Background Teaching and assessing clinical skills competence by using standardized patients (SPs) have gained widespread acceptance as reflected by the addition of the new Clinical Skills Examination to Step II of the USMLE. However, it is not well known whether students who have completed clinical rotations perform clinical skills in a superior fashion to preclerkship students. We compared performance of physical examination skills by medical students at different levels of training during an SP encounter.
Methods We designed and administered an Objective Structured Clinical Examination (OSCE) station to all second- and fourth-year medical students (MSs) as part of existing OSCE testing during 2004-05. The station simulated a patient presenting with symptoms suggestive of pneumonia; students were asked to perform a focused physical examination. Trained SPs assessed performance using a binomial checklist; included pulmonary examination items were inspection, palpation, percussion, and auscultation. The 10-item checklist was designed by a panel of clinician educators. Total score was calculated on a scale of 100.
Results 150 MS-2 students and 163 MS-4 students completed the station. Overall, performance by MS-2 students was superior to that by MS 4 students (87% vs 79%). MS-2 student performance was also superior on items of the lung examination related to palpation and percussion (Table). Performance on the rest of the lung examination was not different (inspection and auscultation; see Table). Overall, both groups performed poorly on items related to examination of the anterior chest and focusing on the abnormal area.
Conclusion When examining a standardized patient with symptoms of pneumonia, the performance of second-year medical students was superior to fourth-year students on a comprehensive pulmonary examination. Whether the difference reflects better “test taking” skills by MS-2, better efficiency by MS-4, or erosion of clinical skills by experiences during the clerkships is unknown.
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