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      Learning physical examination skills outside timetabled training sessions: what happens and why?

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          Abstract

          Lack of published studies on students’ practice behaviour of physical examination skills outside timetabled training sessions inspired this study into what activities medical students undertake to improve their skills and factors influencing this. Six focus groups of a total of 52 students from Years 1–3 using a pre-established interview guide. Interviews were recorded, transcribed and analyzed using qualitative methods. The interview guide was based on questionnaire results; overall response rate for Years 1–3 was 90% ( n = 875). Students report a variety of activities to improve their physical examination skills. On average, students devote 20% of self-study time to skill training with Year 1 students practising significantly more than Year 3 students. Practice patterns shift from just-in-time learning to a longitudinal selfdirected approach. Factors influencing this change are assessment methods and simulated/real patients. Learning resources used include textbooks, examination guidelines, scientific articles, the Internet, videos/DVDs and scoring forms from previous OSCEs. Practising skills on fellow students happens at university rooms or at home. Also family and friends were mentioned to help. Simulated/real patients stimulated students to practise of physical examination skills, initially causing confusion and anxiety about skill performance but leading to increased feelings of competence. Difficult or enjoyable skills stimulate students to practise. The strategies students adopt to master physical examination skills outside timetabled training sessions are self-directed. OSCE assessment does have influence, but learning takes place also when there is no upcoming assessment. Simulated and real patients provide strong incentives to work on skills. Early patient contacts make students feel more prepared for clinical practice.

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          Most cited references37

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          A cognitive perspective on medical expertise: theory and implication.

          A new theory of the development of expertise in medicine is outlined. Contrary to existing views, this theory assumes that expertise is not so much a matter of superior reasoning skills or in-depth knowledge of pathophysiological states as it is based on cognitive structures that describe the features of prototypical or even actual patients. These cognitive structures, referred to as "illness scripts," contain relatively little knowledge about pathophysiological causes of symptoms and complaints but a wealth of clinically relevant information about disease, its consequences, and the context under which illness develops. By contrast, intermediate-level students without clinical experience typically use pathophysiological, causal models of disease when solving problems. The authors review evidence supporting the theory and discuss its implications for the understanding of five phenomena extensively documented in the clinical-reasoning literature: (1) content specificity in diagnostic performance; (2) typical differences in data-gathering techniques between medical students and physicians; (3) difficulties involved in setting standards; (4) a decline in performance on certain measures of clinical reasoning with increasing expertise; and (5) a paradoxical association between errors and longer response times in visual diagnosis.
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            The effect of assessments and examinations on the learning of medical students.

            This paper describes a situation where an alteration in the final-year assessment scheme led to changes in student learning activities which were the exact opposite of those intended. Students were seen to be spending a disproportionate amount of time studying the theoretical components of the course relative to the practical and clinical aspects. The paramount importance of the assessments and examinations in influencing student learning behaviour led the departments concerned to develop a new clinical examination which more clearly reflected the objectives of the course. A questionnaire survey was undertaken to determine how the different sections of the final assessment affected the students' approach to studying. The questionnaire was administered to graduates during their intern year for the 3 years following the introduction of the new clinical examination. Results were also obtained for the year preceding the change. The survey showed that the students developed a high regard for the new examination and its validity as a test of clinical competence. The students found that an increase in ward-based learning activities was essential for success in the final examinations. The new clinical examination has thus influenced students' learning and successfully restored the balance of their learning activities between the clinical and theoretical components of the course.
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              OSCE checklists do not capture increasing levels of expertise.

              To evaluate the effectiveness of binary content checklists in measuring increasing levels of clinical competence. Fourteen clinical clerks, 14 family practice residents, and 14 family physicians participated in two 15-minute standardized patient interviews. An examiner rated each participant's performance using a binary content checklist and a global process rating. The participants provided a diagnosis two minutes into and at the end of the interview. On global scales, the experienced clinicians scored significantly better than did the residents and clerks, but on checklists, the experienced clinicians scored significantly worse than did the residents and clerks. Diagnostic accuracy increased for all groups between the two-minute and 15-minute marks without significant differences between the groups. These findings are consistent with the hypothesis that binary checklists may not be valid measures of increasing clinical competence.
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                Author and article information

                Contributors
                +31-628-359428 , r.duvivier@maastrichtuniversity.nl
                Journal
                Adv Health Sci Educ Theory Pract
                Adv Health Sci Educ Theory Pract
                Advances in Health Sciences Education
                Springer Netherlands (Dordrecht )
                1382-4996
                1573-1677
                28 June 2011
                28 June 2011
                August 2012
                : 17
                : 3
                : 339-355
                Affiliations
                [1 ]Skillslab, Faculty of Health Medicine and Life Sciences, Maastricht University, P. O. Box 616, 6200 MD Maastricht, The Netherlands
                [2 ]Student, Faculty of Health Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
                [3 ]Institute for Medical Education, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
                [4 ]Department of Educational Development and Research, Faculty of Health Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
                Article
                9312
                10.1007/s10459-011-9312-5
                3378843
                21710301
                3a92f850-b446-4dd7-b048-8fc6d8c7697a
                © The Author(s) 2011
                History
                : 23 December 2010
                : 16 June 2011
                Categories
                Article
                Custom metadata
                © Springer Science+Business Media B.V. 2012

                Education
                undergraduate,physical examination skills,clinical skills,practical,medical students
                Education
                undergraduate, physical examination skills, clinical skills, practical, medical students

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