Performance-based Assessment of Internal Medicine Interns

Abstract

This exercise has given the faculty a detailed view of baseline clinical and written documentation skills of our entering interns. Overall, the residents demonstrated at least minimal competency in history taking and communication skills, but not in performing the expected focused physical exam. Their written reports showed adequate documentation of historical items but not of pertinent physical findings. The interns did not consistently make a problem list, provide a differential diagnosis, or show clinical reasoning despite being instructed to do so. There was great variation in performances between interns. Analysis of the interns' evaluations of this exercise showed that they felt it covered appropriate material, and they felt sufficiently prepared. Several interns had never done an OSCE prior to this exam. Written comments were positive about getting structured feedback early in their training. This format has allowed the identification of specific deficiencies in clinical skills for each of our interns, and this information will be used to guide our clinic preceptors in their teaching and in future evaluations. It would be ideal to design a second OSCE based on cases specific to internal medicine for the third-year residents, and compare skills developed over time.

Teaching about substance abuse with objective structured clinical exams

“…When immediate feedback on performance is provided, OSCEs can be formative in developing skills and enhancing knowledge 17,18 . Objective structured clinical exams are widely used in residency training disciplines, including internal medicine, 19,20 surgery, 12 pediatrics, 21 rehabilitation medicine, 22 psychiatry, 23,24 and family medicine 25 . They have also been used to teach and assess specialized skills such as delivering bad news, 26 addressing advanced care directives, 27 demonstrating cultural competence, 28 and ethical decision making 29 …”

Lost in translation: Unveiling medical students' untold errors of medical history documentation

“…Several studies have previously discussed the importance of documentation skills of the medical history interview in medical education and have evaluated documentation skills by medical students showing deficiencies in this competency 12–15 . A documentation analysis was also carried out with postgraduate clinicians 16 .…”

“…[8][9][10][11] Several studies have previously discussed the importance of documentation skills of the medical history interview in medical education and have evaluated documentation skills by medical students showing deficiencies in this competency. [12][13][14][15] A documentation analysis was also carried out with postgraduate clinicians. 16 However, clinicians may focus on a more efficient approach, in comparison with a more complete and systematic approach during medical school.…”

Conceptualization of category-oriented likelihood ratio: a useful tool for clinical diagnostic reasoning

“…Taking an adequate history and physical examination that suggest possible differential diagnoses are very important, so that without an adequate history and physical examination, all the subsequent diagnostic investigations might be misleading [2]. Despite its importance, significant weaknesses in the diagnostic skills among medical students, residents, and practicing physicians have been consistently reported [3,4]. Studies have shown that the most common error in the diagnostic reasoning of medical students and novice physicians is the use of non-discriminatory clinical findings (i.e.…”