key: cord-0948282-nn4v8fkz authors: Park, Kyong-Min; Park, Kye-Yeung; Kim, Nam-Eun; Seo, Bong-Kyung; Park, Hoon-Ki; Hwang, Hwan-Sik title: Effects of Module Development and Role Play Course on Clinical Practice Examination Scores during a 4th Year Clerkship date: 2018-01-23 journal: Korean J Fam Med DOI: 10.4082/kjfm.2018.39.1.23 sha: ddb9dfdd7b98f39f282347a314eefb4a04e722f3 doc_id: 948282 cord_uid: nn4v8fkz BACKGROUND: After introduction of clinical skills assessment in the Korean Medical Licensing Examination, medical schools have reinforced both experiential learning with real patients and preparatory programs. This study was conducted to investigate whether a clinical practice examination (CPX) preparation program improves students' CPX score in terms of case specificity. METHODS: One hundred and thirteen senior students in a medical school participated in this study. During the fourth-year clerkship, 28 students (24.8%) from three rotation groups took a 3-day CPX preparation course consisting of module development, role play, and comprehensive physical exam skills training. Eleven rotation groups (n=85) were compared as control. Both the intervention and control group took two comprehensive CPXs before and after the clerkship was completed. RESULTS: There was no significant difference in age, sex, and school type between the two groups. On pre-test CPX, there was no significant difference in total and sectional scores between the two groups. On post-test CPX, total scores of the intervention group were higher than those of the control groups (69.5±4.3 vs. 67.5±4.4, P<0.05). History taking scores were higher in intervention groups (70.0±6.0 vs. 66.0±6.6, P=0.01). The station scores of vaginal discharge with case similarity were higher in the intervention groups (73.0±6.3 vs. 68.9±9.3, P=0.03). CONCLUSION: A short CPX preparation course improved history taking ability, but its effect was greater only in a specific case, similar to the pre-course case. Whether this effect was due to the test experience or true improvement in competency requires further investigation. One hundred and thirteen students in their fourth-year of a medical school located in Seoul participated in this study. Seventy-one (62.8%) of the subjects were male students, and 57 (50.4%) of the subjects were medical college students. The average age was 26.2±2.5 years. During Table 1 . The other 11 rotation groups had completed their respective community medicine training were not subject to any organized CPX-related training program. Effects of the three-day preparation program could thus be compared through a common subsequent comprehensive CPX between the intervention and control groups. The CPX preparation program was operated by a professor, a clinical instructor, and a medical resident in the department of family medicine. Guidelines for CPX case development was taught as the core lecture on the first day, and each group was then divided into three subgroups consisting of three students each to develop cases on three CPX clinical problems (cough, vaginal discharge, and hand tremor). For case selection, students referred to the '2015 basic clinical practice guidelines, ' published by Korea Association of Medical Colleges, using their experience with the actual patients they came across during their clinical clerkship. The three groups were given the same CPX clinical problems, but were asked to develop modules based on All students took a CPX on 13 stations in February 2015. CPX on 13 stations was conducted again in July 2015 after the fourth-year clerkship. Both examinations involved a 10-minute one-on-one interview with standardized patient and evaluation of standardized patient on clinical competency of students based on a checklist that consists of six sections (patient satisfaction, history taking, physical exam, clinical courtesy, patient education, and patient-physician interaction). This study sought to analyze the difference between the score marked by the students who underwent these programs and the score marked by the student who did not undergo these programs. Two of the taught CPX clinical problems (vaginal discharge, cough) were comprised some of the problems in the CPX taken in July. The scores were determined by standardized patients who acted as raters. A chi square test and Student t-test were used to analyze basic characteristics of students. Student t-test and paired t-test were used to compare CPX results between February and July. Statistical significance was assumed when P<0.05, and the analysis of all data was done using IBM SPSS ver. 21.0 (IBM Corp., Armonk, NY, USA). There was no significant difference in the distribution of age, sex, and school type between the intervention and control group (Table 2) . There was no significant difference between two groups in total score and sectional scores (patient satisfaction, history taking, physical exam, clinical courtesy, patient education, and patient-physician interaction) on the CPX conducted in February 2015 (Table 3) . All scores, except for physical exam, increased in both the intervention group and control group on the CPX conducted in July. In particu- Values are presented as mean±standard error or number (%). *Obtained using a Student t-test for age; the c 2 test was used for sex and type of school. We may interpret it as the educational module being the focus on history taking with case specificity. Other educational interventions, such as a general hands-on skill course for comprehensive physical exam skills, were ineffective enough to affect the area score. There was no significant correlation between school achievement, history taking, and physical exam scores of students; 9) history taking and physical exam, sections that require frequent contact with patients, were regarded by students to be the most difficult on the first CPX held in Korea. 10) This means that it is difficult to significantly increase scores on history taking and physical exam through ordinary curriculum. In this study, activities of students to prepare checklist for role play, feedback weak points during role play using the checklist, and repeatedly learn about the checklists of history taking section are believed to have directly and indirectly increased scores on history taking section. In a study by Han et al., 14) physician-patient interaction (PPI) score had high correlation with history taking. Smith 15) defined history taking as "a communication in which a patient can speak freely and a physician plays the role of an attentive listener to understand and ap- modules in the case of cough, and GERD is a key diagnosis to implicate the digestive system, unlike other cough problems (respiratory system). Therefore, this result suggests that scores may not increase unless role play practice is done on a wide variety of diseases for each item. However, this case specificity alone would not fully explain how the CPX results of the group, which underwent a preparation course, were higher than those of the group that did not undergo a preparation course. Training experiences would have led to acquiring relevant working knowledge and subsequent improvements in clinical competency in general. The limitations of this study are as follows. First, the scope of this study is limited to activities conducted within a single medical school, and thus carries inevitable restrictions when its findings are presented to a broader scope. Second, the long-term effects of CPX preparation education on the performance at the national examination could not be examined, as only the short-term effects were observed and exam- Predicting failing performance on a standardized patient clinical performance examination: the importance of communication and professionalism skills deficits Status of clerkship education and its evaluation in Korean medical schools Evaluation using simulated students for reliability of multiple standardized-patients scoring in clinical performance examinations Teaching clinical performance examination using action learning techniques Patient selection for bedside teaching: inclusion and exclusion criteria used by teachers How to apply small group teaching method Students' views on the use of real patients and simulated patients in undergraduate medical education The change of CPX scores according to repeated CPXs Analysis of the evaluation for clinical performance examination using standardized patients in one medical school Analysis of first clinical skills examination in the Korean medical licensing examination: focus on examinees' experience in a medical school Educational implication of peer evaluation in problem-based learning How to administer the peer evaluation in team-based learning Correlation of CPX scores with the scores of the clinical clerkship assessments and written examinations Comprehension of patient-physician interaction through analysis of relationships between domains in clinical performance examination Patient centered interviewing: an evidence-based method Patient-centeredness of medical students during a real patient encounter and a standardized patient encounter on the clinical performance examination How specific is case specificity? No potential conflict of interest relevant to this article was reported.