A randomized-controlled study of encounter cards to improve oral case presentation skills of medical students
Tóm tắt
OBJECTIVE: To determine the feasibility of oral case presentation (OCP) encounter cards as a tool for formative evaluation, to estimate the reliability and validity of the ratings when used in a medicine clerkship, and to examine whether the use of OCP encounter cards improves students’ OCP skills. DESIGN: Randomized controlled study. SETTING: Medicine core clerkship at a U.S. medical school. PARTICIPANTS/INTERVENTION: Students enrolled in the medicine core clerkship (n=164) from January to December of 2003 were randomly assigned to receive weekly feedback using OCP encounter cards rating nine presentation compentencies or receive usual feedback. Mean OCP ratings were correlated with multiple summative assessments. Performance on an end-of-clerkship OCP was compared between intervention and control groups. MAIN RESULTS: Eighty percent of cards were completed. The mean OCP rating averaged over 9 competencies was 7.7 (SD=0.8) on a 9-point scale. Standard error of ratings was 0.3. OCP ratings were correlated with inpatient evaluations (r=.58), inpatient ratings of presentation skills (r=.43), and final grades (r=.40). Final OCP performance was similar for the intervention and control groups (7.0 vs 7.2, P=.09). CONCLUSION: OCP encounter cards are a novel and feasible tool to assess clerkship students’ oral case presentation skills. OCP card ratings are reproducible, and validity is suggested by their correlation with multiple markers of performance. However, encounter cards did not improve performance on summative oral presentations.
Tài liệu tham khảo
AAMC Medical School Objectives Project. American Association of Medical Colleges Web Site. Available at: http://www.aamc.org/meded/msop. Accessed February 10, 2004.
ACGME Outcome Project. Accreditation Council for Graduate Medical Education Web Site. Available at: http://www.acgme.org. Accessed February 10, 2004.
Kasselbaum DG, Eaglen RH. Shortcomings in the evaluation of students’ clinical skills and behaviors in medical school. Acad Med. 1999;74:842–9.
Klos M, Reuler JB, Nardone DA, Girard DE. An evaluation of trainee performance in the case presentation. J Med Educ. 1983;58:432–4.
Kihm JT, Brown JT, Divine GW, Linzer M. Quantitative analysis of the outpatient oral case presentation. J Gen Intern Med. 1991;6:233–6.
Wiese J, Varosy P, Tierney L. Improving oral presentation skills with a clinical reasoning curriculum: a prospective controlled study. Am J Med. 2002;112:212–8.
Haber RJ, Lingard LA. Learning oral presentation skills, a rhetorical analysis with pedagogical and professional implications. J Gen Intern Med. 2001;16:308–14.
Lye P, Bragg D, Simpson D. Improving feedback with a clinical encounter form. Acad Med. 1997;72:444–5.
Paukert JL, Richards ML, Olney C. An encounter card system for increasing feedback to students. Am J Surg. 2002;183:300–4.
Schum TR, Krippendorf RL, and the Advanced Education Faculty Development Group. Feedback notes: a system for feedback to residents and students. Acad Med. 2000;75:556–7.
Yurchak PM. A guide to medical case presentations. Resident Staff Physician. 1981;109–15.
Norcini JJ, Blank LL, Duffy FD, Fortna GS. The Mini-CEX: a Method for Assessing Clinical Skills. Ann Intern Med. 2003;138:476–81.
Irby DM. Teaching and learning in ambulatory care settings: a thematic review of the literature. Acad Med. 1995;70:898–931.
Kogan JR, Bellini LM, Shea JA. Feasibility, reliability, and validity of the mini-clinical evaluation exercise (mCEX) in a medicine core clerkship. Acad Med. 2003;78(suppl):S33–5.
Hatala R, Norman GR. In-training evaluation during an internal medicine clerkship. Acad Med. 1999;74(suppl):S118–20.
Haber RJ, Avins AL. Do ratings on the American Board of Internal Medicine Resident Evaluation Form detect differences in clinical competence? J Gen Intern Med. 1994;9:140–5.
McLeod PJ. Faculty assessments of case reports of medical students. J Med Educ. 1987;62:673–7.
Noel GL, Herbers JE Jr., Caplow MP, Cooper GS, Pangaro LN, Harvey J. How well do internal medicine faculty members evaluate the clinical skills of residents? Ann Intern Med. 1992;117:757–65.
Herbers JE Jr., Noel GL, Cooper GS, Harvey J, Pangaro LN, Weaver MJ. How accurate are faculty evaluations of clinical competence? J Gen Intern Med. 1989;4:202–8.
Kalet A, Earp JA, Kowlowitz V. How well do faculty evaluate the interviewing skills of medical students? J Gen Intern Med. 1992;7:499–505.
Kroboth FJ, Hanusa BH, Parker S, et al. The inter-rater reliability and internal consistency of a clinical evaluation exercise. J Gen Intern Med. 1992;7:174–9.
Elliot DL, Hickam DH. Evaluation of physical examination skills. Reliability of faculty observers and patient instructors. JAMA. 1987;258:3405–8.
Holmboe ES, Hawkins RE, Huot SJ. Effects of training in direct observation of medical residents’ clinical competence. Ann Intern Med. 2004;140:874–81.
