Early Patient approach with feedback Improves Clinical Skills of Medical Students
1. Early patient approach with
feedback improves
clinical skills of medical students
Kiatsak Rajborirug M.D., Hatyai Medical Education Center, Thailand
8. Bedside teaching was
used for clinical skill
learning. Teacher shows
how to take good history
and physical examination.
Take history and Physical examination -
General, Abdomen, Cardiovascular, Chest and
Neurological exam, etc.
Conventional skill teaching
Follow me
9. Hx, PE & feedback
1Pt /2St /1Fac /1 hr
Early patient approach with feedback
Each pair of medical
students was assigned
to approach a patient
with different common
medical problems under
closed supervision and
immediately feedback
by a facilitator.
10. L
i
b
r
a
r
y
Hx, PE & feedback
1Pt /2St /1Fac /1 hr
Self study
4 hrs
Search for patient problems & learning issues
11. L
i
b
r
a
r
y
Hx, PE & feedback
1Pt /2St /1Fac /1 hr
Self study
4 hrs
Present 10 mins
& briefing 5 mins
Present and wrap up
12. Study profile
1st clinical year med students ( n= 124 )
Conventional clinical skill
teaching (2002-2004)
( n = 56 )
+ Early patient approach
with feedback (2005-2007)
( n = 68 )
13. Study profile: 1st & 2nd evaluation
1st clinical year med students ( n= 124 )
1st clinical year OSCE scores
Conventional clinical skill
teaching (2002-2004)
( n = 56 )
+ Early patient approach
with feedback (2005-2007)
( n = 68 )
2nd clinical year long case examination scores
14. • The curriculum and medical staffs were
rather steady.
• Full scores of all measurement were
adjusted to 100 percent.
Variables
15. OSCE evaluation- 1st clinical year
40 OSCE items
20 - medical based 20 - surgical based
The same 6 tasks
3 History taking – Fever, Headache and
abdominal pain.
3 Physical exam – Chest, Heart and
Skin exam.
16. Long case evaluation- 2nd clinical year
Long case exam score
History taking task
Physical examination task
Presentation
Problem solving
17. Long case evaluation- 2nd clinical year
Long case exam score
History taking task
Physical examination task
Presentation
Problem solving
* Only History taking and PE task were evaluated.
18. Statistic
• Mean score differences between 2 groups were
compared by independent-samples T test.
• Statistical significant differences were
defined as p < 0.05.
20. Fig 1: Mean different admission score.
51
52
53
54
55
56
57
Admissionscore
Conventional
Patientapproach
P
e
r
c
e
n
t
-3.32 %
21. Fig 2: OSCE - Mean different scores of Hx taking skills.
0
10
20
30
40
50
60
70
80
90
Abdominal
pain
Fever Headache
Conventional
Patient approach
P
e
r
c
e
n
t
9.17 %
7.02 % -7.50 %
22. Fig 3: OSCE – Mean different scores of P.E. skills.
0
10
20
30
40
50
60
70
80
Chest exam Heart exam Skin exam
Conventional
Patient approach
P
e
r
c
e
n
t
17.79 % 1.69 %6.34 %
23. Fig 4: Mean different sum OSCE score
69
70
71
72
73
74
75
76
77
78
OSCE sum
Conventional
Patientapproach
5.19 %
P
e
r
c
e
n
t
24. Fig 5: Mean different Long case exam score
72
74
76
78
80
82
84
History taking part Physicalexampart
Conventional
Patient approach
P
e
r
c
e
n
t
0.58 %
2.82 %
25. Conclusion
• Early patient approach with feedback
significantly improves some specific clinical
skills of medical students.
• No significant improvement in long case
examination.
• The benefit in other clinical skills should be
further evaluated.
