scholarly journals Assessing musculoskeletal examination skills and diagnostic reasoning of 4th year medical students using a novel objective structured clinical exam

2016 ◽  
Vol 16 (1) ◽  
Author(s):  
R. Brent Stansfield ◽  
Lisa Diponio ◽  
Cliff Craig ◽  
John Zeller ◽  
Edmund Chadd ◽  
...  
Keyword(s):  
Medical Students ◽  
Diagnostic Reasoning ◽  
Clinical Exam ◽  
Objective Structured Clinical Exam ◽  
Musculoskeletal Examination

scholarly journals The effect of prior experience on diagnostic reasoning: exploration of availability bias

Diagnosis ◽  
2020 ◽  
Vol 7 (3) ◽  
pp. 265-272
Author(s):  
Sandra Monteiro ◽  
Jonathan Sherbino ◽  
Jonathan S. Ilgen ◽  
Emily M. Hayden ◽  
Elizabeth Howey ◽  
...  
Keyword(s):  
Medical Students ◽  
Clinical Features ◽  
Patient Characteristics ◽  
Diagnostic Error ◽  
Diagnostic Reasoning ◽  
Error Rates ◽  
Prior Exposure ◽  
Clinical Vignettes ◽  
Experience Levels ◽  
Similar Patient

AbstractObjectivesDiagnostic reasoning has been shown to be influenced by a prior similar patient case. However, it is unclear whether this process influences diagnostic error rates or whether clinicians at all experience levels are equally susceptible. The present study measured the influence of specific prior exposure and experience level on diagnostic accuracy.MethodsTo create the experience of prior exposure, participants (pre-clerkship medical students, emergency medicine residents, and faculty) first verified diagnoses of clinical vignettes. The influence of prior exposures was measured using equiprobable clinical vignettes; indicating two diagnoses. Participants diagnosed equiprobable cases that were: 1) matched to exposure cases (in one of three conditions: a) similar patient features, similar clinical features; b) dissimilar patient features, similar clinical features; c) similar patient features, dissimilar clinical features), or 2) not matched to any prior case (d) no exposure). A diagnosis consistent with a matched exposure case was scored correct. Cases with no prior exposure had no matched cases, hence validated the equiprobable design.ResultsDiagnosis A represented 47% of responses in condition d, but there was no influence of specific similarity of patient characteristics for Diagnosis A, F(3,712)=7.28, p=0.28 or Diagnosis B, F(3,712)=4.87, p=0.19. When re-scored based on matching both equiprobable diagnoses, accuracy was high, but favored faculty (n=40) 98%, and residents (n=39) 98% over medical students (n=32) 85%, F(2,712)=35.6, p<0.0001. Accuracy for medical students was 84, 87, 94, and 73% for conditions a–d, respectively, interaction F(2,712)=3.55, p<0.002.ConclusionsThe differential diagnosis of pre-clerkship medical students improved with prior exposure, but this was unrelated to specific case or patient features. The accuracy of medical residents and staff was not influenced by prior exposure.

scholarly journals Assessing Diagnostic Reasoning Using a Standardized Case-Based Discussion

2019 ◽  
Vol 6 ◽  
pp. 238212051984941 ◽  
Author(s):  
Ruth M Sutherland ◽  
Katharine J Reid ◽  
Neville G Chiavaroli ◽  
David Smallwood ◽  
Geoffrey J McColl
Keyword(s):  
Medical Students ◽  
Student Performance ◽  
Clinical Training ◽  
Medical Training ◽  
Clinical Information ◽  
Performance Standards ◽  
Diagnostic Reasoning ◽  
First Year ◽  
Oral Assessment ◽  
Case Based

Background: Development of diagnostic reasoning (DR) is fundamental to medical students’ training, but assessing DR is challenging. Several written assessments focus on DR but lack the ability to dynamically assess DR. Oral assessment formats have strengths but have largely lost favour due to concerns about low reliability and lack of standardization. Medical schools and specialist medical colleges value many forms of oral assessment (eg, long case, Objective Structured Clinical Examination [OSCE], viva voce) but are increasingly searching for ways in which to standardize these formats. We sought to develop and trial a Standardized Case-Based Discussion (SCBD), a highly standardized and interactive oral assessment of DR. Methods: Two initial cohorts of medical students (n = 319 and n = 342) participated in the SCBD as part of their assessments. All students watch a video trigger (based on an authentic clinical case) and discuss their DR with an examiner for 15 minutes. Examiners probe students’ DR and assess how students respond to new standardized clinical information. An online examiner training module clearly articulates expected student performance standards. We used student achievement and student and examiner perceptions to gauge the performance of this new assessment form over 2 implementation years. Results: The SCBD was feasible to implement for a large student cohort and was acceptable to students and examiners. Most students and all examiners agreed that the SCBD discussion provided useful information on students’ DR. The assessment had acceptable internal consistency, and the associations with other assessment formats were small and positive, suggesting that the SCBD measures a related, yet novel construct. Conclusions: Rigorous, standardized oral assessments have a place in a programme of assessment in initial medical training because they provide opportunities to explore DR that are limited in other formats. We plan to incorporate an SCBD into our clinical assessments for the first year of clinical training, where teaching and assessing basic DR is emphasized. We will also explore further examiners’ understanding of and approach to assessing DR.

scholarly journals An objective structured clinical examination to assess the communication skills of students

2019 ◽  
Vol 29 (Supplement_4) ◽  
Author(s):  
Z Bekbergenova ◽  
G Derbissalina ◽  
A Umbetzhanova ◽  
G Alibekova ◽  
G Mauletbayeva ◽  
...  
Keyword(s):  
Communication Skills ◽  
Clinical Examination ◽  
Professional Competence ◽  
Communicative Competence ◽  
General Medicine ◽  
Objective Structured Clinical Examination ◽  
Practical Skills ◽  
Clinical Exam ◽  
Objective Structured Clinical Exam

Abstract Background Communicative competence is one of the important components of professional competence that needs to be developed in the process of training future doctors. Methods At the end of the study of the “General Practice” module, students of the 5th year of the specialty General Medicine must pass a two-stage exam consisting of comprehensive testing and acceptance of practical skills of an objective structured clinical exam (OSKE) with the participation of volunteers. Students, who passed the exam, anonymously filled out the questionnaire on the evaluation of the organization of the OSKE with volunteers and their communication skills. Results The analysis of the questionnaires showed that 4% of the students noted the unfriendliness of the volunteers, 27% wrote that it was difficult to engage with the volunteers in the collection of the anamnesis, 2% of the students, unfortunately, had never before encountered a similar situation. 12% of students who passed the exam wished to improve the communication skills of the volunteers themselves, for example, they advised to speak louder, not to ask unnecessary and unnecessary questions, to get more real in the role of the patient. Only 10% of examinees decided that OSKE did not develop their communication skills; 24% noted individual stations, which caused them some difficulties. However, the students themselves acknowledged their poor preparedness, including during communication with standardized patients. Conclusions The analysis of the questionnaires showed that the students themselves are self-critical of their communication skills and recognize the need for their continuous improvement. Key messages The student’s communicative competence can be assessed by conducting an objective structured clinical examination. Conducting an objective structured clinical examination with volunteers can improve the communicative competence of students.

Diagnostic Reasoning and Treatment Planning: I. Diagnosis

1987 ◽  
Vol 21 (4) ◽  
pp. 477-483 ◽  
Author(s):  
Barry Nurcombe ◽  
Ina Fitzhenry-Coor
Keyword(s):  
Information Processing ◽  
Medical Students ◽  
Treatment Planning ◽  
Clinical Reasoning ◽  
Diagnostic Reasoning ◽  
Natural Process ◽  
Research Project ◽  
Deductive Logic ◽  
The University ◽  
University Of Vermont

Information-processing research into the natural process of clinical reasoning is reviewed and the University of Vermont diagnostic reasoning research project is described. Experienced psychiatric diagnosticians use a hypothetico-deductive logic. The development of a profile of diagnostic competencies is outlined and a course in diagnostic reasoning for medical students, which specifically objectified the tactics and strategy of reasoning and resulted in a significant improvement in the profile of competencies, is described. Finally, the organisation of a diagnostic formulation is discussed.

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