[8415.11] Quality and Quantity of Patient Contact Correlates with Performance on a Clinical Skills Exam
Linda R. Tewksbury, Paik Steve, Richter A. Regina, Gillespie C. Colleen, Kalet L. Adina. New York University School of Medicine, New York, NY.
BACKGROUND: The LCME recently reconsidered requiring medical schools to establish quantifying criteria for the number of patient experiences for medical students in different settings as little empirical evidence is available to justify a number threshold.
OBJECTIVE: To explore the relationship between number and types of patients encountered during the pediatric clerkship and performance on an adolescent OSCE.
DESIGN/METHODS: Medical students rotating through the pediatric clerkship were required to enter all patient encounters into a web-based log. Data included time of rotation, age and gender of patient, and level of encounter (observation (OB) vs direct performance (DP) of key elements of history and physical exam). All students subsequently were required to complete a clinical skills exam at the end of 3rd yr. Students were randomly assigned to 8 OSCE stations, one of which included a 15 minute interview with an adolescent SP. The SP evaluated student communication (CS) and history gathering (HG) skills. Clinical reasoning (CR) skills were evaluated by a trained faculty based on the student note summarizing the history, differential diagnosis and treatment plan. Bivariate correlations and muliple linear regression analyses were performed.
RESULTS: 133/162 (82%) of 3rd yr students completing the pediatric clerkship in 2005-6 were assigned to the adolescent OSCE. For the 118 consented students with complete data, the mean (SD) number of total patient encounters was 67 (34). Students encountered a mean (SD) of 13 (5.5) adolescent patients (age 13-19yrs), and 8 (4.5) of these were at DP level. The number of adolescent enounters correlated with CR (r = .21, p<.05 ) but not HG or PE performance on the adolescent OSCE. A backward stepwise regression analysis including time of rotation, number and type (age, gender, level) of encounter demonstrated that the number of adolescent encounters at DP level was the only significant predictor of CR (r2= .241, p=.009).
CONCLUSIONS: The number of independently performed history and physical exams performed by medical students during a pediatric clerkship weakly correlates with clinical reasoning ability as measured by performance on a relevant OSCE. The results suggest that the quantity and quality of patient encounters influences development of clinical skills but further research is required to determine if any threshold exists.