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      Dreyfus scale-based feedback increased medical students’ satisfaction with the complex cluster part of a interviewing and physical examination course and improved skills readiness in Taiwan

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          Abstract

          Purpose

          In contrast to the core part of the clinical interviewing and physical examination (PE) skills course, corresponding to the basic, head-to-toe, and thoracic systems, learners need structured feedback in the cluster part of the course, which includes the gastrointestinal, neuromuscular, and musculoskeletal systems. This study evaluated the effects of using Dreyfus scale-based feedback, which has elements of continuous professional development, instead of Likert scale-based feedback in the cluster part of training in Taiwan.

          Methods

          Instructors and final-year medical students in the 2015–2016 classes of National Yang-Ming University, Taiwan comprised the regular cohort, whereas those in the 2017–2018 classes formed the intervention cohort. In the intervention cohort, Dreyfus scale-based feedback, rather than Likert scale-based feedback, was used in the cluster part of the course.

          Results

          In the cluster part of the course in the regular cohort, pre-trained standardized patients rated the class climate as poor, and students expressed low satisfaction with the instructors and course and low self-assessed readiness. In comparison with the regular cohort, improved end-of-course group objective structured clinical examination scores after the cluster part were noted in the intervention cohort. In other words, the implementation of Dreyfus scale-based feedback in the intervention cohort for the cluster part improved the deficit in this section of the course.

          Conclusion

          The implementation of Dreyfus scale-based feedback helped instructors to create a good class climate in the cluster part of the clinical interviewing and PE skills course. Simultaneously, this new intervention achieved the goal of promoting medical students’ readiness for interviewing, PE, and self-directed learning.

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          Most cited references15

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          Medical graduates’ preparedness to practice: a comparison of undergraduate medical school training

          Background There is evidence that newly qualified doctors do not feel prepared to start work. This study examined views of first year Foundation doctors (F1s) regarding how prepared they felt by their undergraduate medical education for skills required during the first Foundation training year in relation to their type of training. Method One-hundred and eighty two F1s completed a questionnaire during their first rotation of Foundation training. Analysis was conducted by type of medical school training: Problem-Based Learning (PBL), Traditional or Reformed. Results F1s from medical schools with a PBL curriculum felt better prepared for tasks associated with communication and team working, and paperwork than graduates from the other medical school types; but the majority of F1s from all three groups felt well prepared for most areas of practice. Less than half of graduates in all three groups felt well prepared to deal with a patient with neurological/visual problems; write referral letters; understand drug interactions; manage pain; and cope with uncertainty. F1s also indicated that lack of induction or support on starting work was affecting their ability to work in some areas. Conclusions Whilst F1s from medical schools with a PBL curriculum did feel better prepared in multiple areas compared to graduates from the other medical school types, specific areas of unpreparedness related to undergraduate and postgraduate medical training were identified across all F1s. These areas need attention to ensure F1s are optimally prepared for starting work. Electronic supplementary material The online version of this article (doi:10.1186/s12909-017-0859-6) contains supplementary material, which is available to authorized users.
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            The Dreyfus model of clinical problem-solving skills acquisition: a critical perspective

            Context The Dreyfus model describes how individuals progress through various levels in their acquisition of skills and subsumes ideas with regard to how individuals learn. Such a model is being accepted almost without debate from physicians to explain the ‘acquisition’ of clinical skills. Objectives This paper reviews such a model, discusses several controversial points, clarifies what kind of knowledge the model is about, and examines its coherence in terms of problem-solving skills. Dreyfus' main idea that intuition is a major aspect of expertise is also discussed in some detail. Relevant scientific evidence from cognitive science, psychology, and neuroscience is reviewed to accomplish these aims. Conclusions Although the Dreyfus model may partially explain the ‘acquisition’ of some skills, it is debatable if it can explain the acquisition of clinical skills. The complex nature of clinical problem-solving skills and the rich interplay between the implicit and explicit forms of knowledge must be taken into consideration when we want to explain ‘acquisition’ of clinical skills. The idea that experts work from intuition, not from reason, should be evaluated carefully.
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              A pilot study assessing knowledge of clinical signs and physical examination skills in incoming medicine residents.

              Physical exam skills of medical trainees are declining, but most residencies do not offer systematic clinical skills teaching or assessment.
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                Author and article information

                Contributors
                Role: Editor
                Journal
                J Educ Eval Health Prof
                J Educ Eval Health Prof
                JEEHP
                Journal of Educational Evaluation for Health Professions
                Korea Health Personnel Licensing Examination Institute
                1975-5937
                2019
                11 October 2019
                : 16
                : 30
                Affiliations
                [1 ]Department of Medicine, National Yang-Ming University, Taipei, Taiwan
                [2 ]Bali Psychiatric Center, Ministry of Health and Welfare, Taipei, Taiwan
                [3 ]Division of Clinical Skills Training, Department of Medical Education, Taipei Veterans General Hospital, Taipei, Taiwan
                [4 ]Division of General Medicine, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
                [5 ]Office of Medical Education, University of New South Wales Australia, Sydney, Australia
                Hallym University, Korea
                Author notes
                [* ]Corresponding email: yangyy@ 123456vghtpe.gov.tw
                [†]

                These authors contributed equally to this work.

                Author information
                http://orcid.org/0000-0001-8647-1871
                http://orcid.org/0000-0002-1313-4628
                http://orcid.org/0000-0002-7719-0397
                http://orcid.org/0000-0003-3217-6193
                http://orcid.org/0000-0002-9262-0287
                http://orcid.org/0000-0003-3644-727X
                Article
                jeehp-16-30
                10.3352/jeehp.2019.16.30
                6848653
                31614407
                79fcfcb5-eb41-49a2-b423-269cc37cc284
                © 2019, Korea Health Personnel Licensing Examination Institute

                This is an open-access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 4 September 2019
                : 11 October 2019
                Categories
                Research Article

                Assessment, Evaluation & Research methods
                cohort studies,group structure,medical students,personal satisfaction,physical examination,taiwan

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