Early patient approach with feedback improves

clinical skills of medical studentsKiatsak Rajborirug M.D., Hatyai Medical Education Center, Thailand

Cognitive

3 Domains of Medical Education

SkillAttitude

Cognitive

This teaching focus on SKILL.

SkillAttitude

For medical profession : Clinical skill is the most important.

Early patient approach

Feedback

Hypothesis

Early patient approach

Feedback

Improve clinical skills ?

Hypothesis

Bedside teaching was used for clinical skill learning..

Conventional skill teaching

Bedside teaching was used for clinical skill learning. Teacher shows how to take good history and physical examination.

Take history and Physical examination - General, Abdomen, Cardiovascular, Chest and Neurological exam, etc.

Conventional skill teachingFollow me

Hx, PE & feedback 1Pt /2St /1Fac /1 hr

Early patient approach with feedback

Each pair of medical students was assigned to approach a patient with different common medical problems under closed supervision and immediately feedback by a facilitator.

Li b r a r y

Hx, PE & feedback 1Pt /2St /1Fac /1 hr

Self study4 hrs

Search for patient problems & learning issues

Li b r a r y

Hx, PE & feedback 1Pt /2St /1Fac /1 hr

Self study4 hrs

Present 10 mins& briefing 5 mins

Present and wrap up

Study profile

1st clinical year med students ( n= 124 )

Conventional clinical skill teaching (2002-2004)

( n = 56 )

+ Early patient approach with feedback (2005-2007)

( n = 68 )

Study profile: 1st & 2nd evaluation

1st clinical year med students ( n= 124 )

1st clinical year OSCE scores

Conventional clinical skill teaching (2002-2004)

( n = 56 )

+ Early patient approach with feedback (2005-2007)

( n = 68 )

2nd clinical year long case examination scores

• The curriculum and medical staffs were rather steady.

• Full scores of all measurement were adjusted to 100 percent.

Variables

OSCE evaluation- 1st clinical year40 OSCE items

20 - medical based 20 - surgical based

The same 6 tasks

3 History taking – Fever, Headache and

abdominal pain.3 Physical exam – Chest, Heart and

Skin exam.

Long case evaluation- 2nd clinical yearLong case exam score

History taking task

Physical examination task

Presentation

Problem solving

Long case evaluation- 2nd clinical yearLong case exam score

History taking task

Physical examination task

Presentation

Problem solving

* Only History taking and PE task were evaluated.

Statistic

• Mean score differences between 2 groups were compared by independent-samples T test.

• Statistical significant differences were

defined as p < 0.05.

Results

Fig 1: Mean different admission score.

51

52

53

54

55

56

57

Admission score

ConventionalPatient approach

P e r c e n t

-3.32 %

Fig 2: OSCE - Mean different scores of Hx taking skills.

0

10

20

30

40

50

60

70

80

90

Abdominal

pain

Fever Headache

Conventional

Patient approach

P e r c e n t

9.17 %

7.02 % -7.50 %

Fig 3: OSCE – Mean different scores of P.E. skills.

0

10

20

30

40

50

60

70

80

Chest exam Heart exam Skin exam

Conventional

Patient approach

P e r c e n t

17.79 % 1.69 %6.34 %

Fig 4: Mean different sum OSCE score

69

70

71

72

73

74

75

76

77

78

OSCE sum

Conventional

Patient approach

5.19 %

P e r c e n t

Fig 5: Mean different Long case exam score

72

74

76

78

80

82

84

History taking part Physical exam part

Conventional

Patient approach

P e r c e n t

0.58 %

2.82 %

Conclusion

• Early patient approach with feedback

significantly improves some specific clinical skills of medical students.

• No significant improvement in long case examination.

• The benefit in other clinical skills should be further evaluated.