Journal articles: 'Clinical competence – Examinations – Study guides'

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Abdulghani, Hamza Mohammad, Rashid Alrashid, Fahad Abdulhakim Alhussain, Turki Ali Alawbathani, Faisal Bander Almutrafi, Waleed Dekhayel Aldekhayel, Sami Saeed Aljohani, Salem Ali Alammari, and Tauseef Ahmad. "Assessment of Saudi MEDs framework competence in performing clinical and practical skills by final-year medical students." International Journal of ADVANCED AND APPLIED SCIENCES 10, no. 4 (April 2023): 154–61. http://dx.doi.org/10.21833/ijaas.2023.04.019.

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Clinical examinations and practical clinical skills are essential to guide diagnosis and treatment. Competency-based medical education (CBME) is high on today’s medical education agenda, and competence has become the unit of medical education planning in many countries. With the rise of medical education in Saudi Arabia, The Saudi MEDs initiative began as a means of achieving national consensus and developing necessary learning outcomes for medical schools. The aim of this study is to evaluate the final-year medical students’ core clinical competencies and identify the gaps between clinical skills in the Saudi MEDs framework and students’ actual achievement. Online data collection from all fifth-year medical students, to assess their clinical and procedural skills by using Objective Structured Clinical Examination (OSCE) scores and using a self-administered questionnaire that has been developed based on the Saudi MEDs framework. Eight clinical competencies were chosen out of the 17 after consulting the experts in this field. OSCE scores were checked for correlation with their self-assessment scores. The total OSCE scores of 323 students were evaluated which showed 93% of students have passed all eight competencies. Also, 304 students responded to the self-administered questionnaire in the current Saudi MEDs competencies 323 (response rate=94.11). The students were confident in the majority of the eight clinical competencies of the Saudi MEDs framework. Saudi MEDs framework has ensured that Saudi medical or health care education adapted to changing demands, critical competencies are not overlooked, teaching and learning, and evaluation are appropriate at medical schools by implementing the competency framework.

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Shevchenko, O. A., T. A. Holovkova, N. M. Onul, Yu S. Kramaryova, O. P. Shtepa, and S. A. Shchudro. "Preventive Medicine as a Component of Objective Structured Clinical Examination." Ukraïnsʹkij žurnal medicini, bìologìï ta sportu 8, no. 1 (February 27, 2023): 258–63. http://dx.doi.org/10.26693/jmbs08.01.258.

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The purpose of the study was to develop an optimal model of simulation and practical examination stations “hygiene and ecology” as components of objective structured clinical examination for the actualization of the formation of a preventive way of thinking among students of higher medical training. The paper analyzes the Passports of the simulation and practical stations of the objective structured clinical examination, their methodological and logistical support, which will allow to fully perform all the tasks and methods provided by the algorithms for mastering special professional competencies. The simulation station reproduces a number of real-life situations in specific tasks (25 options in total), the solution of which allows to assess the student's mastery of the professional competencies provided by the higher education standard, in particular: determining the risks to public health from the consumption of poor-quality drinking water, determining the nutritional status of the patient and the appropriateness of the prescription of therapeutic nutrition for the prevention of “diseases of civilization”, determining the requirements for compliance with sanitary and epidemiological requirements in health care facilities. The practical station is equipped with modern analytical instruments which allows the student to demonstrate their practical skills, in particular: bacterial air testing with evaluation of the results, research and evaluation of indoor microclimate parameters, research and evaluation of light environment parameters, measurement and evaluation of ionizing radiation, professional hand hygiene in health care facilities. To ensure high-quality training of students to perform the tasks of a practical station additional educational video guides were created, which are posted for general access on the department's page on the website of the University. Conclusion. Ukraine has now formed its own complex set of social, technogenic and environmental problems, which necessitates the development of appropriate skills and abilities in preventive medicine in future general practitioners. Objective structured clinical examination is a modern type of assessment of students' practical knowledge and skills, designed to test their acquisition of clinical skills and competencies that cannot be assessed by traditional forms of examinations. For the practical implementation of the preventive part of objective structured clinical examination in institutions of higher medical education, it should be taken into account that the traditional methods of protection and prevention, which have been developed by mankind over the centuries for the prevention of mass infectious, environmentally dependent, occupational and lifestyle diseases, in modern conditions are insufficient and/or ineffective

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Anim-Boamah, Oboshie, Christmal Dela Christmals, and Susan Jennifer Armstrong. "Clinical nursing competency assessment: a scoping review." Frontiers of Nursing 8, no. 4 (December 1, 2021): 341–56. http://dx.doi.org/10.2478/fon-2021-0034.

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Abstract Objective To ensure that only competent graduates are licensed to practice nursing, councils conduct licensing examinations, which may include among others clinical competency assessment. This review explored current practices in clinical competency assessment of nursing students as part of a larger study aimed at developing an evidence-based, context-specific framework for clinical competency assessment in a sub-Saharan African (SSA) country. Methods A scoping guided by the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) was conducted. Results Findings from 28 out of 1151 studies identified from Scopus, PubMed, CINAHL, Wiley Online Library, and ProQuest were included and synthesized. Results show that a good assessment system must be valid, reliable, transparent, feasible, fair, objective, and must provide feedback and continually improve to have an educational impact. Clinical competency assessment systems must be developed on sound empirical evidence, pilot tested, and involve thorough training and evaluation of the examiners. Continuous evaluation of the assessment system is also essential to ensure the quality and relevance of the assessment system. Only one of the included studies was conducted in Africa. Conclusions The paucity of clinical competency assessment research in sub-Saharan Africa may lead to benchmarking assessment systems on research conducted outside the context. Sub-Saharan Africa has a set of circumstances that demand a context-specific clinical competency assessment framework to guide clinical competency assessment.

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Eley, Catherine, Neil D. Hawkes, Richard J. Egan, David B. Robinson, Chris Brown, Sam Murray, Keith Siau, and Wyn Lewis. "Face validity of a virtual reality simulation platform to improve competency in endoscopy: a prospective observational cohort study." Endoscopy International Open 10, no. 09 (September 2022): E1218—E1224. http://dx.doi.org/10.1055/a-1882-4246.

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Abstract Background and study aims Virtual reality endoscopic simulation training has the potential to expedite competency development in novice trainees. However, simulation platforms must be realistic and confer face validity. This study aimed to determine the face validity of high-fidelity virtual reality simulation (EndoSim, Surgical Science, Gothenburg), and establish benchmark metrics to guide the development of a Simulation Pathway to Improve Competency in Endoscopy (SPICE). Methods A pilot cohort of four experts rated simulated exercises (Likert scale score 1–5) and following iterative development, 10 experts completed 13 simulator-based endoscopy exercises amounting to 859 total metric values. Results Expert metric performance demonstrated equivalence (P = 0.992). In contrast, face validity of each exercise varied among experts (median 4 (interquartile range [IQR] 3–5), P < 0.003) with Mucosal Examination receiving the highest scores (median 5 [IQR 4.5–5], P = 1.000) and Loop Management and Intubation exercises receiving the lowest scores (median 3 [IQR 1–3], P < 0.001, P = 0.004), respectively. The provisional validated SPICE comprised 13 exercises with pass marks and allowance buffers defined by median and IQR expert performance. Conclusions EndoSim Face Validity was very good related to early scope handling skills, but more advanced competencies and translation of acquired clinical skills require further research within an established training program. The existing training deficit with superadded adverse effects of the COVID pandemic make this initiative an urgent priority.

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Wallbridge, Thomas, Angela Holden, Aled Picton, and Janesh Gupta. "Does medical students’ gender affect their clinical learning of gynaecological examination? A retrospective cohort study." Postgraduate Medical Journal 94, no. 1112 (April 25, 2018): 325–29. http://dx.doi.org/10.1136/postgradmedj-2017-135390.

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IntroductionMedical graduates should be competent in gynaecological examination as well as associated skills including speculum use and swabbing. Male and female medical students may have different opportunities to practise these skills in clinical environments, potentially impacting on confidence and competence. This study explores this further via reviewing students’ learning experience in genitourinary medicine (GUM) and obstetrics and gynaecology (O&G) clinics.MethodsCross-sectional study of 759 year 4 and year 5 University of Birmingham medical students via an online questionnaire. This explored degree of participation, impact of gender and self-reported confidence.ResultsOverall response rate was 31% (233/759). Students of either gender who observed an examination being performed by a clinician were more likely to perform the same examination. Female students reported more opportunities to practise gynaecological examination and associated skills. Female students were more likely to be granted consent to perform speculum examinations, vaginal swabbing and vaginal bimanual examinations. Sixty-five per cent of male students felt that their gender affected their learning experience with female patients. Despite this, there was no significant difference in self-reported confidence level in performing gynaecological examinations between genders at the end of placement.ConclusionThe majority of male students perceived that their gender impacted their clinical experience in O&G and GUM. Self-reported confidence levels were unaffected, which could reflect varying approaches to competence between genders. The link between observing examinations and subsequent opportunities to practise is key. This could demonstrate students developing rapport and trust with patients, and clinicians’ roles as gatekeepers.

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Simatupang, Abraham, Mulyadi Djojosaputro, Roma Tobing, Hertina Silaban, and Lili Indrawati. "Integrative Pharmacotherapy Teaching with Objective Structured Pharmacotherapy Examination." Indonesian Journal of Clinical Pharmacy 9, no. 1 (March 31, 2020): 18. http://dx.doi.org/10.15416//ijcp.2020.9.1.18.

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Writing an appropriate prescription is one of the main competencies of medical doctors. Studies reveal that medication error is still a significant issue in health service, and many efforts have been done to minimise this through trainings. Integrative pharmacotherapy is a module delivered for medical students in clinical clerkship, which is adopted and developed from the World Health Organization Guide to Good Prescribing. The aim of the study was to examine the effect of the module on pre-test and post-test scores which consists of 17 clinical cases. The study was done in the Faculty of Medicine, Universitas Kristen Indonesia, East Jakarta from July to November 2018. Eighty one subjects were randomly selected from the data of 100 students who were screened from 200 students based on the exclusion criteria. There was an increase of post-test score which was statistically significant compared to pre-test score, from 42.07±12.45 to 58.47±8.54 (p=0.000, CI -19.36;-13.45). There were 69 (>85%) students having grade D and E in pre-test, but the number decreased to 18 (22,2%) out of 81 subjects in post-test. Both grade C and B students increased from 13.5% to 70.4% and 1% to 7%, respectively. Most of the students were first entries into clinical clerkship, thus, their pre-test scores were very low since they had not had the clinical experience yet. However, at the end of the clerkship, there was a significant increase on their knowledge on pharmacotherapy and prescription for particular diseases. An outcome study to measure the retention and to examine their success on the final competency examination should be done.Keywords: Medical education, OSCE, pharmacotherapy, prescribingPembelajaran Farmakoterapi Integratif dengan Objective Structured Pharmacotherapy ExaminationAbstrakMenulis resep yang benar merupakan salah satu kompetensi dokter. Penelitian menunjukkan kesalahan medikasi masih menjadi masalah besar di pelayanan kesehatan dan banyak upaya sudah dilakukan untuk mengurangi hal tersebut melalui pelatihan. Farmakoterapi integratif adalah sebuah modul yang diberikan kepada mahasiswa kedokteran saat kepaniteraan klinis. Modul ini merupakan hasil adopsi dan dikembangkan dari World Health Organization Guide to Good Prescribing. Tujuan studi ini adalah untuk melihat efek nilai pra-uji dan pasca-uji dengan 17 kasus klinis. Studi dilaksanakan di Fakultas Kedokteran Universitas Kristen Indonesia, Jakarta Timur pada Juli-November 2018. Delapan puluh satu subjek secara acak dipilih dari data 200 mahasiswa berdasarkan kriteria eksklusi. Terdapat peningkatan nilai pasca-uji yang signifikan dibandingkan nilai pra-uji dari 42,07±12,45 ke 58,47±8,54 (p=0,000; CI -19,36; -13,45). Terdapat 69 (>85%) mahasiswa yang memiliki nilai D dan E pada pra-uji, namun angka tersebut turun pada pasca-uji menjadi 18 orang (22,2%) dari jumlah total 81 mahasiswa. Mahasiswa dengan nilai C meningkat dari 13,5% menjadi 70,4%, dan mahasiswa dengan nilai B dari 1% menjadi 7%. Mayoritas mahasiswa pada penelitian ini baru pertama kali mengikuti kepaniteraan klinik sehingga nilai pra-uji yang diperoleh sangat rendah karena belum memiliki pengalaman klinis. Namun, di akhir kepaniteraan, terdapat peningkatan pengetahuan dan penulisan resep terhadap beberapa jenis penyakit yang signifikan. Perlu dilakukan studi jangka panjang untuk mengukur retensi dan keberhasilan mereka di ujian akhir kompetensi.Kata kunci: Farmakoterapi, OSCE, pendidikan kedokteran, penulisan resep

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Turk, Dennis C., James P. Robinson, and Mary Aulet. "Clinical Update: The Impairment Impact Inventory: Comparison of Responses by Treatment-seekers and Claimants Undergoing Independent Medical Examinations." Guides Newsletter 10, no. 1 (January 1, 2005): 6–7. http://dx.doi.org/10.1001/amaguidesnewsletters.2005.janfeb03.

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Abstract In the adversarial setting of an independent medical evaluation (IME), claimants may be incentivized to exaggerate the severity of their problems. The AMA Guides to the Evaluation of Permanent Impairment (AMA Guides) describes a protocol for assessing impairment associated with chronic pain, including the Impairment Impact Inventory (I3) that consists of 26 items that assess the burden of illness in three domains: pain intensity, interference with activities of daily living, and emotional distress. A study was performed to establish preliminary norms for the I3 and to compare responses of claimants undergoing IMEs with those of treatment-seeking chronic pain patients: 183 patients completed the I3, including fibromyalgia syndrome patients (FMS group), 35 multidisciplinary pain center patients (PC group), and 72 claimants undergoing IMEs. Patients in the latter two groups had a variety of chronic pain problems (and hypothetically may be more likely to exaggerate their problems). The three groups had similar mean scores on the total I3 and for each of the FMS, PC, and IME groups. Results support the hypothesis that participants, in aggregate, do not exaggerate their pain when they undergo IMEs, although some quite possibly do. These results are a step toward establishing a scientific basis for the impairment rating system described in the AMA Guides from consensus-based rules to an evidence-based system for making decisions about impairment.

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Eze, Balantine U., Nkiruka N. Okoloagu, and Sunday G. Mba. "Objective Structured Clinical Examination as A Reliable tool in the Summative Evaluation of Final Year Medical Students at Enugu State University College of Medicine." European Journal of Clinical Medicine 3, no. 6 (November 26, 2022): 1–3. http://dx.doi.org/10.24018/clinicmed.2022.3.6.236.

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Objective structured clinical examination (OSCE) is a reliable, objective and reproducible method of summative assessment of clinical competence. The aim of this study is to evaluate the reliability of OSCE for summative evaluation of final year medical students in both Internal Medicine and Surgery. This was a retrospective cross-sectional study of summative assessment of final-year medical students in Internal Medicine and Surgery at College of Medicine, Enugu State University of Science and Technology. The students’ clinical competence was tested by OSCE. The OSCE consisted of two parts. The A part (picture OSCE, replacing traditional short cases) in which questions were given to students from slide shows. The B part (clinical OSCE, replacing traditional long case) consisted of clinical OSCE stations to test students’ ability and skills in history taking, physical examination, counselling/communication skills, ability to make diagnosis, interpretation of laboratory/radiological results and ability to manage common medical emergencies and conditions. The students' scores in the picture OSCE, clinical OSCE, and final total clinical score scores in both Internal Medicine and Surgery were collated and subjected to analysis with SPSS version 25 (IBM; SPSS, Chicago, IL, USA). Correlation was assessed by Pearson correlation, mean scores compared with paired t-test, reliability assessed by calculating Cronbach's alpha. Statistical significance was considered as p <0.05. A total of 120 students sat for the examinations. There were significant positive correlations between students’ score in Surgery clinical OSCE and Internal Medicine clinical OSCE, r =0.617 (p=0.000); students’ scores in Surgery picture OSCE and Internal Medicine Picture OSCE, r=0.647 (p=0.000); and students’ scores in Surgery clinical examinations and Internal Medicine clinical examinations, r= 0.750 (p=0.000). The reliability of Surgery clinical examinations was 0.851 while the reliability of Internal Medicine clinical examinations was 0.816. OSCE is a more reliable tool than traditional method for the summative assessment of final year medical students. OSCE gives a higher correlation coefficient and Cronbach alpha than the traditional method of assessment.

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Berney, Alexandre, Valerie Carrard, Sylvie Berney, Katja Schlegel, Jacques Gaume, Mehdi Gholam, Pierre-Alexandre Bart, et al. "Study protocol for the ETMED-L project: longitudinal study of mental health and interpersonal competence of medical students in a Swiss university using a comprehensive framework of empathy." BMJ Open 11, no. 12 (December 2021): e053070. http://dx.doi.org/10.1136/bmjopen-2021-053070.

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IntroductionPhysician interpersonal competence is crucial for patient care. How interpersonal competence develops during undergraduate medical education is thus a key issue. Literature on the topic consists predominantly of studies on empathy showing a trend of decline over the course of medical school. However, most existing studies have focused on narrow measures of empathy. The first aim of this project is to study medical students’ interpersonal competence with a comprehensive framework of empathy that includes self-reported cognitive and affective empathy, performance-based assessments of emotion recognition accuracy, and a behavioural dimension of empathy. The second aim of the present project is to investigate the evolution of mental health during medical school and its putative link to the studied components of interpersonal competence. Indeed, studies documented a high prevalence of mental health issues among medical students that could potentially impact their interpersonal competence. Finally, this project will enable to test the impact of mental health and interpersonal competence on clinical skills as evaluated by experts and simulated patients.Methods and analysisThis project consists of an observational longitudinal study with an open cohort design. Each year during the four consecutive years of the project, every medical student (curriculum years 1–6) of the University of Lausanne in Switzerland will be asked to complete an online questionnaire including several interpersonal competence and mental health measures. Clinical skills assessments from examinations and training courses with simulated patients will also be included. Linear mixed models will be used to explore the longitudinal evolutions of the studied components of interpersonal competence and mental health as well as their reciprocal relationship and their link to clinical skills.Ethics and disseminationThe project has received ethical approval from the competent authorities. Findings will be disseminated through internal, regional, national and international conferences, news and peer-reviewed journals.

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Huang, Simin, Jing Yang, Feifei Wang, Jun Guo, and Shengming Liu. "Exploration of an Effective Method for the Step-by-Step Presentation of Case Information to Guide Grade 4 Medical Students to Develop Clinical Reasoning Skills." Journal of Curriculum and Teaching 10, no. 1 (February 15, 2021): 36. http://dx.doi.org/10.5430/jct.v10n1p36.

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Clinical reasoning ability is an important competence for a clinician to have. Undergraduate study is a crucial period to strengthen medical students' clinical reasoning skills. The aim of this study was to explore an effective method for guiding students to improve clinical reasoning skills via a step-by-step presentation of case information. The study was conducted among grade 2015 clinical medicine major students who were studying internal medicine. On the basis of the theoretical study and practical training, a method for the step-by-step presentation of case information was designed and implemented to strengthen students’ clinical reasoning skills. Each case was divided into four modules. Module one focused on inquiry, module two focused on physical examination, module three focused on laboratory tests and module four focused on diagnosis and treatment. Four modules were sent to students in turn as homework. The teacher corrected their answers and feedback was individually given. A questionnaire was conducted at the end of semester to assess the effect. The questionnaire revealed that students were satisfied with this training mode. They thought the mode was helpful for improving clinical reasoning ability and consolidating the basic skills such as history taking and physical examination. In conclusion, this effective method provides a training pattern for developing clinical reasoning skills of medical students. Through the process of analysing clinical cases, students are guided to become familiar with the procedures of solving clinical problems from gathering medical information to establishing diagnosis and treatment plans. It helps students to establish a scientific clinical reasoning mode.

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Fikar, Charles R. "Internet Resources for Podiatric Medical Students." Journal of the American Podiatric Medical Association 95, no. 2 (March 1, 2005): 211–15. http://dx.doi.org/10.7547/0950211.

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This article presents a selection of Internet resources covering most of the subject areas found in standard medical education curricula. Basic-sciences sites are emphasized, but clinical resources are also included. Sites were evaluated on the basis of their potential to enhance the learning process, provide practice questions or study guides for examinations, or aid in the preparation of papers. Podiatric medical students, residents, and practitioners who require a quick reference guide to sources covering the basic-science foundations of podiatric medicine or the clinical side of general medicine may find this article useful. (J Am Podiatr Med Assoc 95(2): 211–215, 2005)

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Fikar, Charles R., and Ronald M. Fikar. "Internet Resources for Podiatric Medical Students." Journal of the American Podiatric Medical Association 91, no. 6 (June 1, 2001): 316–23. http://dx.doi.org/10.7547/87507315-91-6-316.

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This paper presents a selection of Internet resources covering most of the subject areas found in standard medical education curricula. Basic sciences sites are emphasized, but clinical resources are also included. Reported sites were judged based on their potential to enhance the learning process, provide practice questions or study guides for examinations, or aid in the preparation of papers. In addition to podiatric medical students, residents and practitioners who require a quick reference source to either the basic science foundations of podiatric medicine or the clinical side of podiatric practice may find this paper useful. (J Am Podiatr Med Assoc 91(6): 316-323, 2001)

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Ní Sheachnasaigh, E., C. Cadogan, and C. Ryan. "A qualitative study of stakeholder perspectives of the current system of assessing pharmacists’ readiness for independent practice in Ireland." International Journal of Pharmacy Practice 32, Supplement_1 (April 1, 2024): i4—i5. http://dx.doi.org/10.1093/ijpp/riae013.006.

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Abstract Introduction Pharmacy students in Ireland are supervised by an approved tutor pharmacist (preceptor) during placement in the final year of the MPharm programme. Since 2020, students must pass two assessments of their readiness to practise – a Competency Assessment completed by their preceptor and an Objective Structured Clinical Examination (OSCE) referred to as the Professional Registration Examination (PRE), prior to registration and independent practice. The Schools of Pharmacy in Ireland are collectively responsible for the PRE, including design and delivery of the national registration examination. A recent scoping review of the methods and processes used to determine pharmacists’ readiness for independent practice identified that Ireland is the only country globally where the Schools of Pharmacy are responsible for the national registration examination.[1] Aim This study aimed to explore pharmacy graduates’ and pharmacy preceptors’ perspectives of the current system of assessing pharmacist’s readiness for independent practice in Ireland. Methods Online, semi-structured interviews were undertaken with preceptors and recent pharmacy graduates. Purposive sampling was used to invite potential participants for interview. Preceptor participants were invited to take part via newsletter invitation and graduates were recruited via social media (Twitter advertisement). Interviews were recorded and transcribed verbatim. The topic guides were developed based on findings from a linked scoping review and the research team’s experience of the assessments.[1] The topic guides were piloted and refined. Key topics included participants’ awareness and perceptions of current assessments to determine readiness for independent practice and participants’ views regarding the readiness of newly registered pharmacists for independent pharmacy practice. Recruitment continued until thematic saturation was reached. Data were analysed using thematic analysis. Results Fifteen interviews were conducted with preceptors (n=7, female=5, male=2) and recent graduates (n=8, female=5, male=3). The key themes identified were: The Competency Assessment Process, The Professional Registration Examination, Pharmacy Curriculum, Placement Training, Alternative Assessment Methods and Challenges Post-Registration. The most frequently noted issues relating to pharmacy curriculum and training were lack of training and practise in development of soft skills, people management and conflict resolution. Participants expressed concern regarding the fact that legal constraints were preventing students from developing skills required of pharmacists, especially in relation to decision making and prescription checking, and this is considered an impediment to fully preparing students for independent practice. Readiness to practise of graduates is considered context-specific with concerns expressed in relation to locuming practices of newly registered pharmacists. Conclusion This study has highlighted a number of stakeholder concerns regarding the current system of assessment of readiness to practise of pharmacists in Ireland, in particular in relation to the Competency Assessment process. While the interview technique facilitated collection of detailed information, the sample size would prevent generalisation to the target population. The possibility of interviewer bias and/or social desirability bias in participants should be acknowledged. Further research is required to explore the feasibility of the improvements proposed by participants. References 1. Ni Sheachnasaigh E, Cadogan C, Strawbridge J et al. A scoping review of the methods and processes used by regulatory bodies to determine pharmacists’ readiness for practice. Res Soc Admin Pharm 2022;18(12):4028–4037.

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Matet, Alexandre, Ludovic Fournel, François Gaillard, Laurence Amar, Jean-Benoit Arlet, Stéphanie Baron, Anne-Sophie Bats, et al. "Impact of integrating objective structured clinical examination into academic student assessment: Large-scale experience in a French medical school." PLOS ONE 16, no. 1 (January 14, 2021): e0245439. http://dx.doi.org/10.1371/journal.pone.0245439.

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Purpose Objective structured clinical examinations (OSCE) evaluate clinical reasoning, communication skills, and interpersonal behavior during medical education. In France, clinical training has long relied on bedside clinical practice in academic hospitals. The need for a simulated teaching environment has recently emerged, due to the increasing number of students admitted to medical schools, and the necessity of objectively evaluating practical skills. This study aimed at investigating the relationships between OSCE grades and current evaluation modalities. Methods Three-hundred seventy-nine 4th-year students of University-of-Paris Medical School participated to the first large-scale OSCE at this institution, consisting in three OSCE stations (OSCE#1–3). OSCE#1 and #2 focused on cardiovascular clinical skills and competence, whereas OSCE#3 focused on relational skills while providing explanations before planned cholecystectomy. We investigated correlations of OSCE grades with multiple choice (MCQ)-based written examinations and evaluations of clinical skills and behavior (during hospital traineeships); OSCE grade distribution; and the impact of integrating OSCE grades into the current evaluation in terms of student ranking. Results The competence-oriented OSCE#1 and OSCE#2 grades correlated only with MCQ grades (r = 0.19, P<0.001) or traineeship skill grades (r = 0.17, P = 0.001), respectively, and not with traineeship behavior grades (P>0.75). Conversely, the behavior-oriented OSCE#3 grades correlated with traineeship skill and behavior grades (r = 0.19, P<0.001, and r = 0.12, P = 0.032), but not with MCQ grades (P = 0.09). The dispersion of OSCE grades was wider than for MCQ examinations (P<0.001). When OSCE grades were integrated to the final fourth-year grade with an incremental 10%, 20% or 40% coefficient, an increasing proportion of the 379 students had a ranking variation by ±50 ranks (P<0.001). This ranking change mainly affected students among the mid-50% of ranking. Conclusion This large-scale French experience showed that OSCE designed to assess a combination of clinical competence and behavioral skills, increases the discriminatory capacity of current evaluations modalities in French medical schools.

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Hsieh, Suh-Ing, Li-Ling Hsu, Katherine A. Hinderer, Hui-Ling Lin, Yi-Ping Tseng, Chen-Yi Kao, Ching-Yun Lee, et al. "The Effects of a Scenario-Based Spiritual Care Course on Spiritual Care Competence among Clinical Nurses: A Quasi-Experimental Study." Healthcare 11, no. 1 (December 22, 2022): 36. http://dx.doi.org/10.3390/healthcare11010036.

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Across their lifespans, and in many clinical settings, patients have spiritual care needs. Many nurses lack competence related to providing spiritual care. Popular educational strategies, such as simulated educational programs and objective structured clinical examinations (OSCE), have not been widely adopted in nursing spiritual care education. The purpose of this study was to explore the effects of a scenario-based spiritual care course on spiritual care competence in nurses. This quasi-experimental study employed a repeated-measures pre-test/post-test design with assessments immediately before, immediately after, and 3 months post-intervention. Nurses providing direct patient care in diverse clinical settings were recruited from a large medical foundation in northern Taiwan. The intervention was a one day scenario-based spiritual care course and OSCE. The experimental group (n = 53) and controls (n = 85) were matched for their similar units, ages, working experience, and clinical ladder status. The Spiritual Care Competence Scale (SCCS), Spiritual Perspective Scale (SPS), Spiritual Care Perspective Scale-Revised (SCPS-R), and reflection logs were completed by both experimental and control groups. The Course Satisfaction Scale, OSCE Checklist, and Standardized Patient Feedback Scale (SPFS) were completed by the experimental group only. The experimental group had significantly higher SPS scores and self-evaluated SCCS scores, and lower SCPS-R scores (more positive spiritual perspectives), than controls at 3 months post-intervention. The experimental group showed significant within-subject effects at three time points on SPS scores, SCPS-R scores, and self-evaluated SCCS scores. Mean global performance of OSCE was 3.40 ± 0.91, and SP feedback indicated strengths and areas for improvement. In conclusion, the scenario-based spiritual care course effectively enhanced nurses’ spiritual care competence, competence, and skills. Blended education techniques can therefore enhance nurses’ ability to support patients with spiritual care needs.

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Cheung, Warren J., Teresa M. Chan, Karen E. Hauer, Robert A. Woods, Jill McEwen, Lynsey J. Martin, Catherine Patocka, Sandy L. Dong, Munsif Bhimani, and Tamara McColl. "CAEP 2019 Academic Symposium: Got competence? Best practices in trainee progress decisions." CJEM 22, no. 2 (March 2020): 187–93. http://dx.doi.org/10.1017/cem.2019.480.

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ABSTRACTBackgroundCompetence committees play a key role in a competency-based system of assessment. These committees are tasked with reviewing and synthesizing clinical performance data to make judgments regarding residents’ competence. Canadian emergency medicine (EM) postgraduate training programs recently implemented competence committees; however, a paucity of literature guides their work.ObjectiveThe objective of this study was to develop consensus-based recommendations to optimize the function and decisions of competence committees in Canadian EM training programs.MethodsSemi-structured interviews of EM competence committee chairs were conducted and analyzed. The interview guide was informed by a literature review of competence committee structure, processes, and best practices. Inductive thematic analysis of interview transcripts was conducted to identify emerging themes. Preliminary recommendations, based on themes, were drafted and presented at the 2019 CAEP Academic Symposium on Education. Through a live presentation and survey poll, symposium attendees representing the national EM community participated in a facilitated discussion of the recommendations. The authors incorporated this feedback and identified consensus among symposium attendees on a final set of nine high-yield recommendations.ConclusionThe Canadian EM community used a structured process to develop nine best practice recommendations for competence committees addressing: committee membership, meeting processes, decision outcomes, use of high-quality performance data, and ongoing quality improvement. These recommendations can inform the structure and processes of competence committees in Canadian EM training programs.

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McAlpine, Kristen, and Stephen Steele. "Missing the mark: Current practices in teaching the male urogenital examination to Canadian undergraduate medical students." Canadian Urological Association Journal 10, no. 7-8 (August 16, 2016): 281. http://dx.doi.org/10.5489/cuaj.3679.

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Introduction: The urogenital physical examination is an important aspect of patient encounters in various clinical settings. Introductory clinical skills sessions are intended to provide support and alleviate students’ anxiety when learning this sensitive exam. The techniques each Canadian medical school uses to guide their students through the initial urogenital examination has not been previously reported.Methods: This study surveyed pre-clerkship clinical skills program directors at the main campus of English-speaking Canadian medical schools regarding the curriculum they use to teach the urogenital examination.Results: A response rate of 100% was achieved, providing information on resources and faculty available to students, as well as the manner in which students were evaluated. Surprisingly, over onethird of the Canadian medical schools surveyed failed to provide a setting in which students perform a urogenital examination on a patient in their pre-clinical years. Additionally, there was no formal evaluation of this skill set reported by almost 50% of Canadian medical schools prior to clinical training years.Conclusions: To ensure medical students are confident and accurate in performing a urogenital examination, it is vital they be provided the proper resources, teaching, and training. As we progress towards a competency-based curriculum, it is essential that increased focus be placed on patient encounters in undergraduate training. Further research to quantify students’ exposure to the urogenital examination during clinical years would be of interest. Without this commitment by Canadian medical schools, we are doing a disservice not only to the medical students, but also to our patient population.

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Fikar, Charles R., and Scott H. Nguyen. "Internet Resources for Podiatric Medical Students." Journal of the American Podiatric Medical Association 97, no. 6 (November 1, 2007): 486–92. http://dx.doi.org/10.7547/0970486.

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In this article, we present a selection of Internet resources covering subject areas found in standard medical education curricula. Basic sciences and clinical resource sites are explored. We also review Web sites that offer useful materials that can be downloaded to handheld devices such as palmtop computers, smartphones, and portable media players. We judged the sites based on their potential to enhance the learning process, provide practice questions or study guides for examinations, or aid in the preparation of manuscripts. Medical students, residents, educators, and practitioners of podiatric medicine and surgery who require a quick reference source to either the basic science foundations of podiatric medicine or the clinical side of basic medicine, may find this paper useful. (J Am Podiatr Med Assoc 97(6): 486–492, 2007)

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Klig, Jean E., William M. Kettyle, Joshua M. Kosowsky, William R. Phillips, Jr., Susan E. Farrell, Edward M. Hundert, John L. Dalrymple, and Mary Ellen J. Goldhamer. "A pilot clinical skills coaching program to reimagine remediation: a cohort study." MedEdPublish 13 (May 18, 2023): 29. http://dx.doi.org/10.12688/mep.19621.1.

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Background New approaches are needed to improve and destigmatize remediation in undergraduate medical education (UME). The COVID-19 pandemic magnified the need to support struggling learners to ensure competency and readiness for graduate medical education (GME). Clinical skills (CS) coaching is an underutilized approach that may mitigate the stigma of remedial learning. Methods A six-month CS coaching pilot was conducted at Harvard Medical School (HMS) as a destigmatized remedial learning environment for clerkship and post-clerkship students identified as ‘at risk’ based on objective structured clinical examinations (OSCE). The pilot entailed individual and group coaching with five faculty, direct bedside observation of CS, and standardized patient encounters with video review. Strengths-based coaching principles and appreciative inquiry were emphasized. Results Twenty-three students participated in the pilot: 14 clerkship students (cohort 1) and 9 post-clerkship students (cohort 2). All clerkship students (cohort 1) demonstrated sustained improvement in CS across three OSCEs compared to baseline: at pilot close, at 6-months post pilot, and at 21-24 months post-pilot all currently graduating students (10/10, 100%) passed the summative OSCE, an HMS graduation requirement. All post-clerkship students (cohort 2) passed the HMS graduation OSCE (9/9,100%). Feedback survey results included clerkship students (9/14; 64%) and post-clerkship students (7/9; 78%); all respondents unanimously agreed that individual coaching was “impactful to my clinical learning and practice”. Faculty and leadership fully supported the pilot as a destigmatized and effective approach to remediation. Conclusion Remediation has an essential and growing role in medical schools. CS coaching for remedial learning can reduce stigma, foster a growth mindset, and support sustained progress for ‘at risk’ early clerkship through final year students. An “implementation template” with suggested tools and timelines can be locally adapted to guide CS coaching for UME remediation. The CS coaching pilot model is feasible and can be generalized to many UME programs.

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Klig, Jean E., William M. Kettyle, Joshua M. Kosowsky, William R. Phillips, Jr., Susan E. Farrell, Edward M. Hundert, John L. Dalrymple, and Mary Ellen J. Goldhamer. "A pilot clinical skills coaching program to reimagine remediation: a cohort study." MedEdPublish 13 (July 13, 2023): 29. http://dx.doi.org/10.12688/mep.19621.2.

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Background New approaches are needed to improve and destigmatize remediation in undergraduate medical education (UME). The COVID-19 pandemic magnified the need to support struggling learners to ensure competency and readiness for graduate medical education (GME). Clinical skills (CS) coaching is an underutilized approach that may mitigate the stigma of remedial learning. Methods A six-month CS coaching pilot was conducted at Harvard Medical School (HMS) as a destigmatized remedial learning environment for clerkship and post-clerkship students identified as ‘at risk’ based on objective structured clinical examinations (OSCE). The pilot entailed individual and group coaching with five faculty, direct bedside observation of CS, and standardized patient encounters with video review. Strengths-based coaching principles and appreciative inquiry were emphasized. Results Twenty-three students participated in the pilot: 14 clerkship students (cohort 1) and 9 post-clerkship students (cohort 2). All clerkship students (cohort 1) demonstrated sustained improvement in CS across three OSCEs compared to baseline: at pilot close, at 6-months post pilot, and at 21-24 months post-pilot all currently graduating students (10/10, 100%) passed the summative OSCE, an HMS graduation requirement. All post-clerkship students (cohort 2) passed the HMS graduation OSCE (9/9,100%). Feedback survey results included clerkship students (9/14; 64%) and post-clerkship students (7/9; 78%); all respondents unanimously agreed that individual coaching was “impactful to my clinical learning and practice”. Faculty and leadership fully supported the pilot as a destigmatized and effective approach to remediation. Conclusion Remediation has an essential and growing role in medical schools. CS coaching for remedial learning can reduce stigma, foster a growth mindset, and support sustained progress for ‘at risk’ early clerkship through final year students. An “implementation template” with suggested tools and timelines can be locally adapted to guide CS coaching for UME remediation. The CS coaching pilot model is feasible and can be generalized to many UME programs.

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Sigalet, Elaine L., Dismas Matovelo, Jennifer L. Brenner, Maendeleo Boniphace, Edgar Ndaboine, Lusako Mwaikasu, Girles Shabani, Julieth Kabirigi, Jaelene Mannerfeldt, and Nalini Singhal. "Rater training for standardised assessment of Objective Structured Clinical Examinations in rural Tanzania." BMJ Paediatrics Open 4, no. 1 (December 2020): e000856. http://dx.doi.org/10.1136/bmjpo-2020-000856.

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ObjectivesTo describe a simulation-based rater training curriculum for Objective Structured Clinical Examinations (OSCEs) for clinician-based training for frontline staff caring for mothers and babies in rural Tanzania.BackgroundRater training for OSCE evaluation is widely embraced in high-income countries but not well described in low-income and middle-income countries. Helping Babies Breathe, Essential Care for Every Baby and Bleeding after Birth are standardised training programmes that encourage OSCE evaluations. Studies examining the reliability of assessments are rare.MethodsTraining of raters occurred over 3 days. Raters scored selected OSCEs role-played using standardised learners and low-fidelity mannikins, assigning proficiency levels a priori. Researchers used Zabar’s criteria to critique rater agreement and mitigate measurement error during score review. Descriptive statistics, Fleiss’ kappa and field notes were used to describe results.ResultsSix healthcare providers scored 42 training scenarios. There was moderate rater agreement across all OSCEs (κ=0.508). Kappa values increased with Helping Babies Breathe (κ=0.28–0.48) and Essential Care for Every Baby (κ=0.42–0.77) by day 3 of training, but not with Bleeding after Birth (κ=0.58–0.33). Raters identified average proficiency 50% of the time.ConclusionOur study shows that the in-country raters in this study had a hard time identifying average performance despite moderate rater agreement. Rater training is critical to ensure that the potential of training programmes translates to improved outcomes for mothers and babies; more research into the concepts and training for discernment of competence in this setting is necessary.

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Tolsgaard, Martin, Cergika Veluppillai, Alexandra Gueneuc, Caroline Taksøe-Vester, Nadim Hajal, Jean-Marc Levaillant, Yves Ville, Ann Tabor, and Gihad Chalouhi. "When Are Trainees Ready to Perform Transvaginal Ultrasound? An Observational Study." Ultraschall in der Medizin - European Journal of Ultrasound 40, no. 03 (October 25, 2018): 366–73. http://dx.doi.org/10.1055/a-0753-0259.

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Abstract Purpose The purpose of this study was two-fold: (1) To determine how the number of ultrasound scans a trainee has completed predicts the trainee’s diagnostic accuracy when performing transvaginal ultrasound examinations, and (2) to examine the utility of simulation-based assessment of ultrasound competence for determining readiness for independently performing examinations. Materials and Methods 101 OB/GYN trainees were surveyed regarding their clinical experience and the number of scans they had completed. All participants completed five different cases on a transvaginal virtual-reality ultrasound simulator (Scantrainer, Medaphor). The participants’ diagnostic accuracy was recorded and expert raters evaluated their performance using the Objective Structured Assessment of Ultrasound Skills (OSAUS) scale. The utility of simulation-based assessments was assessed with respect to reliability, validity, acceptability, and costs. The main outcome was diagnostic accuracy for five different ultrasound cases. Results Although the number of scans was associated with diagnostic accuracy (p = 0.006), it was a poor predictor (AUC 0.69) of diagnostic accuracy. Only 56.6 % (n = 34) of participants who had more than 100 transvaginal scans demonstrated a diagnostic accuracy of 0.80 or above. The reliability of the OSAUS assessments was high (ICC 0.82) and the majority of participants supported the use of simulation-based assessments for future licensing exams (70.3 %). The running costs of simulation-based assessments (154 EUR per participant) were lower than for practical examinations using real patients. Conclusion The number of completed ultrasound scans was a poor predictor of the trainees’ diagnostic accuracy. Instead, simulation-based assessments can be used to ensure that trainees are ready for independently performing future scans.

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Arrogante, Oscar, Eva María López-Torre, Laura Carrión-García, Alberto Polo, and Diana Jiménez-Rodríguez. "High-Fidelity Virtual Objective Structured Clinical Examinations with Standardized Patients in Nursing Students: An Innovative Proposal during the COVID-19 Pandemic." Healthcare 9, no. 3 (March 20, 2021): 355. http://dx.doi.org/10.3390/healthcare9030355.

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In response to the cancellation of in-person objective structured clinical examinations (OSCEs) prompted by confinement due to the COVID-19 pandemic, we designed a solution to adapt our traditional OSCEs to this new reality in nursing education. We implemented an innovative teaching proposal based on high-fidelity virtual OSCEs with standardized patients. The purposes of our study were to describe this innovative teaching proposal and compare nursing competence acquisition in final year nursing students through virtual and in-person OSCE modalities. The study included 234 undergraduate students: 123 students were assessed through high-fidelity virtual OSCEs during May 2020, whereas 111 students were assessed through in-person OSCEs during May 2019. The structure of OSCEs, including its stations, clinical simulated scenarios, and checklists, was the same in both OSCE modalities. The effect size of the differences among the competence categories of checklists, including their total scores, was small. Regarding our virtual OSCEs was similarly successful to in-person OSCEs, this online format was found to be useful, feasible, and cost-saving when in-person OSCE was not possible. Therefore, high-fidelity virtual OSCEs with standardized patients could be considered as another choice of OSCE not only in the current COVID-19 pandemic but could also be extended to normal situations, even post-pandemic.

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Barsuk, Jeffrey H., Elaine R. Cohen, Joe Feinglass, William C. McGaghie, and Diane B. Wayne. "Residents' Procedural Experience Does Not Ensure Competence: A Research Synthesis." Journal of Graduate Medical Education 9, no. 2 (April 1, 2017): 201–8. http://dx.doi.org/10.4300/jgme-d-16-00426.1.

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ABSTRACT Background Many medical certifying bodies require that a minimum number of clinical procedures be completed during residency training to obtain board eligibility. However, little is known about the relationship between the number of procedures residents perform and their clinical competence. Objective This study evaluated associations between residents' medical procedure skills measured in a simulation laboratory and self-reported procedure experience and year of training. Methods This research synthesis extracted and summarized data from multiple cohorts of internal medicine, emergency medicine, anesthesiology, and neurology resident physicians who performed simulated clinical procedures. The procedures were central venous catheter insertion, lumbar puncture, paracentesis, and thoracentesis. We compared residents' baseline simulated performance to their self-reported procedure experience using data from 7 research reports written by Northwestern University investigators between 2006 and 2016. We also evaluated how performance differed by postgraduate year (PGY). Results A total of 588 simulated procedures were performed during the study period. We found significant associations between passing the skills examinations and higher number of self-reported procedures performed (P = .011) and higher PGY (P < .001). However, performance for all procedures was poor, as only 10% of residents passed the assessments with a mean of 48% of checklist items correct (SD = 24.2). The association between passing the skills examination and year of training was mostly due to differences between PGY-1 and subsequent years of training. Conclusions Despite positive associations between self-reported experience and simulated procedure performance, overall performance was poor. Residents' clinical experience is not a proxy for skill.

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Bartlett, Mike. "Introducing the BCAT: A Tool to Aid Treatment Providers in Assessing Adjudicative Competence." Journal of Forensic Social Work 7, no. 1 (January 27, 2023): 14–31. http://dx.doi.org/10.15763/issn.1936-9298.2023.7.1.14-31.

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The most frequently requested forensic evaluations are to assess a defendant's competency to proceed, yet inefficiencies in the competency review process often lead to wasted state resources and prolonged detainment. When a judge identifies a defendant as incompetent, criminal proceedings are postponed and the defendant is typically ordered to receive competency restoration treatment. The court also schedules a hearing to review the defendant’s progress toward competency and orders a competency examiner to prepare a progress report for that hearing. If the court then determines the defendant is competent their case will proceed, otherwise the court will generally order that competency restoration treatment continue. These competency examinations and their associated court hearings typically occur in standard intervals, such as every three months. It is common for defendants to be restored to competency prior to their next scheduled court hearing, but competency examiners and courts are often not apprised of this development. This is partially due to dynamics associated with treatment providers. Though treatment providers such as psychiatrists and clinical social workers are trained in mental health issues, they are not typically trained to determine if a defendant is competent. Consequently, they may inadvertently continue to provide daily competency restoration treatment to a defendant who has already been restored to competency. Such occurrences contribute to a waste of resources, unnecessarily long detainment for competency restoration treatment, and an unnecessarily long postponement of legal proceedings. This study examines whether the Bartlett Competency Assessment Tool (BCAT) could be utilized by treatment providers to assist them in determining if a defendant is likely competent to proceed and thus ready for a formal competency examination. The recommendation of the BCAT was compared to the recommendation of formal competency examinations for 27 defendants and accurately predicted the outcome of the examinations in 25 cases, or 92 percent of the time (96 percent of the time if situations with feigned symptoms are excluded). Implications and limitations of these findings are discussed, including the potential of the BCAT to help states better utilize resources and reduce unnecessary treatment and detainment.

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McGuinness, Alison, Beverly Snaith, Jean Wilson, and Stephen Wolstenhulme. "A Cohort Study to Evaluate Emergency Medicine Ultrasound by Non-Sonographers in Clinical Practice." Ultrasound 19, no. 4 (October 20, 2011): 214–20. http://dx.doi.org/10.1258/ult.2011.011029.

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Previous research has evaluated the sensitivity and specificity of emergency medicine ultrasound (EMU); however, the literature on clinical governance issues such as the quality of training, competence of the operator, development of clinical guidelines or standard setting within individual trusts is very limited. Although national guidelines have been issued regarding governance of non-radiology performed ultrasound, it is unclear whether the expectations provided within the guidance are being implemented in clinical practice. The aim of this study was to explore the clinical governance and service provision of emergency medicine practitioners who had attended a two-day formal training course on EMU. The method used was a prospective non-randomized study using an electronic questionnaire to 160 clinicians who had attended a two-day EMU course. The questions investigated the clinicians’ EMU clinical practice in their departments including profession, grade, number of scans, types of examinations, equipment used and clinical governance arrangements such as scope of practice, audit, guidelines, support, archiving of reports and images. Responses were obtained from 59 of 160 (37%) delegates. The mean time they had been involved in emergency medicine was 8.31 years. Most (73%) were performing EMU in their current roles. Nearly all (86%) felt that the two-day course had given them adequate training and over half were performing extra examinations to those taught on the course. Only 23 (39%) respondents had supervision in their workplace after the course. Less than half (46%) were aware of national EMU guidelines, and only 22% of respondents indicated there were local clinical guidelines in place. A significant proportion of departments (37%) do not undertake audit. In conclusion, most of the respondents were not aware of the national guidelines around EMU and there was a lack of evidence that clinical governance issues were being enforced by all trusts. Many departments showed a limited use of clinical guidelines, audit regimes or competency assessment.

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Wong, Florence M. F., Alice M. L. Chan, Natalie P. M. Lee, and Kevin K. H. Luk. "Can High-Fidelity Patient Simulation Be Used for Skill Development in Junior Undergraduate Students: A Quasi-Experimental Study." Healthcare 11, no. 15 (August 7, 2023): 2221. http://dx.doi.org/10.3390/healthcare11152221.

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High-fidelity patient simulation (HFPS) is widely used in professional training to enhance students’ competence in clinical management. A guideline for HFPS provides a systematic approach to direct students to learning during the simulation process. Problem-solving (PS) and clinical reasoning (CR) skills are essential to developing students’ professional competence in safe and effective care. These two skills should be initiated in the early training. A structured guideline was developed for HFPS. This study aimed to investigate the effects of the structured HFPS guideline on the development of PS and CR skills in junior nursing students. The students were required to go through four sessions, pre-briefing, simulation design, facilitation, and debriefing, for the HFPS; the study utilized the Problem-Solving Inventory (PSI) and the Nurses’ Clinical Reasoning Scale (NCRS) to measure PS and CR abilities before and after HFPS. Bivariate analysis, a one-sample t-test, and an independent t-test were performed to evaluate the performance of the PS and CR skills during the two study periods. A total of 189 students were recruited, with 92 in the intervention group and 97 in the control group. The research assistant was responsible for student recruitment through email invitations and allocating the students into the control group or the intervention group. A Wilcoxon analysis was performed and revealed significant differences in PS and CR between the two groups (p < 0.001). The analytic results showed that the PSI, particularly in domains of Problem-Solving Confidence (PSC) (p < 0.001) and overall PS (p < 0.001), and the CR (p < 0.001) had significant improvement after HFPS, particularly in the intervention group. The study concluded that the structured HFPS guideline significantly improved the students’ problem-solving and clinical reasoning abilities. Nurse educators play an important role in providing explicit learning instructions in a simulation guideline that directs and guides students to learn at each stage of HFPS. The students can be directed to be engaged in their learning through HFPS to enhance their competence in knowledge and skill development (PS and CR) for their personal and professional development.

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Mir, Javaid Ahmad, Bushra Mushtaq, and Onaisa Aalia Mushtaq. "A comprehensive case study on vitiligo: Navigating challenges and treatment strategies." IP Indian Journal of Clinical and Experimental Dermatology 9, no. 4 (January 15, 2024): 244–48. http://dx.doi.org/10.18231/j.ijced.2023.047.

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This in-depth case study examines the complex terrain of vitiligo and the difficulties that thirty-year-old Mrs. A. must overcome. The storey is told via a thorough analysis of her clinical appearance, which includes the emergence of distinct, symmetrical white spots on several body regions. Given Mrs. A's medical history of general health and her elevated stress levels prior to the depigmentation, the diagnostic procedure is carefully broken down, including physical examinations, medical history evaluations, and pertinent laboratory testing. Examining the epidemiology of vitiligo, the study clarifies its worldwide frequency, age at start, genetic predispositions, autoimmune correlations, and subtle effects on people from various ethnic origins. This case study stands out for its examination of the discrepancy between traditional textbook representations and the dynamic, Mrs. A's emotional and psychological reactions to vitiligo require individualised care. A multidisciplinary approach guides the development of treatment strategies that include photo therapy, topical corticosteroids, and specialised psychological support. The storey ends with a discussion of the follow-up procedure, an assessment of the effectiveness of the treatment, emotional healing, and the continued difficulties of long-term care. This case study provides insightful information about the comprehensive care of vitiligo sufferers, highlighting the significance of customised, team-based approaches in addressing the complex aspects of this skin disease.

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Ekman, Sirkka-Liisa, Tarja-Brita Robins Wahlin, Matti Viitanen, Astrid Norberg, and Bengt Winblad. "Preconditions for Communication in the Care of Bilingual Demented Persons." International Psychogeriatrics 6, no. 1 (March 1994): 105–20. http://dx.doi.org/10.1017/s1041610294001675.

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This study describes how demented immigrants' communicative performance together with caregivers who speak/do not speak these people's native language relates to the demented persons' cognitive, linguistic, and neuropsychological abilities. The study was carried out among demented persons who were born in Finland and had immigrated to Sweden. Their life history, linguistic history and linguistic behavior, and communication in standardized situations were assessed. Neuropsychological and medical examinations were performed for diagnostic reasons. The results show that many of these Finnish immigrants had difficulties communicating with their Swedish-speaking caregivers, while their communication with a Finnish-speaking caregiver was adequate. The frequent misunderstanding of a person's message often leads to a one-way communication, in which the caregiver commands and interrupts the demented person. The demented Finnish immigrants functioned on a level of manifest competence that seemed far below their level of latent competence. It seems reasonable that the presence of Finnish-speaking caregivers is an environmental change that would markedly enhance the demented Finnish immigrants' performance and quality of life and also reduce the costs for their care.

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Liu, Ping, Xuan Dong, Fei Liu, and Haixia Fu. "Effects of virtual reality OSCE on nursing students’ education: a study protocol for systematic review and meta-analysis." BMJ Open 14, no. 5 (May 2024): e082847. http://dx.doi.org/10.1136/bmjopen-2023-082847.

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IntroductionVirtual objective structured clinical examination (OSCE) has been shown to influence the performance of nursing students. However, its specific effects, particularly students’ competence, stress, anxiety, confidence, satisfaction with virtual reality OSCE and examiners’ satisfaction, remain unclear.Method and analysisThis study aims to assess the effects of virtual reality OSCE on nursing students’ education. The study follows the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocol guidelines. A literature search is performed on electronic databases, namely, PubMed, Web of Science, CINAHL, EBSCO, EMBASE and the Cochrane Library. The inclusion criteria adhere to the PICOS principle, encompassing nursing students, including those studying in school and those engaged in hospital internship. This review includes studies on the use of virtual reality OSCE as an assessment tool, compared with traditional clinical examinations, such as in-person OSCE. The outcome assessments encompass (1) competence, (2) stress, (3) anxiety, (4) confidence, (5) student satisfaction with virtual reality OSCE and (6) examiners’ satisfaction. These studies are designed as randomised controlled trials (RCTs) or quasi-experimental research. The search time is from the inception of each database to 30 June 2023, without language restriction. Studies for inclusion are screened by two reviewers for data extraction dependently. Any dispute is resolved through discussion. Unresolved disputes are decided by consulting a third author. For the risk of bias (ROB) assessment, the Cochrane ROB tool for RCTs and the risk of bias in non-randomised studies of intervention tool are used. Moreover, RevMan V.5.3 is used for meta-analysis.Ethics and disseminationThis study protocol does not include any clinical research and thus does not require ethical approval. Research findings are published in a peer-reviewed journal.PROSPERO registration numberCRD42023437685.

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Ouldali, Naïm, Enora Le Roux, Albert Faye, Claire Leblanc, François Angoulvant, Diane Korb, Clémence Delcour, et al. "Early formative objective structured clinical examinations for students in the pre-clinical years of medical education: A non-randomized controlled prospective pilot study." PLOS ONE 18, no. 12 (December 7, 2023): e0294022. http://dx.doi.org/10.1371/journal.pone.0294022.

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Background The value of formative objective structured clinical examinations (OSCEs) during the pre-clinical years of medical education remains unclear. We aimed to assess the effectiveness of a formative OSCE program for medical students in their pre-clinical years on subsequent performance in summative OSCE. Methods We conducted a non-randomized controlled prospective pilot study that included all medical students from the last year of the pre-clinical cycle of the Université Paris-Cité Medical School, France, in 2021. The intervention group received the formative OSCE program, which consisted of four OSCE sessions, followed by debriefing and feedback, whereas the control group received the standard teaching program. The main objective of this formative OSCE program was to develop skills in taking a structured medical history and communication. All participants took a final summative OSCE. The primary endpoint was the summative OSCE mark in each group. A questionnaire was also administered to the intervention-group students to collect their feedback. A qualitative analysis, using a convenience sample, was conducted by gathering data pertaining to the process through on-site participative observation of the formative OSCE program. Results Twenty students were included in the intervention group; 776 in the control group. We observed a significant improvement with each successive formative OSCE session in communication skills and in taking a structured medical history (p<0.0001 for both skills). Students from the intervention group performed better in a summative OSCE that assessed the structuring of a medical history (median mark 16/20, IQR [15; 17] versus 14/20, [13; 16], respectively, p = 0.012). Adjusted analyses gave similar results. The students from the intervention group reported a feeling of improved competence and a reduced level of stress at the time of the evaluation, supported by the qualitative data showing the benefits of the formative sessions. Conclusion Our findings suggest that an early formative OSCE program is suitable for the pre-clinical years of medical education and is associated with improved student performance in domains targeted by the program.

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Mateiko, N., and А. Lyshak. "CLINICAL-PSYCHOLOGICAL COMPETENCE OF THE SPECIALIST IN THE PERFORMANCE OF FORENSIC-PSYCHOLOGICAL EXAMINATION." Criminalistics and Forensics, no. 65 (May 18, 2020): 643–53. http://dx.doi.org/10.33994/kndise.2020.65.63.

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The article is dedicated to the importance by expert’s psychologist clinical and psychological competence, because its purpose is to identify the mental characteristics of a particular person and its behavior in the legally relevant circumstances during preliminary and pretrial investigation in criminal and civil cases. Forensic psychological examination establishes the presence or absence of pathological deviations in mental functioning of the subject person and their impact on the ability to display, reflect, and regulate incriminating activities, solves the question of the interaction of psychological and psychopathological factors, clinical mental health cases or borderline mental health options. Expert assessment needs to study the influence of parents or persons who replace them, on the mental state of children, personality traits of each parent, features of the child’s perception of the relationship between the parents, ways of solving their conflict situations, the influence of such situations on the formation of attitudes and values in the child. The degree of attachment of the child to the parents or persons who replace them, especially their mental development and age is taken into account. When any mental disorders are detected in a child or parent, it is carried out complex psychological and psychiatric examination to determine the ability of parents their functions, resolving the issue of cause and effect of family conflict. Research findings made by an expert psychologist in the form of an expert opinion are taken as a basis in court cases or investigative decisions are provided by an expert psychologist in the form of an expert opinion, which contains the plot of the case, dynamics data of child’s mental development, the conditions of education and training, individual psychological characteristics, which have arisen in different periods of life, progress and results of individual psychological examination at individual, the method used, interview data, retrospective psychological analysis of the questions posed. When conducting a re-examination, in the research part of the expert’s opinion it is necessary to indicate the reasons for the differences with the findings of previous examinations, if any such differences existed.

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Branson, Amanda, Pamela Myles, Mishka Mahdi, and Roz Shafran. "The Relationship between Competence and Patient Outcome with Low-Intensity Cognitive Behavioural Interventions." Behavioural and Cognitive Psychotherapy 46, no. 1 (September 14, 2017): 101–14. http://dx.doi.org/10.1017/s1352465817000522.

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Background: Little is understood about the relationship between therapist competence and the outcomes of patients treated for common mental health disorders. Furthermore, the evidence is yet to extend to competence in the delivery of low-intensity cognitive behavioural interventions. Understanding this relationship is essential to the dissemination and implementation of low-intensity cognitive behavioural interventions. Aims: The aim of this study was to explore the relationship between Psychological Well-being Practitioner (PWP) competence and patient outcome within the framework of the British government's Improving Access to Psychological Therapies (IAPT) initiative. Method: Forty-seven PWPs treating 3688 patients participated. Relationships between PWP scores on three observed standardized clinical examinations and reliable change in patients’ symptoms of anxiety and depression were explored at two time points: during the year-long training phase, and over a 12-month follow-up. Results: Results indicated that patients treated by qualified PWPs achieved superior outcomes than those treated by trainees. Little support was found for a general association between practitioner competence in delivering low-intensity cognitive behavioural interventions and patient outcome, either during or post-training; however, significantly more patients of the most competent PWPs demonstrated reliable improvement in their symptoms of anxiety and depression than would be expected by chance alone and fewer deteriorated compared with those treated by the least competent PWPs. Conclusion: Results were indicative of a complex, non-linear relationship, with patient outcome affected by PWP status (trainee or qualified) and by competence at its extremes. The implications of these results for the dissemination and implementation of low-intensity cognitive behavioural interventions are discussed.

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Alimehmeti, Ridvan, Arsen Seferi, Florian Dashi, Aurora Muça, Elizana Petrela, Arba Cecia, Kliti Pilika, and Gramoz Brace. "Ulnar Nerve Entrapment at Elbow, a Retrospective Clinical Observational Study." Albanian Journal of Trauma and Emergency Surgery 7, no. 1 (January 20, 2023): 1130–41. http://dx.doi.org/10.32391/ajtes.v7i1.314.

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Importance: Ulnar neuropathy at the elbow is the second most frequent entrapment neuropathy, affecting 6% of the population. Surgical criteria are based on a general agreement but remain controversial about which procedure is associated with the best results and the fewest complications. This data can help evaluate the effectiveness of operative techniques in symptomatic cure. Material and Methods: The study analysis included 26 out of 35 patients with 'Ulnar neuropathy at elbow' diagnosis, treated between January 2017- March 2022 at the Department of Neurosciences, University Service of Neurosurgery, University Hospital Center “Mother Theresa”, Tirana, Albania. 9 patients from the time period January-June 2018 were excluded from this study analysis due to lack of access to data. Data sources such as medical records and documentation copies of instrumental examinations were extracted from archives of Statistics Service and Hospital Registers, University Hospital Center “Mother Theresa”, Tirana, Albania. Phone follow-up was applied as well. Results: We report 26 patients analyzed retrospectively (female: male ratio 1:2.71). 29 operated extremities were studied: 26 with Cubital Tunnel Syndrome, of which 2 presented with ipsilateral Carpal Tunnel Syndrome and 1 bilateral; 2 with contralateral Carpal Tunnel Syndrome. There were 11 patients gr. II McGowan and 15 patients gr. III McGowan. There are no positive elbow flexion-extension test cases, indicative of the transposition technique. All patients were clinically evaluated at a distance of 1-3 years post-operatively and 19% presented objective symptoms. Long-term follow-up shows the motor and sensory improvement for gr. II McGowan patients, while gr. III McGowan patients show only sensory and grip improvement, with the persistence of muscular atrophy. The most frequent cause of compression was determined fibrosis and hypertrophy around the Osborne ligament (13/26). Conclusions: Clinical stage of neuropathy is the decisive factor influencing prognosis. Simple decompression in situ is sufficient in most cases. Dynamic intraoperative testing of sulcus competence, to assess (sub)luxation of the ulnar after decompression, determines the final operative technique.

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Lafave, Mark R., and Larry Katz. "Validity and Reliability of the Standardized Orthopedic Assessment Tool (SOAT): A Variation of the Traditional Objective Structured Clinical Examination." Journal of Athletic Training 49, no. 3 (June 1, 2014): 373–80. http://dx.doi.org/10.4085/1062-6050-49.1.12.

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Context: Health care professions have replaced traditional multiple choice tests or essays with structured and practical, performance-based examinations with the hope of eliminating rater bias and measuring clinical competence. Objective: To establish the validity and reliability of the Standardized Orthopedic Assessment Tool (SOAT) as a measure of clinical competence of orthopaedic injury evaluation. Design: Descriptive laboratory study. Setting: University. Patients or Other Participants: A total of 60 undergraduate students and 11 raters from 3 Canadian universities and 1 standardized patient. Intervention(s): Students were required to complete a 30-minute musculoskeletal evaluation in 1 of 2 randomly assigned mock scenarios involving the knee (second-degree medial collateral ligament sprain) or the shoulder (third-degree supraspinatus muscle strain). Main Outcome Measure(s): We measured interreliability with an intraclass correlation coefficient (ICC) (2,k) and stability of the tool with standard error of measurement and confidence intervals. Agreement was measured using Bland-Altman plots. Concurrent validity was measured using a Pearson product moment correlation coefficient whereby the raters' global rating of a student was matched to the cumulative mean grade score. Results: The ICCs were 0.75 and 0.82 for the shoulder and knee cases, respectively. Bland-Altman plots indicated no systematic bias between raters. In addition, Pearson product moment correlation analysis demonstrated a strong relationship between the overall cumulative mean grade score and the global rating score of the examinees' performances. Conclusions: This study demonstrated good interrater reliability of the SOAT with a standard error of measurement that indicated very modest stability, strong agreement between raters, and correlation indicative of concurrent validity.

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Seymour-Walsh, Amy. "The development and critique of validated assessment tools for pre-hospital resuscitation skills." International Journal of Emergency Services 8, no. 1 (May 7, 2019): 50–63. http://dx.doi.org/10.1108/ijes-03-2018-0018.

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Purpose The purpose of this paper is to describe the development of clinically credible skill practice and assessment guides for intraosseous (IO) needle insertion and laryngeal mask airway (LMA) insertion as two essential components of advanced life support (ALS) training. Design/methodology/approach A modified Delphi approach was used to determine expert consensus in the application of IO and LMA devices for the pre-hospital and emergency setting. Nine pre-hospital clinical specialists were recruited to participate in this Delphi study to determine consensus of clinical expert practice. Findings Two rounds were required to obtain a performance and assessment checklist for each skill. Both lists were then further modified to maximise their useability. However, the development of a “validated” checklist using a pre-determined process such as a Delphi approach is challenged. Rather, the implementation of these tools in a stated context, and analysis of the data they generate, is an essential aspect of validation which the Delphi approach does not address. Research limitations/implications Participant feedback regarding the rationale for their scores was limited in this study in order to minimise participant input and maximise completion of all rounds of the study. Further, devices used in the study may no longer be first-line choices with the advent of more modern devices including semi-automatic IO devices and LMAs which do not have inflatable cuffs. The refined checklists are able to be adapted to these newer devices. Practical implications Pre-hospital education contexts which may not have access to expert assessors who are skilled in providing global judgements now have access to clinically relevant skill-specific assessment tools for IO and LMA insertion. Originality/value Worldwide, ALS accreditation and competence is demanded of countless health professionals, and to date, validated practice and assessment guides specifically developed for the emergency setting for which they are used, are not available in the published literature. This paper proposes to fill that gap, in addition to guiding clinical education researchers in strategies to develop valid assessment tools through rigorous critique.

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Kockwelp, Pascal, Marcel Meyerheim, Dimitar Valkov, Marvin Mergen, Anna Junga, Antonio Krüger, Bernhard Marschall, Markus Holling, and Benjamin Risse. "VR-based Competence Training at Scale: Teaching Clinical Skills in the Context of Virtual Brain Death Examination." Proceedings of the ACM on Human-Computer Interaction 8, EICS (June 17, 2024): 1–31. http://dx.doi.org/10.1145/3664635.

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Teaching medical practical and soft skills in clinical routines is increasingly difficult, and manikin or actor-based simulations have gained popularity in the last decades. These simulations, however, hardly scale with the demand, are commonly insufficient to train crucial clinical competencies, and cannot portray complex visual and dynamic symptomatologies as required in, for example, brain death examinations. In this paper, we explore the requirements and challenges of integrating a large-scale high-throughput VR setup into a real medical curriculum and describe our approaches and implementation. Therefore we extend and evaluate an interactive virtual reality-based simulation for training brain death diagnostics in a virtual intensive care environment, featuring a fully reactive simulated patient. To enable the required scalability we integrated the simulation into a dedicated hardware and software framework, enabling 12 simultaneous VR trainings which are controlled by a centralized server system. Using this setup we continuously collected feedback on the application's usability and realism from hundreds of students to gain first insights into the applicability of large-scale VR-based learning systems in real course designs. After integrating this feedback, we conducted a controlled curricular study in which we compared the virtual brain death simulation with the classical manikin-based training approach. Our results indicate that the immersive learning experience is perceived to be more realistic and engaging and is overall preferred by the students while also providing the same learning effect as the alternatives.

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Manley, Kristyn, Sian Edwards, Jane Mears, and Dimitrios Siassakos. "Hybrid simulation compared to manikin alone in teaching pelvic examinations: a randomised control trial." BMJ Simulation and Technology Enhanced Learning 2, no. 1 (February 2016): 6–10. http://dx.doi.org/10.1136/bmjstel-2015-000078.

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IntroductionPerforming a pelvic examination is a core skill for all medical undergraduates. The use of hybrid simulation, manikin with patient actress, to attain technical and communication skills competencies and to improve the quality of care we offer women, has not been compared to other teaching methods before. Outcome measures were technical skills, communication skills and confidence in completing a pelvic examination.MethodsA cluster randomised control trial was conducted over an academic year. Forty-eight medical students who completed an 8-week obstetrics and gynaecology attachment were recruited. Clusters were randomly assigned for initial training on hybrid or manikin only models and attended an end of attachment Objective Structured Clinical Assessment.ResultsOutcome data were received for 43/48 students (89.5%). Following the objectively structured clinical examination, the hybrid trained cohort had higher technical scores (mean 23 (95% CI 20.1 to 25.8) vs 16.7 (CI 14.7 to 18.6); mean difference 6.3, CI 3.0 to 9.6) and communication skills scores (mean 22.6 (CI 21.2 to 23.8) vs 15.9 (CI 14.4 to 17.3); mean difference 6.7, CI 4.8 to 8.5) compared to the manikin only trained participants. Confidence in undertaking future pelvic examinations were similar in the control and intervention groups; (p=0.10, r=0.18).ConclusionsThis study demonstrates the value of hybrid simulation compared to manikins alone in improving the short-term acquisition of competence in simulated pelvic examinations at an undergraduate level. Future research should focus on whether hybrid models lead to long-term acquisition of skill and comparison of these models with other innovative methods such as clinical teaching associates.

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Kinney, Anthony E. (Toby), Amy Nordon-Craft, Suzan (Suzie) Kardong-Edgren, and Anne Thompson. "Enhanced Learning Using Digital Recordings with Integrated Standardized Patient Examinations (ISPEs) in Physical Therapy Education: A Qualitative Pilot Study." Education Sciences 13, no. 9 (September 17, 2023): 948. http://dx.doi.org/10.3390/educsci13090948.

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(1) Background: Integrated standardized patient examinations (ISPEs) allow students to demonstrate competence with curricular learning and communication. Digital recordings of these experiences provide an objective permanent record, allowing students to review and improve their performance. Although recordings have been utilized as a tool in physical therapy education, no studies have described the impact of reviewing recordings of ISPE. This qualitative pilot study aimed to investigate student perceptions and learning after reviewing their recordings of ISPE. (2) Methods: Second-year Doctor of Physical Therapy students (n= 23) participated in the study by completing an anonymous online survey after reviewing their recordings from three ISPEs. Thematic analysis was used to identify codes and central themes from the survey data. (3) Results: The results showed that 95.6% of students found the video review process beneficial. Five themes emerged: (i) digital recordings provide an objective performance assessment, (ii) approaches to self-review vary, (iii) it provides an opportunity for growth, (iv) a holistic review is possible, and (v) students need structure and guidance in the process. (4) Conclusions: Study findings indicate that a review of the recordings of ISPEs facilitates the development of clinical skills for physical therapy students. Implementing an explicit framework for reviewing the recordings may enhance the process and facilitate further promotion of reflection-on-action.

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Lee, Jae-Sung, and Youngjoon, Kang. "The effects of experience as a rater upon the objective clinical skill examination." Journal of Medicine and Life Science 13, no. 1 (June 1, 2016): 4–6. http://dx.doi.org/10.22730/jmls.2016.13.1.4.

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Introduction : Our knowledge and competence would be improved after teaching or evaluating others.We presumed that the experience of evaluating others affect the knowledge and competence for a task. This study examinedthe effects of experience as a evaluator.Methods : 34 students were randomly allocated into the 2 groups. The one is the evaluator group and the other is theapplicant group. Before simulation, all of students were compared with 3 written tests and clinical performance examination. Allof the students were put into the task to make check list, so they knew the contents of 33 objective skill clinicalexaminations(OSCE). The applicant group had undergone 33 OSCEs. The evaluator group had evaluated the simulation groupwith check list. The evaluator group had executed same 33 OSCE on the next day. We compared the score of OSCEs between2 groups. We surveyed how much they thought their knowledge and performance were increased.Results : The applicant group were evaluated 33 object skills clinical examinations by the evaluator group. The evaluatorgroup acquired higher score than the applicant group in 21 clinical skill tests. The 12 clinical skill test score of the evaluatorgroup were higher than the applicant group significantly. But the applicant group were superior than the evaluator group in theonly 5 clinical skills significantly. The evaluator group was higher in 9 clinical skill test and lower in 7 clinical skills than theapplicant group. But it were not statistically significant(Figure. 1). 28 students answered the questionnaire about the increase oftheir comprehension, skill performance The average of their interest as an evaluator was 4.21(0.69). The average ofcomprehension extension after evaluation was 4.64(0.48). The average of skill improvement was 4.45(0.60)Conclusion : The experience as a evaluator can increase the understanding and the performance of clinical skills.

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Dembélé, Mamadou, Alassane Kouma, Mamadou N'diaye, Zoumana Cheick Berete, Souleymane Sanogo, Ousmane Traoré, Issa Cissé, et al. "Radio-Clinical and Surgical Confrontation of Abdominal and Pelvic Emergencies: About 55 Cases at the Fertilia Medical Clinic in Bamako." Scholars Journal of Medical Case Reports 11, no. 09 (September 9, 2023): 1625–30. http://dx.doi.org/10.36347/sjmcr.2023.v11i09.014.

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Background: This study was initiated to compare the diagnostic hypotheses of doctors in the emergency department, ultrasound results and operative reports of patients seen for acute abdominal and/or pelvic pain. Patients and method: This is a prospective descriptive study of 12 months from January to December 2022, involving 55 consenting patients, hospitalized at the Fertilia medical clinic in Bamako and having benefited from at least one imaging examination to abdominal and pelvic emergency. Ultrasounds were performed using General Electric Voluson E8, Logic9 and Vivid3 devices. The x-rays were taken by an Italian Mecall machine. Result: Our study involved a sample of 55 consenting patients with acute abdominal and/or pelvic pain. The average age was 25.5 years. The male sex was the most represented with a sex ratio of 1.5. The most common etiology mentioned was appendicitis, i.e. 38%. The diagnostic hypotheses formulated by the host doctors were confirmed by imaging in 87.2% of cases and those of imaging confirmed by surgery in 60% of cases. Conclusion: Abdominal emergencies are frequent in consultations and mainly affect young people. The approach to the management of emergency patients requires a well-performed clinical examination which guides the choice of the imaging examination which remains most often necessary not only to make the diagnosis but also to guide the therapeutic actions. Imaging helps to correct the clinical suspicion. Despite these good results, progress remains to be made, especially in terms of the prescription of radiological examinations, in this case that concerning information.

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Rosmaria, Rosmaria, Fitriani Fitriani, Lia Artika Sari, Dian Diniyati, and Neti Herawati. "Effectiveness of a Modified Phantom-based Mannequin in Improving Vaginal Toucher Examination Skills of Midwifery Students." Journal of Holistic Nursing And Midwifery 34, no. 1 (December 1, 2023): 64–70. http://dx.doi.org/10.32598/jhnm.34.1.2538.

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Introduction: The goal of clinical practice is to provide students with practical training experience and the ability to work as a team. Objective: This study aims to analyze the effectiveness of a phantom-based mannequin in improving midwifery students’ performance in vaginal toucher (VT) examinations Materials and Methods: This is a quasi-experimental study with a pre-test/post-test design. Participants were 70 final-year midwifery students in two groups of factory mannequin (n=35) and modified mannequin (n=35). The instrument used for assessing performance was a validated 10-item scale. Data analysis was done using paired t-test, Kolmogorov-Smirnov test, and ANCOVA. Results: Participants had a mean age of 21.6±2.2 years in the modified mannequin group and 21.3±2.4 years in the factory mannequin group. There was no significant improvement in students’ performance after using the factory mannequin, but the modified mannequin improved their skills, since there was a significant difference in VT examination performance before and after using the modified mannequin (mean difference=3.97, P=0.001). The ANCOVA results showed a significant difference in the mean post-test scores between the factory and modified mannequin groups (mean difference=1.59,η2=0.299, P<0.05). Conclusion: The modified mannequin is more effective than the common factory mannequins in improving the VT examination performance of midwifery students. For this reason, these devices are highly recommended for practical learning of VT examinations.

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Alunno, Alessia, Aurélie Najm, Francisca Sivera, Catherine Haines, Louise Falzon, and Sofia Ramiro. "Assessment of competences in rheumatology training: results of a systematic literature review to inform EULAR points to consider." RMD Open 6, no. 2 (September 2020): e001330. http://dx.doi.org/10.1136/rmdopen-2020-001330.

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ObjectiveTo summarise the literature on the assessment of competences in postgraduate medical training.MethodsA systematic literature review was performed within a EULAR taskforce on the assessment of competences in rheumatology training and other related specialities (July 2019). Two searches were performed: one search for rheumatology and one for related medical specialities. Two reviewers independently identified eligible studies and extracted data on assessment methods. Risk of bias was assessed using the medical education research study quality instrument.ResultsOf 7335 articles in rheumatology and 2324 reviews in other specialities, 5 and 31 original studies were included, respectively. Studies in rheumatology were at variable risk of bias and explored only direct observation of practical skills (DOPS) and objective structured clinical examinations (OSCEs). OSCEs, including clinical, laboratory and imaging stations, performed best, with a good to very good internal consistency (Cronbach’s α=0.83–0.92), and intrarater reliability (r=0.80–0.95). OSCEs moderately correlated with other assessment tools: r=0.48 vs rating by programme directors; r=0.2–0.44 vs multiple-choice questionnaires; r=0.48 vs DOPS. In other specialities, OSCEs on clinical skills had a good to very good inter-rater reliability and OSCEs on communication skills demonstrated a good to very good internal consistency. Multisource feedback and the mini-clinical evaluation exercise showed good feasibility and internal consistency (reliability), but other data on validity and reliability were conflicting.ConclusionDespite consistent data on competence assessment in other specialities, evidence in rheumatology is scarce and conflicting. Overall, OSCEs seem an appropriate tool to assess the competence of clinical skills and correlate well with other assessment strategies. DOPS, multisource feedback and the mini-clinical evaluation exercise are feasible alternatives.

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Pattinson, Julie, Carol Blow, Bijoy Sinha, and Aloysius Siriwardena. "Exploring reasons for differences in performance between UK and international medical graduates in the Membership of the Royal College of General Practitioners Applied Knowledge Test: a cognitive interview study." BMJ Open 9, no. 5 (May 2019): e030341. http://dx.doi.org/10.1136/bmjopen-2019-030341.

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ObjectivesInternational medical graduates (IMGs) perform less well in national postgraduate licensing examinations compared with UK graduates, even in computer-marked multiple-choice licensing examinations. We aimed to investigate thought processes of candidates answering multiple- choice questions, considering possible reasons for differential attainment between IMGs and UK graduates.DesignWe employed a semistructured qualitative design using cognitive interviews. Systematic grounded theory was used to analyse data from ‘think aloud’ interviews of general practitioner specialty trainees (GPSTs) while answering up to 15 live questions from the UK Membership of the Royal College of General Practitioners Applied Knowledge Test (AKT).SettingEast Midlands, UK.Participants21 GPSTs including 13IMGs and 8 UK-trained doctors.OutcomesPerceptions of participants on how they answered AKT questions together with strategies used or difficulties experienced.ResultsWe interviewed 21 GPSTs (8 female, 13 male, 13 IMGs, 14 from black and minority ethnic groups, age 24–64 years) in years 1–3 of training between January and April 2017. Four themes were identified. ‘Theoretical versus real-life clinical experience’: participants reported difficulties recalling information and responding to questions from theoretical learning compared with clinical exposure; rote learning helped some IMGs recall rare disease patterns. Recency, frequency, opportunity and relevance: participants reported greater difficulty answering questions not recently studied, less frequently encountered or perceived as less relevant. Competence versus insight: some participants were over optimistic about their performance despite answering incorrectly. Cultural barriers: for IMGs included differences in undergraduate experience, lack of familiarity with UK guidelines and language barriers which overlapped with the other themes.ConclusionsThe difficulties we identified in candidates when answering AKT questions may be addressed through training. IMGs face additional difficulties which impede examination success due to differences in educational experience, content familiarity and language, which are also potentially amenable to additional training support.

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Yang, Jing, Chun-ting Lu, Dan Wang, Bi-yao Su, and Si-min Huang. "Reflection on and Exploration of a Standardized Resident Training Programme Based on a Comprehensive Examination of Clinical Skills." International Research in Higher Education 3, no. 2 (April 3, 2018): 17. http://dx.doi.org/10.5430/irhe.v3n2p17.

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To identify the optimal clinical skills training programme for internal medicine residents by reflecting upon and analysing the usual training plan and arrangement, and practical tests according to the national standardized resident training policies and requirements. The 3-year-rotation and training plan of the 2013 and 2014 internal medicine resident cohorts, the basic skills and case analysis scores on the basic entrance examination and final graduation examination were reflected, summarized and compared with the ultimate purpose of evaluating standardized resident training. This knowledge was used to perfect a competency-oriented training system that integrated clinical theory, clinical scenarios, clinical skills, bedside teaching, learning, etc. After a 3-year programme of standardized training, the residents’ clinical skills were significantly improved. Statistically significant enhancements (P<0.05) were observed in the case analysis and clinical skills test scores between the basic entrance and graduation examinations of the trainees in both the 2013 and 2014 cohorts. No significant differences (P>0.05) were observed between the trainees in the 2013 and 2014 cohorts in their graduation scores on the clinical skills and case analysis tests, suggesting that both cohorts achieved the same level of mastery and reached the standardized training target, which also reflected the homogeneity of the residency training programme. While this study indicated that the training method was effective, exploring better models in the future is warranted. In conclusion, as a national policy, continuously incorporating reflection and exploration is necessary for designing a reasonable programme for standardized resident training. In this study, analysis of the basic entrance and graduation examinations of comprehensive clinical skills were important for developing an effective standardized resident training programme and training team with satisfactory teaching effects. By this way, implementing and starting new training methods gradually will be improved and especially carried out from 2015 cohorts. Therefore, the residents' clinical competence will be enhanced and also for undergraduates’ and postgraduates’ education as well. At last, the national education criteria for residency will be met.

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Ma, Hongyang, Yuqian Kou, Hongcheng Hu, Yuwei Wu, and Zhihui Tang. "An Investigative Study on the Oral Health Condition of Individuals Undergoing 3D-Printed Customized Dental Implantation." Journal of Functional Biomaterials 15, no. 6 (June 5, 2024): 156. http://dx.doi.org/10.3390/jfb15060156.

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Background: The advent of three-dimensional (3D) printing technology has revolutionized the field of dentistry, enabling the precise fabrication of dental implants. By utilizing 3D printing, dentists can devise implant plans prior to surgery and accurately translate them into clinical procedures, thereby eliminating the need for multiple surgical procedures, reducing surgical discomfort, and enhancing surgical efficiency. Furthermore, the utilization of digital 3D-printed implant guides facilitates immediate restoration by precisely translating preoperative implant design plans, enabling the preparation of temporary restorations preoperatively. Methods: This comprehensive study aimed to assess the postoperative oral health status of patients receiving personalized 3D-printed implants and investigate the advantages and disadvantages between the 3D-printed implant and conventional protocol. Additionally, variance analysis was employed to delve into the correlation between periodontal status and overall oral health. Comparisons of continuous paired parameters were made by t-test. Results: The results of our study indicate a commendable one-year survival rate of over 94% for 3D-printed implants. This finding was corroborated by periodontal examinations and follow-up surveys using the Oral Health Impact Profile-14 (OHIP-14) questionnaire, revealing excellent postoperative oral health status among patients. Notably, OHIP-14 scores were significantly higher in patients with suboptimal periodontal health, suggesting a strong link between periodontal health and overall oral well-being. Moreover, we found that the operating time (14.41 ± 4.64 min) was less statistically significant than for the control group (31.76 ± 6.83 min). Conclusion: In conclusion, personalized 3D-printed implant surgery has emerged as a reliable clinical option, offering a viable alternative to traditional implant methods. However, it is imperative to gather further evidence-based medical support through extended follow-up studies to validate its long-term efficacy and safety.

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Chajhlana, Sunil Pal singh, Manoj Aravind Bhumi, Rama Krishna Narashima Mahabhashyam, Sai Ram A., and Maruti Sarma Mannava Varaprasada. "Objective structured clinical examination for formative assessment of final year part-1 MBBS students." International Journal Of Community Medicine And Public Health 5, no. 1 (December 23, 2017): 313. http://dx.doi.org/10.18203/2394-6040.ijcmph20175798.

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Background: The aim of medical education is to develop overall medical student’s clinical competency at all the levels. Practical examinations play a major role in the overall assessment of the cognitive, affective as well as psychomotor domains of the individuals. Different variability in clinical examination, student’s variability, the examiner’s variability and the patient’s variability and the attitude towards disease may have effect on the assessment of the students. Objective structured clinical examination (OSCE) was designed to test the clinical competence by bed side while simultaneously improving objectivity and reliability. The objectives of the study were to assess the effectiveness of OSCE for assessment tool as compared to traditional method of assessment; to know the perception of students participated toward OSCE. Methods: Study was conducted among a batch of 25 students of VIth semester student posted in Department of Community medicine. After undergoing traditional method of examination, all the participating students underwent OSCE and the marks were recorded. Student’s perception regarding OSCE was recorded using a questionnaire. Results: Marks scored by the students in OSCE were significantly higher than traditional practical examination. 92% students agree that OSCE useful tool in overall assessment of the student, better form of assessment & learning, easy to pass and score better marks than traditional method of examination. Conclusions: OSCE useful tool in overall assessment of the student, better form of assessment & learning, score better marks and has less emotional stress in OSCE, when compared to viva voce.

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CHEN, Shiah-Lian, and I.-Chen LIAO. "Effectiveness of Using a Self-Directed Learning Program to Teach Physical Examination and Health Assessment Skills: A Quasi-Experimental Study." Journal of Nursing Research 32, no. 2 (April 2024): e320. http://dx.doi.org/10.1097/jnr.0000000000000603.

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ABSTRACT Background Conducting health assessments and physical examinations are essential skills for independent practice. Exploring how to teach these skills effectively is essential. Purpose This study was designed to validate the effectiveness of a self-directed learning program in improving nursing student outcomes in terms of their learning health assessment and physical examination skills. Method A quasi-experimental design was used, and second-year nursing students enrolled in a health assessment and physical examination course at a university of science and technology in central Taiwan were recruited using purposive sampling. Both the control and experimental groups were taught using a traditional teaching method. The experimental group additionally participated in a self-directed learning program. Structured questionnaires, including the Chinese version of the Self-Directed Learning Readiness Scale, Scales of Motivation and Learning Strategies, Interpersonal Skills Assessment Tool, the Course Satisfaction Evaluation Scale, and the Perception of Health Assessment and Physical Examination Competence Scale, were used to collect data at three time points. Results After controlling for the effects of pretest scores, after the intervention, the experimental group achieved significantly higher scores than the control group for self-directed learning (creative learning and love of learning), learning motivation (goal orientation, work value, expected success, and test anxiety), and cognitive strategies (total score, elaboration strategy, recitation strategy, and monitoring strategy). In addition, the health assessment exercise improved interpersonal and communication skills, and learning satisfaction was significantly higher in the experimental group than the control group. Conclusions/Implications for Practice A physical examination and health assessment course designed using the self-directed learning framework can effectively improve student competence in related skills to enhance their ability to assess patient health problems in clinical settings. This study presents an alternative approach to teaching health assessment and physical examination courses and validates the positive effect of this approach on student learning outcomes.

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Khan, Mohammad Kamran, and Mahendra Kumar Jindal. "Random Tree Algorithm to Analyse the Relation between Type of Traumatic Dental Injuries and Its Demographic and Predisposing Factors - A Cross-Sectional Study." Indian Journal of Dental Research 34, no. 2 (2023): 114–18. http://dx.doi.org/10.4103/ijdr.ijdr_846_21.

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Background and Aim: Traumatic dental injuries (TDIs) have become the public dental health problem worldwide in children and adolescents. These injuries are complex and multifactorial in aetiology. This study was done with the aim to analyse the association of 'type of TDI' with its demographic and various predisposing factors in children by an advanced statistical method of machine learning (ML) of artificial intelligence (AI). Materials and Methods: The present study's data were gathered by conducting the observational cross-sectional study among index age-groups 12 and 15 years children of randomly selected schools of different geographical regions. Structured interviews and dental examinations performed were done to record the variables of TDIs in self-constructed proforma. The gathered data were analysed by employing the random-tree model of machine learning algorithm of IBM SPSS Modeler version-18 software. Results: Molar-relationship (2.5), age (1.75), sex (1.5) and geographical region/area (~1.5) were the most important predictors (factors) for the determination of type of dental injury as shown by the random tree model, whereas clinical factors like overjet (0.75), lip-competence (0.5) and overbite (0.5) showed lesser importance in the determination of type of TDIs. Conclusion: Demographic factors (age, sex and geographical region) and one clinical factor (molar-relation) were found as the stronger factors for determining the type of traumatic dental injury in children.

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Widjaja, Evelin Maharani, and Enny Irawaty. "HUBUNGAN EMPATI DENGAN HASIL UJIAN KETERAMPILAN KOMUNIKASI DOKTER-PASIEN DAN BREAKING BAD NEWS." Jurnal Muara Sains, Teknologi, Kedokteran dan Ilmu Kesehatan 6, no. 2 (October 31, 2022): 161–70. http://dx.doi.org/10.24912/jmstkik.v6i2.12716.

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Empathy is the ability to understand someone else’s experiences, emotions, and feelings. Empathy is one of the professional qualities in patient-centered health services. Empathy in medical education is closely related to the student's mastery of clinical competence. The student’s empathy measurement becomes crucial in acquiring feedback regarding empathy learning at the preclinical education stage. It encourages the study of the relationship between empathy and doctor-patient communication and breaking bad news (BBN) skill examination results. This study used a cross-sectional design on Faculty of Medicine students of Universitas Tarumanagara. Empathy was assessed using The Toronto Empathy Questionnaire while the results of the doctor-patient communication and BBN skills examinations were collected from the respondents via Google Form. In this study, the number of respondents was as many as 124 students with the majority of them being female (71.8%). A total of 78.2% of respondents possessed high empathy. A total of 94.4% of respondents passed the doctor-patient communication skills examination and 98.4% of respondents passed the BBN skills examination. Respondents who passed both of the examinations were 92.7%. Empathy and the results of the two clinical skills examinations were analyzed using Fisher's exact test which led to the discovery of a p-value >0.05. In this study, it can be concluded that there is no significant relationship between empathy and the results of the doctor-patient communication and BBN skills examinations on Faculty of Medicine students of Universitas Tarumanagara. Keywords: empathy, clinical skills, medical students Abstrak Empati merupakan kemampuan untuk memahami pengalaman, emosi, dan perasaan orang lain. Empati termasuk salah satu kualitas profesionalisme dalam pelayanan kesehatan yang berpusat pada pasien. Empati pada tahap pendidikan kedokteran berkaitan erat dengan penguasaan mahasiswa terhadap suatu kompetensi klinis. Pengukuran tingkat empati mahasiswa menjadi hal yang penting sebagai umpan balik terhadap pembelajaran empati pada tahap pendidikan pre-klinik. Hal ini mendorong untuk dilakukannya penelitian mengenai hubungan empati dengan hasil ujian keterampilan komunikasi dokter-pasien dan breaking bad news (BBN). Penelitian ini menggunakan desain cross sectional terhadap mahasiswa Fakultas Kedokteran Universitas Tarumanagara. Empati dinilai dengan menggunakan The Toronto Empathy Questionnaire serta hasil ujian keterampilan komunikasi dokter-pasien dan BBN ditanyakan ke responden melalui Google Form. Jumlah responden pada penelitian ini sebanyak 124 mahasiswa dengan mayoritas responden berjenis kelamin perempuan (71,8%). Sebanyak 78,2% responden memiliki empati tinggi. Sebanyak 94,4% responden lulus ujian keterampilan komunikasi dokter-pasien dan 98,4% responden lulus dalam ujian keterampilan BBN. Responden yang lulus pada kedua ujian keterampilan tersebut sebesar 92,7%. Empati dan hasil ujian kedua keterampilan klinis dianalisis dengan menggunakan uji Fisher’s exact dan didapatkan p value >0,05. Pada penelitian ini dapat disimpulkan bahwa tidak terdapat hubungan yang bermakna antara empati dengan hasil ujian keterampilan komunikasi dokter-pasien dan BBN pada mahasiswa Fakultas Kedokteran Universitas Tarumanagara.

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Journal articles on the topic 'Clinical competence – Examinations – Study guides'

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