Evaluating the validity evidence of an OSCE: results from a new medical school

Background

To prevent the problems of traditional clinical evaluation, the “Objective Structured Clinical Examination (OSCE)” was presented by Harden as a more valid and reliable assessment instrument. However, an essential condition to guarantee a high-quality and effective OSCE is the assurance of evidence to support the validity of its scores. This study examines the psychometric properties of OSCE scores, with an emphasis on consequential and internal structure validity evidence.

Methods

Fifty-three first year medical students took part in a summative OSCE at the Lebanese American University-School of Medicine. Evidence to support consequential validity was gathered by using criterion-based standard setting methods. Internal structure validity evidence was gathered by examining various psychometric measures both at the station level and across the complete OSCE.

Results

Compared to our actual method of computing results, the introduction of standard setting resulted in lower students’ average grades and a higher cut score. Across stations, Cronbach’s alpha was moderately low.

Conclusion

Gathering consequential and internal structure validity evidence by multiple metrics provides support for or against the quality of an OSCE. It is critical that this analysis be performed routinely on local iterations of given tests, and the results used to enhance the quality of assessment.

     

Situational awareness within objective structured clinical examination stations in undergraduate medical training - a literature search

Background

Medical students may not be able to identify the essential elements of situational awareness (SA) necessary for clinical reasoning. Recent studies suggest that students have little insight into cognitive processing and SA in clinical scenarios. Objective Structured Clinical Examinations (OSCEs) could be used to assess certain elements of situational awareness. The purpose of this paper is to review the literature with a view to identifying whether levels of SA based on Endsley’s model can be assessed utilising OSCEs during undergraduate medical training.

Methods

A systematic search was performed pertaining to SA and OSCEs, to identify studies published between January 1975 (first paper describing an OSCE) and February 2017, in peer reviewed international journals published in English. PUBMED, EMBASE, PsycINFO Ovid and SCOPUS were searched for papers that described the assessment of SA using OSCEs among undergraduate medical students. Key search terms included “objective structured clinical examination”, “objective structured clinical assessment” or “OSCE” and “non-technical skills”, “sense-making”, “clinical reasoning”, “perception”, “comprehension”, “projection”, “situation awareness”, “situational awareness” and “situation assessment”. Boolean operators (AND, OR) were used as conjunctions to narrow the search strategy, resulting in the limitation of papers relevant to the research interest. Areas of interest were elements of SA that can be assessed by these examinations.

Results

The initial search of the literature retrieved 1127 publications. Upon removal of duplicates and papers relating to nursing, paramedical disciplines, pharmacy and veterinary education by title, abstract or full text, 11 articles were eligible for inclusion as related to the assessment of elements of SA in undergraduate medical students.

Discussion

Review of the literature suggests that whole-task OSCEs enable the evaluation of SA associated with clinical reasoning skills. If they address the levels of SA, these OSCEs can provide supportive feedback and strengthen educational measures associated with higher diagnostic accuracy and reasoning abilities.

Conclusion

Based on the findings, the early exposure of medical students to SA is recommended, utilising OSCEs to evaluate and facilitate SA in dynamic environments.

     

Building a bigger tent in point-of-care ultrasound education: a mixed-methods evaluation of interprofessional,near-peer teaching of internal medicine residents by sonography students

Background

Point-of-care-ultrasound (POCUS) training is expanding in undergraduate and graduate medical education, but lack of trained faculty is a major barrier. Two strategies that may help mitigate this obstacle are interprofessional education (IPE) and near-peer teaching. The objective of this study was to evaluate a POCUS course in which diagnostic medical sonography (DMS) students served as near-peer teachers for internal medicine residents (IMR) learning to perform abdominal sonography.

Methods

Prior to the IPE workshop, DMS students participated in a train-the-trainer session to practice teaching and communication skills via case-based simulation. DMS students then coached first-year IMR to perform POCUS examinations of the kidney, bladder, and gallbladder on live models. A mixed-methods evaluation of the interprofessional workshop included an objective structured clinical exam (OSCE), course evaluation, and qualitative analysis of focus group interviews.

Results

Twenty-four of 24 (100%) IMR completed the OSCE, averaging 97.7/107 points (91.3%) (SD 5.2). Course evaluations from IMR and DMS students were globally positive. Twenty three of 24 residents (96%) and 6/6 DMS students (100%) participated in focus group interviews. Qualitative analysis identified themes related to the learning environment, scanning technique, and suggestions for improvement. IMR felt the interprofessional training fostered a positive learning environment and that the experience complimented traditional faculty-led workshops. Both groups noted the importance of establishing mutual understanding of expectations and suggested future workshops have more dedicated time for DMS student demonstration of scanning technique.

Conclusion

An interprofessional, near-peer workshop was an effective strategy for teaching POCUS to IMR. This approach may allow broader adoption of POCUS in medical education, especially when faculty expertise is limited.

     

Advances in clinical pharmacy education in Germany: a quasi-experimental single-blinded study to evaluate a patient-centred clinical pharmacy course in psychiatry

Background

The pharmacy profession has shifted towards patient-centred care. To meet the new challenges it is necessary to provide students with clinical competencies. A quasi-experimental single-blinded teaching and learning study was carried out using a parallel-group design to evaluate systematically the benefits of clinical teaching in pharmacy education in Germany.

Methods

A clinical pharmacy course on a psychiatric ward was developed and implemented for small student groups. The learning aims included: the improvement of patient and interdisciplinary communication skills and the identification and management of pharmaceutical care issues. The control group participated only in the preparation lecture, while the intervention group took part in the complete course. The effects were assessed by an objective structured clinical examination (OSCE) and a student satisfaction survey.

Results

The intervention group achieved significantly better overall results on the OSCE assessment (46.20?±?10.01 vs. 26.58?±?12.91 of a maximum of 90 points; p <?0.0001).The practical tasks had the greatest effect, as reflected in the outcomes of tasks 1–5 (34.94?±?9.60 vs. 18.63?±?10.24 of a maximum of 60 points; p?<?0.0001). Students’ performance on the theoretical tasks (tasks 6–10) was improved but unsatisfying in both groups considering the maximum score (11.50?±?4.75 vs. 7.50?±?4.00 of a maximum of 30 points; p?<?0.0001). Of the students, 93% rated the course as practice-orientated, and 90% felt better prepared for patient contact. Many students suggested a permanent implementation and an extension of the course.

Conclusions

The results suggest that the developed ward-based course provided learning benefits for clinical skills. Students’ perception of the course was positive. Implementation into the regular clinical pharmacy curriculum is therefore advisable.

     

The validity and reliability of the sixth-year internal medical examination administered at the King Abdulaziz University Medical College

Background

Exams are essential components of medical students’ knowledge and skill assessment during their clinical years of study. The paper provides a retrospective analysis of validity evidence for the internal medicine component of the written and clinical exams administered in 2012 and 2013 at King Abdulaziz University’s Faculty of Medicine.

Methods

Students’ scores for the clinical and written exams were obtained. Four faculty members (two senior members and two junior members) were asked to rate the exam questions, including MCQs and OSCEs, for evidence of content validity using a rating scale of 1–5 for each item.Cronbach’s alpha was used to measure the internal consistency reliability. Correlations were used to examine the associations between different forms of assessment and groups of students.

Results

A total of 824 students completed the internal medicine course and took the exam. The numbers of rated questions were 320 and 46 for the MCQ and OSCE, respectively. Significant correlations were found between the MCQ section, the OSCE section, and the continuous assessment marks, which include 20 long-case presentations during the course; participation in daily rounds, clinical sessions and tutorials; the performance of simple procedures, such as IV cannulation and ABG extraction; and the student log book.Although the OSCE exam was reliable for the two groups that had taken the final clinical OSCE, the clinical long- and short-case exams were not reliable across the two groups that had taken the oral clinical exams. The correlation analysis showed a significant linear association between the raters with respect to evidence of content validity for both the MCQ and OSCE, r?=?.219 P?<?.001 and r?=?.678 P?<?.001, respectively, and r?=?.241 P?<?.001 and r?=?.368 P?=?.023 for the internal structure validity, respectively. Reliability measured using Cronbach’s alpha was greater for assessments administered in 2013.

Conclusion

The pattern of relationships between the MCQ and OSCE scores provides evidence of the validity of these measures for use in the evaluation of knowledge and clinical skills in internal medicine. The OSCE exam is more reliable than the short- and long-case clinical exams and requires less effort on the part of examiners and patients.

     

An innovative OSCE clinical log station: a quantitative study of its influence on Log use by medical students

Background

A Clinical Log was introduced as part of a medical student learning portfolio, aiming to develop a habit of critical reflection while learning was taking place, and provide feedback to students and the institution on learning progress. It was designed as a longitudinal self-directed structured record of student learning events, with reflection on these for personal and professional development, and actions planned or taken for learning.As incentive was needed to encourage student engagement, an innovative Clinical Log station was introduced in the OSCE, an assessment format with established acceptance at the School. This study questions: How does an OSCE Clinical Log station influence Log use by students?

Methods

The Log station was introduced into the formative, and subsequent summative, OSCEs with careful attention to student and assessor training, marking rubrics and the standard setting procedure. The scoring process sought evidence of educational use of the log, and an ability to present and reflect on key learning issues in a concise and coherent manner.

Results

Analysis of the first cohort’s Log use over the four-year course (quantified as number of patient visits entered by all students) revealed limited initial use. Usage was stimulated after introduction of the Log station early in third year, with some improvement during the subsequent year-long integrated community-based clerkship. Student reflection, quantified by the mean number of characters in the ‘reflection’ fields per entry, peaked just prior to the final OSCE (mid-Year 4). Following this, very few students continued to enter and reflect on clinical experience using the Log.

Conclusion

While the current study suggested that we can’t assume students will self-reflect unless such an activity is included in an assessment, ongoing work has focused on building learner and faculty confidence in the value of self-reflection as part of being a competent physician.

     

Testing an Online,Theory-Based Intervention to Reduce Pre-drinking Alcohol Consumption and Alcohol-Related Harm in Undergraduates: a Randomized Controlled Trial

Purpose

The present study tested the efficacy of a theory-based online intervention comprising motivational (autonomy support) and volitional (implementation intention) components to reduce pre-drinking alcohol consumption and alcohol-related harm.

Method

Undergraduate students (N?=?202) completed self-report measures of constructs from psychological theories, pre-drinking alcohol consumption, and alcohol-related harm at baseline and were randomly assigned to one of four intervention conditions in a 2 (autonomy support: present/absent)?×?2 (implementation intention: present/absent) design. Participants completed follow-up measures of all variables at 4 weeks post-intervention. All participants received national guidelines on alcohol consumption and an e-mail summary of intervention content at its conclusion. Participants also received weekly SMS messages in the 4-week post-intervention period restating content relevant to their intervention condition.

Results

Neither statistically significant main effect for either the autonomy support or implementation intention intervention components nor an interaction effect was found on the outcome measures. However, statistically significant reductions in pre-drinking alcohol consumption and alcohol-related harm were observed across all groups at follow-up, when compared to baseline.

Conclusion

Reductions in outcome measures were likely related to elements common to each condition (i.e., provision of national guidelines, assessment of outcome measures, e-mail summary, and SMS messages), rather than motivational and volitional components.

     

Temporal stability of objective structured clinical exams: a longitudinal study employing item response theory

Background

The objective structure clinical examination (OSCE) has been used since the early 1970s for assessing clinical competence. There are very few studies that have examined the psychometric stability of the stations that are used repeatedly with different samples. The purpose of the present study was to assess the stability of objective structured clinical exams (OSCEs) employing the same stations used over time but with a different sample of candidates, SPs, and examiners.

Methods

At Time 1, 191 candidates and at Time 2 (one year apart), 236 candidates participated in a 10-station OSCE; 6 of the same stations were used in both years. Generalizability analyses (Ep²) were conducted. Employing item response analyses, test characteristic curves (TCC) were derived for each of the 6 stations for a 2-parameter model. The TCCs were compared across the two years, Time 1 and 2.

Results

The Ep² of the OSCEs exceeded.70. Standardized thetas (θ) and discriminations were equivalent for the same station across the two year period indicating equivalent TCCs for a 2-parameter model.

Conclusion

The 6 OSCE stations used by the AIMG program over two years have adequate internal consistency reliability, stable generalizability (Ep²) and equivalent test characteristics. The process of assessment employed for IMG’s are stable OSCE stations that may be used several times over without compromising psychometric properties.With careful security, high-stakes OSCEs may use the same stations that have high internal consistency and generalizability repeatedly as the psychometric properties are stable over several years with different samples of candidates.

     

Anatomy meets dentistry! <Emphasis Type="Italic">Linking anatomy and clinical practice in the preclinical dental curriculum</Emphasis>

Background

Establishing a strong link early on between preclinical coursework and the clinical context is necessary for students to be able to recognize the practical relevance of the curriculum during their preclinical anatomical courses and to transfer knowledge more easily. Our objective was to enhance the clinical relevance of a preclinical anatomy course for second-year medical students of dentistry by implementing an interdisciplinary skills training course on “Palpation of the Head and Neck Muscles” and to measure the learning outcomes.

Methods

For the curricular development of the expanded course module, Kern’s 6-step approach was applied including subjective evaluation. We used a peer-teaching format supported by an e-learning application. A randomized control study measured effects of the two components (skills training, e-module) on learning outcomes. Four learning methods were compared: (1) lecture, (2) lecture?+?e-module, (3) lecture?+?skills training, (4) lecture?+?skills training?+?e-module. An objective structured clinical examination (OSCE) was used to measure and compare learning outcomes.

Results

The two-way variance analysis demonstrated that participation in the skills training had a statistically significant effect on the OSCE results (p?=?0.0007). Students who participated in the skills training did better (φ 107.4?±?14.4 points) than students who only attended the lecture (φ 88.8?±?26.2 points). Students who used the e-module but did not attend the skills training earned a slightly but not significantly higher average number of points (φ 91.8?±?31.3 points) than those who only attended the lecture. The learning outcomes of the skills training were again significantly increased when the training was combined with the e-module (φ 121.8?±?21.8 points), thus making it the ideal method for achieving the learning objectives defined in this study.

Conclusions

The “Palpation of the Head and Neck Muscles” interdisciplinary skills training course linking basic anatomical knowledge and clinical skills led to clearly improved learning outcomes for both, anatomical knowledge and clinical skills. The additional use of an e-learning tool (e-module) improved the learning effect.

     

Adaptation and reliability of the readiness for inter professional learning scale (RIPLS) in the Chinese health care students setting

Background

Interprofessional collaboration (IPC) primarily aims to enhance collaborative skills and to improve the awareness of teamwork and collaborative competencies of health care students. The Readiness for Interprofessional Learning Scale (RIPLS) was used to assess such skills. The aim of this study was to adapt a Chinese version of the RIPLS among Chinese health care students and to test the psychometric properties of the modified instrument.

Methods

The questionnaire was translated following a two-step process, comprising forward and backward translations and a pilot test. The Chinese version was tested on a group of students from various health care professions. Cronbach’s α coefficients were calculated for each of the four factors and also for the entire questionnaire in order to evaluate the internal consistency of the Chinese version of the RIPLS.

Results

Of the 295 health care students surveyed, 282 (96.5%) completed the questionnaire. Cronbach’s α coefficient for the overall scale was 0.842. Internal consistencies within each factor were good (α?>?0.70) except for the factor “Roles and Responsibilities”, where α?=?0.216. Confirmatory factor analysis showed that the data fit the four-factor structure.

Conclusion

The Chinese version of the RIPLS was an acceptable instrument for evaluating the attitudes of the health care students in China. The factor “Roles and Responsibilities” requires further scrutiny and development, at least in the Chinese context.

     

A survey of medical students to assess their exposure to and knowledge of renal transplantation

Background

Within the field of renal transplantation there is a lack of qualified and trainee surgeons and a shortage of donated organs. Any steps to tackle these issues should, in part, be aimed at future doctors.

Methods

A questionnaire was distributed to final year students at a single medical school in the UK to assess their exposure to and knowledge of renal transplantation.

Results

Although 46% of responding students had examined a transplant recipient, only 14% had ever witnessed the surgery. Worryingly, 9% of students believed that xenotransplantation commonly occurs in the UK and 35% were unable to name a single drug that a recipient may need to take.

Conclusions

This survey demonstrates a lack of exposure to, and knowledge of, the field of renal transplantation. Recommendations to address the problems with the recruitment of surgeons and donation of organs, by targeting medical students are made.

     

Medical education in a foreign language and history-taking in the native language in Lebanon – a nationwide survey

Background

With the adoption of the English language in medical education, a gap in clinical communication may develop in countries where the native language is different from the language of medical education. This study investigates the association between medical education in a foreign language and students’ confidence in their history-taking skills in their native language.

Methods

This cross-sectional study consisted of a 17-question survey among medical students in clinical clerkships of Lebanese medical schools. The relationship between the language of medical education and confidence in conducting a medical history in Arabic (the native language) was evaluated (n?=?457).

Results

The majority (88.5%) of students whose native language was Arabic were confident they could conduct a medical history in Arabic. Among participants enrolled in the first clinical year, high confidence in Arabic history-taking was independently associated with Arabic being the native language and with conducting medical history in Arabic either in the pre-clinical years or during extracurricular activities. Among students in their second clinical year, however, these factors were not associated with confidence levels.

Conclusions

Despite having their medical education in a foreign language, the majority of students in Lebanese medical schools are confident in conducting a medical history in their native language.

     

Examining the Associations Between Overeating,Disinhibition, and Hunger in a Nonclinical Sample of College Women

Background

Binge eating (BE) has long been identified as a correlate of overweight and obesity. However, less empirical attention has been given to overeating with and without loss of control (LOC) in nonclinical samples.

Purpose

The goal of the present study was to examine the association of (1) established correlates of BE, namely, weight and shape concerns, dietary restraint, and negative affect, and (2) three additional correlates, disinhibition, hunger, and interoceptive awareness (IA), to overeating in a nonclinical sample of college women.

Method

Female students (n?=?1,447) aged 18 to 21 years recruited from colleges in three Canadian metropolitan areas completed self-report questionnaires in class to assess sociodemographic and anthropomorphic characteristics, overeating, LOC, dietary restraint, negative affect, weight and shape concerns, IA, disinhibition, and hunger.

Results

The established correlates of BE were significant correlates of all types of overeating and explained 33 % of the variance. Disinhibition was the most strongly associated correlate of overeating.

Conclusions

Findings suggest that established correlates of BE are associated with other types of overeating such as objective overeating (OOE), as are disinhibition and hunger.

     

A Family Day program enhances knowledge about medical school culture and necessary supports

Background

A Family Day program was implemented at Indiana University School of Medicine to educate the families and friends of in-coming medical students about the rigors of medical school and the factors that contribute to stress.

Methods

Surveys that assessed knowledge, beliefs, and attitudes about medical school were administered to participants before and after the program.

Results

After the program, participants showed a significant improvement in their understanding of medical school culture and the importance of support systems for medical students. Post-test scores improved by an average of 29% (P < 0.001) in each of the two years this program was administered.

Conclusions

The inclusion of family members and other loved ones in pre-matriculation educational programs may serve to mitigate the stress associated with medical school by enhancing the students' social support systems.

     

The fairness,predictive validity and acceptability of multiple mini interview in an internationally diverse student population- a mixed methods study

Background

International medical students, those attending medical school outside of their country of citizenship, account for a growing proportion of medical undergraduates worldwide. This study aimed to establish the fairness, predictive validity and acceptability of Multiple Mini Interview (MMI) in an internationally diverse student population.

Methods

This was an explanatory sequential, mixed methods study. All students in First Year Medicine, National University of Ireland Galway 2012 were eligible to sit a previously validated 10 station MMI. Quantitative data comprised: demographics, selection tool scores and First Year Assessment scores. Qualitative data comprised separate focus groups with MMI Assessors, EU and Non-EU students.

Results

109 students participated (45% of class). Of this 41.3% (n = 45) were Non-EU and 35.8% (n = 39) did not have English as first language. Age, gender and socioeconomic class did not impact on MMI scores. Non-EU students and those for whom English was not a first language achieved significantly lower scores on MMI than their EU and English speaking counterparts (difference in mean 11.9% and 12.2% respectively, P<0.001). MMI score was associated with English language proficiency (IELTS) (r = 0.5, P<0.01). Correlations emerged between First Year results and IELTS (r = 0.44; p = 0.006; n = 38) and EU school exit exam (r = 0.52; p<0.001; n = 56). MMI predicted EU student OSCE performance (r = 0.27; p = 0.03; n = 64). In the analysis of focus group data two overarching themes emerged: Authenticity and Cultural Awareness. MMI was considered a highly authentic assessment that offered a deeper understanding of the applicant than traditional tools, with an immediate relevance to clinical practice. Cultural specificity of some stations and English language proficiency were seen to disadvantage international students. Recommendations included cultural awareness training for MMI assessors, designing and piloting culturally neutral stations, lengthening station duration and providing high quality advance information to candidates.

Conclusion

MMI is a welcome addition to assessment armamentarium for selection, particularly with regard to stakeholder acceptability. Understanding the mediating and moderating influences for differences in performance of international candidates is essential to ensure that MMI complies with the metrics of good assessment practice and principles of both distributive and procedural justice for all applicants, irrespective of nationality and cultural background.

     

Reflective practice and its role in facilitating creative responses to dilemmas within clinical communication - a qualitative analysis

Background

Good communication is a major factor in delivering high quality in care. Research indicates that current communication skills training alone might not sufficiently enable students to find context-specific creative solutions to individual complex personal and interpersonal challenges in the clinical context. This study explores medical students’ experiences with real communication dilemmas in a facilitated group setting. The aims were to gain a better understanding of whether and, if so, how reflective practice can enhance students’ ability to find creative individual solutions in difficult communication situations and to identify factors within the reflective setting that foster their creative competency.

Methods

Thematic content analysis was used to perform a secondary analysis of semi-structured interview data from a qualitative evaluation of a group reflective practice training for final-year medical students. The categories that arose from the iterative deductive-inductive approach were analyzed in light of current scientific understandings of creativity.

Results

Reflection on real difficult clinical communication situations appears to increase medical students’ ability to handle such situations creatively. Although group reflection on clinical dilemmas involving personal aspects can stir up emotions, participating students stated they had learned a cognitive process tool that enhanced their communicative competence in clinical practice. They also described changes in personal attitudes: they felt more able to persevere and to tolerate ambiguity, described themselves more open and self-efficient in such complex clinical communication situations and thus more motivated. Furthermore, they reported on factors that were essential in this process, such as reflection on current and real challenges, a group format with a trainer.

Conclusions

Reflective practice providing a cognitive process tool and using real clinical challenges and trainer support in communication education may provide learners with the skills and attitudes to develop creativity in practice. Implementing reflection training in clinical communication education may increase students’ overall communicative competency.

     

Changes of empathy in medical college and medical school students: 1-year follow up study

Background

This study aims to determine the correlation between medical education systems, medical college (MC) and medical school (MS), and empathy by investigating the changes in empathy among students with each additional year of medical education.

Methods

The subjects were MC and MS students who had participated in the same study the previous year. All participants completed the same self-report instruments: a questionnaire on sociodemographic characteristics, and the Korean edition of the Student Version of the Jefferson Scale of Empathy (JSE-S-K), Among 334 students, the final analysis was conducted on the data provided by 113 MC and 120 MS students, excluding 101 with incomplete data.

Results

The age and sex did not affect the changes in empathy. Though the JSE-S-K score of MS was significantly higher than that of MC in initial investigation, this study found no difference of empathy between MC and MS.

Conclusion

Empathy increased significantly after one year of medical education. The difference between two education systems, MC and MS, did not affect the changes in empathy.

     

<Emphasis Type="Italic">Helicobacter bilis</Emphasis>-Associated Suppurative Cholangitis in a Patient with X-Linked Agammaglobulinemia

?

Helicobacter bilis is a commensal bacterium causing chronic hepatitis and colitis in mice. In humans, enterohepatic Helicobacter spp. are associated with chronic hepatobiliary diseases.

Purpose

We aimed at understanding the microbial etiology in a patient with X-linked agammaglobulinemia presenting with suppurative cholangitis.

Methods

16S rDNA PCR directly performed on a liver biopsy retrieved DNA of H. bilis.

Results

Clinical outcome resulted in the normalization of clinical and biological parameters under antibiotic treatment by a combination of ceftriaxone, metronidazole, and doxycyclin followed by a 2-week treatment with moxifloxacin and a 2-month treatment with azithromycin.

Conclusion

In conclusion, these data suggest a specific clinical and microbiological approach in patients with humoral deficiency in order to detect H. bilis hepatobiliary diseases.

     

Developing essential professional skills: a framework for teaching and learning about feedback

Background

The ability to give and receive feedback effectively is a key skill for doctors, aids learning between all levels of the medical hierarchy, and provides a basis for reflective practice and life-long learning. How best to teach this skill?

Discussion

We suggest that a single "teaching the skill of feedback" session provides superficial and ineffective learning in a medical culture that often uses feedback skills poorly or discourages feedback. Our experience suggests that both the skill and the underlying attitude informing its application must be addressed, and is best done so longitudinally and reiteratively using different forms of feedback delivery. These feedback learning opportunities include written and oral, peer to peer and cross-hierarchy, public and private, thereby addressing different cognitive processes and attitudinal difficulties.

Summary

We conclude by asking whether it is possible to build a consensus approach to a framework for teaching and learning feedback skills?

     

A one-day surgical-skill training course for medical students’ improved surgical skills and increased interest in surgery as a career

Background

Despite many high-quality programs in basic surgical-skill education, the surgical skill of junior doctors varies widely. This, together with the waning interest in surgery as a career among medical students, is a serious issue confronted by hospitals and healthcare systems worldwide. We, therefore, developed and implemented an intensive one-day surgical-skill training course for two purposes; it would improve surgical skills and increase interest in surgery among medical students.

Methods

The surgical-skill training program is named Surgical Skill Weekend (SSW) and it includes hands-on training sessions for surgical-suturing techniques and advanced surgical procedures (i.e. laparoscopic and robot-assisted surgery), hybrid simulation sessions, and an operating-room session where aforementioned sessions are all put together. By the end of the program, students’ improvements in surgical-suturing skills were assessed by experts in a form of checklist, and changes in the interest in a surgical career, if there were any, were answered by the students who participated in the program.

Results

A total of ninety-one (91) medical students participated in the 2015 and 2016 SSW courses. Their overall satisfaction level with the course was very high (Very satisfied: 78%, Quite satisfied: 22%). All of the participant’s surgical-suturing skills significantly improved (median score range: 14–20, P?<?0.05) and their interest in a surgical career increased significantly (from 56% to 81%, P?<?0.05) by completing the program.

Conclusions

An intensive and comprehensive surgical-skill training program for medical students can not only improve surgical-suturing skills but also increase interest in surgery as a career.