Teaching foundational physical examination skills: Study results comparing lay teaching associates and physician instructors
ABSTRACT The purpose of this pilot study was to determine differences in the physical exam skills of first-year medical students learning physical exam exclusively from standardized physical examination teaching associates (SPETAs) or physician faculty.
In all, 144 first-year medical students were randomized to receive SPETA or physician-led physical examination instruction. Students participated in an OSCE assessment immediately following the end of the curriculum block.
SPETA-trained students performed equivalently to physician faculty trained students across all stations with a mean of 82.9% versus 81.2% (p = .226). Students taught by SPETAs performed significantly better on the abdominal OSCE with a mean score of 88.8%, while physician faculty taught students had a mean score of 85.4% (p = .03).
Findings from this study suggest that SPETAs can effectively teach foundational physical examination skills to medical students at a similar and sometimes better performance level as physician faculty.
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ABSTRACT: Objective The main objective was to gain a deeper understanding of how medical students perceive and experience learning from gynecological teaching women (GTW) instead of physicians in their first pelvic examination. A second aim was to describe how the women experience their roles as GTW. Methods Data was collected from individual interviews with 24 medical students from a medical school in Sweden and with 5 GTW. Discourse analysis was performed to acquire a deeper understanding of the informants’ experiences and to understand social interactions. Results Five themes revealed in the medical studentś experiences: “Hoping that anxiety will be replaced with security,” “Meeting as equals creates a sense of calm,” “Succeeding creates a sense of security for the future,” “Wanting but not having the opportunity to learn more,” and “Feeling relieved and grateful. One theme revealed in the GTW experiences: “Hoping to relate in a trustworthy way.” Conclusion To replace physicians with GTW may facilitate the learning process and may also help medical students improve their communicative skills. Using GTW will hopefully further improve students’ basic medical examination techniques and physician-patient relationships. Practice implications Since GTW seems to increase self-confidence and skills of medical students performing their first pelvic examination we recommend that the use of GTW is considered in the training of medical students.Patient Education and Counseling 07/2014; 96(1). DOI:10.1016/j.pec.2014.04.013 · 2.60 Impact Factor
Article: Patient instructors in rheumatology[Show abstract] [Hide abstract]
ABSTRACT: Patient instructors are patients trained to teach students in focussed history taking and/or examination in the context of the patient's specific illness. Their espousal has been quite extensively reported in rheumatology. The majority of studies show that patient instructors are effective in enhancing the knowledge and skills relevant to practice concerned with patients with the given conditions (in this case, typically rheumatoid arthritis and osteoarthritis). Most studies show patient instructors to be as effective as clinicians in this respect. They are especially effective at enhancing students' understanding of the impact of living with a chronic condition. With appropriate (quite extensive) training, they can also assess the examination skills of students, both undergraduate and postgraduate. Students value them, and the patient instructors themselves derive benefit from the activity. There are issues to be aware of regarding the adoption of patient instructors. The training required is significant. If employed as described in the literature, quite significant selection criteria come into play. In some cases, patient instructors feel under-rewarded financially; they should not be seen as medical education on the cheap. Nonetheless, patient instructors represent an excellent, relatively under-utilised, resource for the aiding of student learning in many areas of medicine.Medical Teacher 05/2012; 34(7):539-42. DOI:10.3109/0142159X.2012.678425 · 2.05 Impact Factor
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ABSTRACT: The accuracy and reproducibility of medical skills assessment is generally low. Rater training has little or no effect. Our knowledge in this field, however, relies on studies involving video ratings of overall clinical performances. We hypothesised that a rater training focussing on the frame of reference could improve accuracy in grading the curricular assessment of a highly standardised physical head-to-toe examination. Twenty-one raters assessed the performance of 242 third-year medical students. Eleven raters had been randomly assigned to undergo a brief frame-of-reference training a few days before the assessment. 218 encounters were successfully recorded on video and re-assessed independently by three additional observers. Accuracy was defined as the concordance between the raters' grade and the median of the observers' grade. After the assessment, both students and raters filled in a questionnaire about their views on the assessment. Rater training did not have a measurable influence on accuracy. However, trained raters rated significantly more stringently than untrained raters, and their overall stringency was closer to the stringency of the observers. The questionnaire indicated a higher awareness of the halo effect in the trained raters group. Although the self-assessment of the students mirrored the assessment of the raters in both groups, the students assessed by trained raters felt more discontent with their grade. While training had some marginal effects, it failed to have an impact on the individual accuracy. These results in real-life encounters are consistent with previous studies on rater training using video assessments of clinical performances. The high degree of standardisation in this study was not suitable to harmonize the trained raters' grading. The data support the notion that the process of appraising medical performance is highly individual. A frame-of-reference training as applied does not effectively adjust the physicians' judgement on medical students in real-live assessments.