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

Direct observation of medical students' history and physical examination (H&P) skills by attendings is essential in ensuring trainees' competence. This study compared whether partial observations by multiple pediatric attendings across various clinical encounters versus a full observation by one attending affected students' performance on the pediatric Objective Structured Clinical Examination (OSCE) and the Year 3 Clinical Performance Examination (CPX3).

For the 2013-2014 and 2014-2015 academic years, 323 medical students submitted either H&P checklists completed by one attending observing an entire H&P (full observations) versus multiple attendings observing portions of the H&P (partial observations). The full and partial observation groups were compared by their pediatric OSCE and CPX3 performance.

Students submitting full observations (n = 185) versus partial observations (n = 138) revealed no difference in OSCE (3.10 vs 3.10, P = 0.98) or CPX3 scores (74.49 vs 75.31, P = 0.18). Students submitting checklists by clerkship midpoint performed better on the OSCE (3.11 vs 2.88, P = 0.001) and CPX3 (75.00 vs 72.25, P = 0.03).

Partial versus full observations of students' H&P skills have no effect on standardized clinical examination performance, and clerkships should consider using partial observations of students for efficient assessments. Promptness of checklist submission also may be an indicator of examination performance.