The Change of CPX Scores according to Repeated CPXs

Most medical schools have held clinical skills training programs recently. Despite these educational endeavors, few studies have attempted to address the effect of clinical skills assessments on clinical performance. This study investigated whether repeated experiences with the examination improved medical students' history-taking, physical exams, and patient-physician interactions (PPIs).

The subjects of the study were 101 4th-year medical students who participated in the clinical performance examination (CPX) 3 times. They completed their core clerkship before acquiring the first CPX scores; we tracked down the scores of three sets of CPX for 3 subdomains (history taking, physical exam, and patient-physician interaction) and investigated the changes in these scores. Additionally, we classified the research subjects into 3 groups by total CPX score-higher (upper 30%, n=30), intermediate (medium 40%, n=40), and lower (lower 30%, n=30)-and compared the curves for each group.

Significant improvements were made on history taking and physical exam (F=130.786/237.358, p<0.01), while proficiency on the PPI declined (F=17.621, p<0.01). Additionally, scores in all levels improved continuously on history taking and physical exam, while students of the high and low levels experienced a sharp decline on the PPI (F=11.628, p<0.01).

Improvement in the history-taking score reflects an accumulation of clinical knowledge and clinical exposure. Improvement on the physical exam score is affected by repeated practice on similar or identical cases and receipt of feedback. That PPI can deteriorate might be an effect of one's negative experience in a clinical clerkship.