early patient approach with feedback improves clinical skills of medical students
TRANSCRIPT
![Page 1: Early Patient approach with feedback Improves Clinical Skills of Medical Students](https://reader031.vdocuments.mx/reader031/viewer/2022022202/5884f94d1a28abf76f8b7a0b/html5/thumbnails/1.jpg)
Early patient approach with feedback improves
clinical skills of medical studentsKiatsak Rajborirug M.D., Hatyai Medical Education Center, Thailand
![Page 2: Early Patient approach with feedback Improves Clinical Skills of Medical Students](https://reader031.vdocuments.mx/reader031/viewer/2022022202/5884f94d1a28abf76f8b7a0b/html5/thumbnails/2.jpg)
Cognitive
3 Domains of Medical Education
SkillAttitude
![Page 3: Early Patient approach with feedback Improves Clinical Skills of Medical Students](https://reader031.vdocuments.mx/reader031/viewer/2022022202/5884f94d1a28abf76f8b7a0b/html5/thumbnails/3.jpg)
Cognitive
This teaching focus on SKILL.
SkillAttitude
![Page 4: Early Patient approach with feedback Improves Clinical Skills of Medical Students](https://reader031.vdocuments.mx/reader031/viewer/2022022202/5884f94d1a28abf76f8b7a0b/html5/thumbnails/4.jpg)
For medical profession : Clinical skill is the most important.
![Page 5: Early Patient approach with feedback Improves Clinical Skills of Medical Students](https://reader031.vdocuments.mx/reader031/viewer/2022022202/5884f94d1a28abf76f8b7a0b/html5/thumbnails/5.jpg)
Early patient approach
Feedback
Hypothesis
![Page 6: Early Patient approach with feedback Improves Clinical Skills of Medical Students](https://reader031.vdocuments.mx/reader031/viewer/2022022202/5884f94d1a28abf76f8b7a0b/html5/thumbnails/6.jpg)
Early patient approach
Feedback
Improve clinical skills ?
Hypothesis
![Page 7: Early Patient approach with feedback Improves Clinical Skills of Medical Students](https://reader031.vdocuments.mx/reader031/viewer/2022022202/5884f94d1a28abf76f8b7a0b/html5/thumbnails/7.jpg)
Bedside teaching was used for clinical skill learning..
Conventional skill teaching
![Page 8: Early Patient approach with feedback Improves Clinical Skills of Medical Students](https://reader031.vdocuments.mx/reader031/viewer/2022022202/5884f94d1a28abf76f8b7a0b/html5/thumbnails/8.jpg)
Bedside teaching was used for clinical skill learning. Teacher shows how to take good history and physical examination.
Take history and Physical examination - General, Abdomen, Cardiovascular, Chest and Neurological exam, etc.
Conventional skill teachingFollow me
![Page 9: Early Patient approach with feedback Improves Clinical Skills of Medical Students](https://reader031.vdocuments.mx/reader031/viewer/2022022202/5884f94d1a28abf76f8b7a0b/html5/thumbnails/9.jpg)
Hx, PE & feedback 1Pt /2St /1Fac /1 hr
Early patient approach with feedback
Each pair of medical students was assigned to approach a patient with different common medical problems under closed supervision and immediately feedback by a facilitator.
![Page 10: Early Patient approach with feedback Improves Clinical Skills of Medical Students](https://reader031.vdocuments.mx/reader031/viewer/2022022202/5884f94d1a28abf76f8b7a0b/html5/thumbnails/10.jpg)
Li b r a r y
Hx, PE & feedback 1Pt /2St /1Fac /1 hr
Self study4 hrs
Search for patient problems & learning issues
![Page 11: Early Patient approach with feedback Improves Clinical Skills of Medical Students](https://reader031.vdocuments.mx/reader031/viewer/2022022202/5884f94d1a28abf76f8b7a0b/html5/thumbnails/11.jpg)
Li b r a r y
Hx, PE & feedback 1Pt /2St /1Fac /1 hr
Self study4 hrs
Present 10 mins& briefing 5 mins
Present and wrap up
![Page 12: Early Patient approach with feedback Improves Clinical Skills of Medical Students](https://reader031.vdocuments.mx/reader031/viewer/2022022202/5884f94d1a28abf76f8b7a0b/html5/thumbnails/12.jpg)
Study profile
1st clinical year med students ( n= 124 )
Conventional clinical skill teaching (2002-2004)
( n = 56 )
+ Early patient approach with feedback (2005-2007)
( n = 68 )
![Page 13: Early Patient approach with feedback Improves Clinical Skills of Medical Students](https://reader031.vdocuments.mx/reader031/viewer/2022022202/5884f94d1a28abf76f8b7a0b/html5/thumbnails/13.jpg)
Study profile: 1st & 2nd evaluation
1st clinical year med students ( n= 124 )
1st clinical year OSCE scores
Conventional clinical skill teaching (2002-2004)
( n = 56 )
+ Early patient approach with feedback (2005-2007)
( n = 68 )
2nd clinical year long case examination scores
![Page 14: Early Patient approach with feedback Improves Clinical Skills of Medical Students](https://reader031.vdocuments.mx/reader031/viewer/2022022202/5884f94d1a28abf76f8b7a0b/html5/thumbnails/14.jpg)
• The curriculum and medical staffs were rather steady.
• Full scores of all measurement were adjusted to 100 percent.
Variables
![Page 15: Early Patient approach with feedback Improves Clinical Skills of Medical Students](https://reader031.vdocuments.mx/reader031/viewer/2022022202/5884f94d1a28abf76f8b7a0b/html5/thumbnails/15.jpg)
OSCE evaluation- 1st clinical year40 OSCE items
20 - medical based 20 - surgical based
The same 6 tasks
3 History taking – Fever, Headache and
abdominal pain.3 Physical exam – Chest, Heart and
Skin exam.
![Page 16: Early Patient approach with feedback Improves Clinical Skills of Medical Students](https://reader031.vdocuments.mx/reader031/viewer/2022022202/5884f94d1a28abf76f8b7a0b/html5/thumbnails/16.jpg)
Long case evaluation- 2nd clinical yearLong case exam score
History taking task
Physical examination task
Presentation
Problem solving
![Page 17: Early Patient approach with feedback Improves Clinical Skills of Medical Students](https://reader031.vdocuments.mx/reader031/viewer/2022022202/5884f94d1a28abf76f8b7a0b/html5/thumbnails/17.jpg)
Long case evaluation- 2nd clinical yearLong case exam score
History taking task
Physical examination task
Presentation
Problem solving
* Only History taking and PE task were evaluated.
![Page 18: Early Patient approach with feedback Improves Clinical Skills of Medical Students](https://reader031.vdocuments.mx/reader031/viewer/2022022202/5884f94d1a28abf76f8b7a0b/html5/thumbnails/18.jpg)
Statistic
• Mean score differences between 2 groups were compared by independent-samples T test.
• Statistical significant differences were
defined as p < 0.05.
![Page 19: Early Patient approach with feedback Improves Clinical Skills of Medical Students](https://reader031.vdocuments.mx/reader031/viewer/2022022202/5884f94d1a28abf76f8b7a0b/html5/thumbnails/19.jpg)
Results
![Page 20: Early Patient approach with feedback Improves Clinical Skills of Medical Students](https://reader031.vdocuments.mx/reader031/viewer/2022022202/5884f94d1a28abf76f8b7a0b/html5/thumbnails/20.jpg)
Fig 1: Mean different admission score.
51
52
53
54
55
56
57
Admission score
ConventionalPatient approach
P e r c e n t
-3.32 %
![Page 21: Early Patient approach with feedback Improves Clinical Skills of Medical Students](https://reader031.vdocuments.mx/reader031/viewer/2022022202/5884f94d1a28abf76f8b7a0b/html5/thumbnails/21.jpg)
Fig 2: OSCE - Mean different scores of Hx taking skills.
0
10
20
30
40
50
60
70
80
90
Abdominal
pain
Fever Headache
Conventional
Patient approach
P e r c e n t
9.17 %
7.02 % -7.50 %
![Page 22: Early Patient approach with feedback Improves Clinical Skills of Medical Students](https://reader031.vdocuments.mx/reader031/viewer/2022022202/5884f94d1a28abf76f8b7a0b/html5/thumbnails/22.jpg)
Fig 3: OSCE – Mean different scores of P.E. skills.
0
10
20
30
40
50
60
70
80
Chest exam Heart exam Skin exam
Conventional
Patient approach
P e r c e n t
17.79 % 1.69 %6.34 %
![Page 23: Early Patient approach with feedback Improves Clinical Skills of Medical Students](https://reader031.vdocuments.mx/reader031/viewer/2022022202/5884f94d1a28abf76f8b7a0b/html5/thumbnails/23.jpg)
Fig 4: Mean different sum OSCE score
69
70
71
72
73
74
75
76
77
78
OSCE sum
Conventional
Patient approach
5.19 %
P e r c e n t
![Page 24: Early Patient approach with feedback Improves Clinical Skills of Medical Students](https://reader031.vdocuments.mx/reader031/viewer/2022022202/5884f94d1a28abf76f8b7a0b/html5/thumbnails/24.jpg)
Fig 5: Mean different Long case exam score
72
74
76
78
80
82
84
History taking part Physical exam part
Conventional
Patient approach
P e r c e n t
0.58 %
2.82 %
![Page 25: Early Patient approach with feedback Improves Clinical Skills of Medical Students](https://reader031.vdocuments.mx/reader031/viewer/2022022202/5884f94d1a28abf76f8b7a0b/html5/thumbnails/25.jpg)
Conclusion
• Early patient approach with feedback
significantly improves some specific clinical skills of medical students.
• No significant improvement in long case examination.
• The benefit in other clinical skills should be further evaluated.
![Page 26: Early Patient approach with feedback Improves Clinical Skills of Medical Students](https://reader031.vdocuments.mx/reader031/viewer/2022022202/5884f94d1a28abf76f8b7a0b/html5/thumbnails/26.jpg)
![Page 27: Early Patient approach with feedback Improves Clinical Skills of Medical Students](https://reader031.vdocuments.mx/reader031/viewer/2022022202/5884f94d1a28abf76f8b7a0b/html5/thumbnails/27.jpg)