficient.Tumors that had been undetected by PE and MMG were significantly smaller in size than those that had been detected, but this was not the case for tumors that had gone unnoticed by US. Therefore, we considered that oversight during US examination is more likely due to difficulty making diagnostic differentiation between cancer and fatty tissue or cyst, etc. than tumor size. We found that those cases which had gotten pass PE had a significantly lower histological grade malignancy and a lower grade of invasiveness than the other cases of breast cancer, even though the former tended to show lymphatic metastasis frequently. Furthermore, all of these metastatic breast cancers had a smaller diameter ranging from 0.8cm to 0.9cm. This suggested hat we cannot afford to let them pass because they are non-palpable. At present, the Japanese Ministry of Health, Labor and Welfare are recommending the breast cancer mass-screening by use of PE in combinationwith MMG. However, because MMG is not always omnipotent and lets many breast cancer cases pass, we should conduct the mass screening with US and MMG but without PE.
cisplatin/etoposide protocol ; Malignant neoplasm of breast ; Clinical examination ; Mammography ; Cases

BACKGROUND: OSCE was conducted to measure the immediate outcome of ICM. The measurement focused on basic clinical skills. METHODS: The subject of study was 115 third year medical students who took ICM course. The examination consisted of ten 5-minute stations with nine cases that represented commonly encountered problems in primary care. OSCE stations were duplicated into two sites. Therefore, same OSCE was performed six times in each sites. We evaluated the reliability of OSCE scores and compared the mean scores according to the examination sites and time sequences. Also, we got feedback from all participants by questionnaires. RESULTS: Mean of total OSCE score was 52.1. Cronbach alpha of total station was 0.559. For blood pressure check, lung physical examination, and neck mass physical examination station, there was a significant difference in mean scores as the time sequences(p<0.05). Both students and examiners evaluated the OSCE positively, and felt that OSCE was meaningful experience to prepare clinical skills. CONCLUSION: We can confirm that OSCE is a reasonable evaluation tool for ICM. However, further trials to develop the more reliable and valid examinations will be warranted.
Blood Pressure ; Clinical Competence ; Clinical Medicine* ; Humans ; Lung ; Neck ; Physical Examination ; Primary Health Care ; Students, Medical ; Surveys and Questionnaires

This study was conducted to analyze the strengths and weaknesses of a 3-week family medicine clerkship program based on the results of an online survey taken by the students (N=127) and a structured interview with a focus group (n=10), aimed to improve the quality of the clerkship program. The online survey contained questions pertaining to goals, schedule, contents, arrangement, atmosphere, environment, evaluation, and satisfaction regarding the clerkship. The focus group interview addressed the schedule and achievements of the program. Scores were reported on a 5-point Likert scale. Most students were highly satisfied with the overall quality of the clerkship. The structured interview results showed that 97.6% of the clerkship program was executed according to the schedule. The focus group reported a perfect score of 5 points on several measures including: accomplishment of the educational goals of the family medicine clerkship, providing many chances to obtain medical histories and perform physical examinations on real patients, experience with various symptoms and diseases, positive attitudes of faculty members when teaching, notification of the guidelines for evaluation beforehand, well-constructed and effective clerkship schedule, and reflection of student feedback. However, the focus group gave low scores on: support for health accidents of students, access to patient information, enough opportunities to practice clinical skills, appropriate rest facilities for students, and fairness of clerkship evaluation process. In conclusion, the structured evaluation performed after the 3-week clerkship program motivated students and helped them ensure an efficient clerkship. This structured evaluation also suggested basic data to make the professor who is subject of the assessment. This study shows that structured assessment is an effective method which can be used to improve the quality of clerkships.
Appointments and Schedules ; Atmosphere ; Clinical Clerkship ; Clinical Competence ; Family Practice ; Focus Groups ; Humans ; Methods ; Physical Examination ; Self-Evaluation Programs ; Surveys and Questionnaires

PURPOSE: The purpose of this study was evaluation of the current status of medical students' documentation of patient medical records METHODS: We checked the completeness, appropriateness, and accuracy of 95 Subjective-Objective-Assessment-Plan (SOAP) notes documented by third-year medical students who participated in clinical skill tests on December 1, 2014. Students were required to complete the SOAP note within 15 minutes of an standard patient (SP)-encounter with a SP complaining rhinorrhea and warring about meningitis. RESULTS: Of the 95 SOAP notes reviewed, 36.8% were not signed. Only 27.4% documented the patient's symptoms under the Objective component, although all students completed the Subjective notes appropriately. A possible diagnosis was assessed by 94.7% students. Plans were described in 94.7% of the SOAP notes. Over half the students planned workups (56.7%) for diagnosis and treatment (52.6%). Accurate documentation of the symptoms, physical findings, diagnoses, and plans were provided in 78.9%, 9.5%, 62.1%, and 38.0% notes, respectively. CONCLUSION: Our results showed that third-year medical students' SOAP notes were not complete, appropriate, or accurate. The most significant problems with completeness were the omission of students' signatures, and inappropriate documentation of the physical examinations conducted. An education and assessment program for complete and accurate medical recording has to be developed.
Clinical Competence ; Diagnosis ; Education ; Humans ; Medical Records ; Meningitis ; Physical Examination ; Pilot Projects* ; Soaps* ; Students, Medical*

BACKGROUND: Ultrasonography is an important diagnostic tool for many aspects of clinical medicine. It is a non-invasive method of examination that provides high-resolution images in real time. However, some dermatologists may be anxious about the efficacy of ultrasonography. OBJECTIVE: To evaluate the diagnostic accuracy and to assess the utility of diagnostic ultrasonography for subcutaneous benign lesions. METHODS: The study included 96 patients with subcutaneous benign lesions who underwent ultrasonography and then received a pathologic diagnosis after biopsy or surgery at our hospital from July 2010 to December 2012. This study evaluated the number of cases in which the preoperative diagnosis after ultrasonography or just after physical examination agreed to the pathologic diagnosis. RESULTS: Ultrasonography significantly increased the diagnostic yield of subcutaneous benign lesions (after physical examination, 54.2%; after ultrasonography, 84.4%; p<0.001). The sensitivity for the diagnosis of lipoma (after physical examination, 70%; after ultrasonography, 92.5%; p<0.001) and the specificity for the diagnosis of epidermal cyst (after physical examination, 84.1%; after ultrasonography, 94.2%; p<0.001) significantly increased after ultrasonography. The sensitivity for the diagnosis of epidermal cyst and pilomatricoma also tended to increase after ultrasonography. CONCLUSION: The study results suggested that ultrasonography is useful for diagnosis and/or preoperative examination of subcutaneous benign lesions.
Biopsy ; Clinical Medicine ; Epidermal Cyst ; Humans ; Lipoma ; Physical Examination ; Pilomatrixoma ; Sensitivity and Specificity ; Statistics as Topic