Medical Student H&Ps: Do You Have to Observe Them All At Once?

Area of Science:

• Medical Education
• Clinical Skills Assessment

Background:

• Direct observation of medical students' history and physical examination (H&P) skills by attending physicians is crucial for assessing trainee competence.
• Current assessment methods vary, with some utilizing full observations by a single attending and others employing partial observations by multiple attendings.

Purpose of the Study:

• To compare the impact of partial versus full H&P observations on medical students' performance in standardized clinical examinations.
• To determine if different observation methods affect outcomes on the pediatric Objective Structured Clinical Examination (OSCE) and the Year 3 Clinical Performance Examination (CPX3).

Main Methods:

• A comparative study involving 323 medical students over two academic years (2013-2014 and 2014-2015).
• Students were divided into groups based on whether they received full H&P observations (n=185) or partial observations (n=138).
• Performance was evaluated using pediatric OSCE and CPX3 scores.

Main Results:

• No significant difference was found in OSCE scores between students who underwent full observations (3.10) and partial observations (3.10, P=0.98).
• Similarly, no significant difference was observed in CPX3 scores between the full (74.49) and partial (75.31, P=0.18) observation groups.
• Students who submitted checklists by the midpoint of their clerkship demonstrated better performance on both OSCE (3.11 vs 2.88, P=0.001) and CPX3 (75.00 vs 72.25, P=0.03).

Conclusions:

• Partial observations of students' H&P skills are as effective as full observations in predicting standardized clinical examination performance.
• Medical clerkships can adopt partial observation strategies for more efficient assessment of student H&P skills.
• The timeliness of checklist submission may correlate with improved examination performance, suggesting its potential as an assessment metric.