PURPOSE: The purpose of this study is to investigate the reliability and validity of new clinical performance examination (CPX) for assessing clinical reasoning skills and evaluating clinical reasoning ability of the students. METHODS: Third-year medical school students (n=313) in Busan-Gyeongnam consortium in 2014 were included in the study. One of 12 stations was developed to assess clinical reasoning abilities. The scenario and checklists of the station were revised by six experts. Chief complaint of the case was rhinorrhea, accompanied by fever, headache, and vomiting. Checklists focused on identifying of the main problem and systematic approach to the problem. Students interviewed the patient and recorded subjective and objective findings, assessments, plans (SOAP) note for 15 minutes. Two professors assessed students simultaneously. We performed statistical analysis on their scores and survey. RESULTS: The Cronbach α of subject station was 0.878 and Cohen κ coefficient between graders was 0.785. Students agreed on CPX as an adequate tool to evaluate students' performance, but some graders argued that the CPX failed to secure its validity due to their lack of understanding the case. One hundred eight students (34.5%) identified essential problem early and only 58 (18.5%) performed systematic history taking and physical examination. One hundred seventy-three of them (55.3%) communicated correct diagnosis with the patient. Most of them had trouble in writing SOAP notes. CONCLUSION: To gain reliability and validity, interrater agreement should be secured. Students' clinical reasoning skills were not enough. Students need to be trained on problem identification, reasoning skills and accurate record-keeping.
Checklist ; *Clinical Competence ; Communication ; Comprehension ; *Education, Medical, Undergraduate ; Educational Measurement/*standards ; Humans ; Medical History Taking ; Medical Records ; Observer Variation ; Physical Examination ; Physician-Patient Relations ; *Problem-Based Learning ; Reproducibility of Results ; Republic of Korea ; *Schools, Medical ; *Students, Medical ; Surveys and Questionnaires ; *Thinking ; Universities

The aim of this report was to discuss the development and content of a guide on clinical performance and basic clinical skills for medical students. We published the first edition of this guide in 2010 and will publish the second edition in 2016. Initially, we took a survey on important clinical presentations and fundamental clinical and technical skills in 41 medical schools in Korea. Ultimately, we chose 80 core clinical presentations and 56 clinical skills. In the guide to basic clinical skills, we described the physical examination and technical skills according to the preprocedural preparation, procedure, and postprocedural process. In the guide on clinical performance, we reviewed patient encounters-from history taking and the physical examination to patient education. We included communication skills, principles of patient safety, and clinical reasoning schemes into the guides. In total, 43 academic faculty members helped develop the basic clinical skills guide, 75 participated in establishing the clinical performance guide, and 16 advisors from 14 medical specialty societies contributed to the guide. These guides can help medical students approach patients holistically and safely.
Clinical Competence/*standards ; Educational Measurement/*methods ; Humans ; *Practice Guidelines as Topic ; Republic of Korea ; *Students, Medical

PURPOSE: Clinical performance examination (CPX) has been used to assess clinical competence as one step of medical license examination. Initial CPX score of the fourth year medical student is important since it indicates how to prepare successfully for the final examination. This study was conducted to assess the predictors of CPX scores of the fourth year medical students who completed core clinical clerkship. METHODS: One hundred eleven fourth year medical students took a formative CPX in February. The score was compared with the scores of cognitive area and those of behavioral area which students had acquired in the past. We analyzed the correlation between the scores and determined the predictors of the fourth year CPX score. RESULTS: The fourth year CPX score showed stronger correlation with the scores of behavioral area than those of cognitive area. The significant predictors of fourth year CPX score included third year simple procedure exam score and third year clerkship CPX score. The risk factors for low fourth year CPX score included second year patient-physician interaction (PPI) score and third year CPX score after adjusted for age, sex, and school type. The risk factors of being selected as a low PPI score group of fourth year included low PPI scores of first, second, and third year exams. CONCLUSION: Our study highlights importance of educational balance between cognitive and behavioral areas. To improve clinical competence of final year medical students, clinical interview training using standardized patient with other modules is to be enhanced and initiated early in the medical curriculum.
Adult ; Behavior ; *Clinical Clerkship ; Clinical Competence/*standards ; Cognition ; Education, Medical, Undergraduate/*methods ; Educational Measurement/*methods ; Female ; Humans ; Male ; Students, Medical/psychology ; Young Adult

PURPOSE: This study analyzed the perceptions of medical students and faculty regarding disclosure of test items on the Korean medical licensing examination. METHODS: I conducted a survey of medical students from medical colleges and professional medical schools nationwide. Responses were analyzed from 718 participants as well as 69 faculty members who participated in creating the medical licensing examination item sets. Data were analyzed using descriptive statistics and the chi-square test. RESULTS: It is important to maintain test quality and to keep the test items unavailable to the public. There are also concerns among students that disclosure of test items would prompt increasing difficulty of test items (48.3%). Further, few students found it desirable to disclose test items regardless of any considerations (28.5%). The professors, who had experience in designing the test items, also expressed their opposition to test item disclosure (60.9%). CONCLUSION: It is desirable not to disclose the test items of the Korean medical licensing examination to the public on the condition that students are provided with a sufficient amount of information regarding the examination. This is so that the exam can appropriately identify candidates with the required qualifications.
*Attitude ; *Disclosure ; *Education, Medical ; *Educational Measurement ; *Faculty, Medical ; Humans ; Information Dissemination ; *Licensure, Medical ; Perception ; Physicians/standards ; Republic of Korea ; *Students, Medical

INTRODUCTIONPlanning a high-stake clinical examination requires the evaluation of several psychometric and logistical variables. The authors conducted generalisability and decision studies to answer the following research questions in the context of the surgical long case: (1) Does the addition of a third examiner have any added benefit, vis-à-vis reliability, to the examination? (2) Is global marking more reliable than an itemised marking template? (3) What would be the impact on reliability if there was a reduction in the number of examinees that each panel of examiners is required to assess?

METHODSA third examiner and global marking were introduced. Separate generalisability and decision studies were carried out for both the two- and three-examiner models as well as for itemised and global scores.

RESULTSThe introduction of a third examiner resulted in a modest gain of reliability by 0.05-0.07. Gain in reliability was higher when each candidate was allowed to undertake a higher number of clinical cases. Both the global and itemised scores provided equivalent reliability (generalisability coefficient 0.74-0.89).

CONCLUSIONOur results showed that only a modest improvement in reliability of the surgical long case is achieved through the introduction of an additional examiner. Although the reliability of global scoring and the itemised marking template was comparable, the latter may provide opportunities for individualised feedback to examinees.

Clinical Competence ; Education, Medical, Undergraduate ; methods ; standards ; Educational Measurement ; methods ; Humans ; Medical History Taking ; methods ; Observation ; Professional-Patient Relations ; Psychometrics ; methods ; Reproducibility of Results ; Schools, Medical ; Singapore

American Diagnostic Radiology Residency and Fellowship programmes are Graduate Medical Education programmes in the United States (US) equivalent to the Postgraduate Medical Education programmes in Singapore. Accreditation Council for Graduate Medical Education (ACGME) accredited diagnostic radiology residency programmes require 5 years total with Post Graduate Year (PGY) 1 year internship in a clinical specialty, e.g. Internal Medicine following medical school. PGY Years 2 to 5 are the core years which must include Radiology Physics, Radiation Biology and rotations in 9 required subspecialty rotations: Abdominal, Breast, Cardiothoracic, Musculoskeletal, Neuroradiology, Nuclear and Paediatric Radiology, Obstetric & Vascular Ultrasound and Vascular Interventional Radiology. A core curriculum of lectures must be organised by the required 9 core subspecialty faculty. All residents (PGY 2 to 4) take a yearly American College of Radiology Diagnostic In-Training Examination based on national benchmarks of medical knowledge in each subspecialty. Because the American Board of Radiology (ABR) examinations are changing, until 2012, residents have to take 3 ABR examinations: (i) ABR physics examination in the PGY 2 to 3 years, (ii) a written examination at the start of the PGY 5 year and (iii) an oral exam at the end of the PGY 5 year. Beginning in 2013, there will be only 2 examinations: (i) the physics and written examinations after PGY 4 will become a combined core radiology examination. Beginning in 2015, the final certifying examination will be given 15 months after the completion of residency. After residency, ACGME fellowships in PGY 6 are all one-year optional programmes which focus on only one subspecialty discipline. There are 4 ACGME accredited fellowships which have a Board Certifi cation Examination: Neuroradiology, Nuclear, Paediatric and Vascular Interventional Radiology. Some ACGME fellowships do not have a certifying examination: Abdominal, Endovascular Surgical Neuroradiology and Musculoskeletal Radiology. One year unaccredited fellowships can also be taken in Breast, Cardiothoracic or Women's Imaging.
Accreditation ; Clinical Competence ; statistics & numerical data ; Communication ; Curriculum ; Education, Medical, Graduate ; statistics & numerical data ; Educational Measurement ; Educational Status ; Fellowships and Scholarships ; statistics & numerical data ; Health Knowledge, Attitudes, Practice ; Humans ; Internship and Residency ; statistics & numerical data ; Radiology ; education ; standards ; Singapore ; United States

The MRCP(UK) PACES examination has been sat by almost 40,000 candidates in 10 countries around the world since its introduction in 2001. The examination assesses skills of relevance to the practice and delivery of high quality clinical care and is the leading international postgraduate summative assessment of this kind. In 2009, the examination was revised, and this article describes those revisions, focussing on the clinical skills assessed.
Clinical Competence ; standards ; statistics & numerical data ; Communication ; Curriculum ; Education, Medical, Graduate ; standards ; statistics & numerical data ; Educational Measurement ; methods ; standards ; statistics & numerical data ; Health Knowledge, Attitudes, Practice ; Humans ; Internationality ; Physician-Patient Relations ; Point-of-Care Systems ; Program Evaluation ; United Kingdom ; Workplace

INTRODUCTIONThe purpose of this study was to understand the learning of internal medicine of 7th year medical students through records of the "Learning Passport".

MATERIALS AND METHODSBetween June 2005 and June 2006, data from the learning passport (a type of logbook) of 207 7th year medical students at the Department of Internal Medicine, National Taiwan University Hospital (NTUH) were collected.

RESULTSAmong the 19 symptoms/signs listed in the logbook, a large number of students did not learn well on low back pain, skin rash, oedema, oliguria and anxiety/depression; only a few students rated themselves as knowledgeable about anxiety/depression, malaise, skin rash, headache and anorexia. Among the 16 diseases listed, a large number of students did not learn well on chronic obstructive pulmonary disease, stroke, hypertension, coronary artery disease and cirrhosis; only a few students rated themselves as knowledgeable about shock, respiratory failure, consciousness disturbance, sepsis and renal failure. Among the 21 physical examination skills listed, a large number of students did not learn well on the male genitalia, eyes, cognitive status, mental state and the digital rectal examination; only a few students rated themselves as fully competent about cognitive status, mental state, eyes, neurology examination and ENT examination. Among the 11 laboratory skills and image interpretation skills listed, a large number of students did not learn well on blood smear, Gram's stain and specimen sampling; only a few students rated themselves as fully competent about the interpretation of brain computed tomographic (CT) scan, blood smear and Gram's stain. Among the 12 procedures and therapeutic skills listed, a large number of students did not learn well on observation of lumbar puncture, basic cardiopulmonary resuscitation (CPR) and aseptic procedure; only a few students rated themselves as fully competent about basic CPR and transfusion management.

CONCLUSIONSThe weak points of intern training conducted by the Department of Internal Medicine, NTUH were revealed by analysis obtained from their logbooks. Thus, we need to strengthen the learning of the interns in these specific parts and assess their performance based on the use of portfolios.

Clinical Competence ; Education, Medical, Graduate ; standards ; Educational Measurement ; methods ; Hospitals, University ; Internal Medicine ; education ; Self Efficacy ; Taiwan

Clinical Competence ; standards ; Education, Medical ; methods ; standards ; Educational Measurement ; methods ; Humans

INTRODUCTIONWe developed "Case-Based Integrated Teaching (C-BIT)" in our medical school to integrate the content of various disciplines through a core patient design that introduces major diseases to students. This article presents the concepts, development and initial evaluation of the teachers' and students' responses to C-BIT.

MATERIALS AND METHODSTeachers' manuals for 18 major diseases were completed. Eighty teachers from various disciplines participated in writing the first 10 manuals. On the basis of this experience, 57 teachers subsequently prepared another 8 manuals. Each manual is composed of a brief summary of a patient with a major disease, learning objectives, case presentation, questions, a teaching guide and references for all disciplines. Teachers' and students' responses to a questionnaire were recorded.

RESULTSMost respondents agreed that C-BIT is patient-centred and can be used to improve curriculum integration, reduce duplication in teaching and enhance communication among the faculty members from various disciplines. One-third of the teachers contributed to more than one C-BIT manual, indicating their enthusiasm for the development of C-BIT. Most of the students agreed that C-BIT can enhance discussion, integrate the curriculum and promote active learning.

CONCLUSIONWe have developed a new format for teaching materials that enhance teacher-student and teacher-teacher interactions, reduces redundant content and integrates disciplines through patient-oriented medical education.

Education, Medical, Undergraduate ; methods ; standards ; Educational Measurement ; Humans ; Manuals as Topic ; standards ; Pilot Projects ; Problem-Based Learning ; organization & administration ; Retrospective Studies ; Surveys and Questionnaires ; Taiwan