University of Pittsburgh School of Medicine, University of Pittsburgh Medical Center, Department of Surgery, Pittsburgh, Pennsylvania 15213, USA.
J Surg Educ. 2011 Jul-Aug;68(4):266-9. doi: 10.1016/j.jsurg.2011.02.012. Epub 2011 Apr 16.
There is poor interrater reliability in the assessment of a medical student's ability to generate a differential diagnosis list using Likert-based scales in the surgical clerkship. This important clinical skill is tested on the United States Medical Licensing Examination Step 2 Clinical Skills Examination.
We hypothesize that third-year medical students in the surgical clerkship will be able to accurately diagnose adult patients with acute abdominal pain after performing a focused history and physical examination in a 3-station Objective Structured Clinical Examination (OSCE). Second, we want to test our hypothesis that service assessments of a student's ability to analyze data will not correspond with OSCE performance.
In this retrospective study, third-year medical student differential diagnosis lists from a 3-station OSCE and medical student clerkship assessments were collected from the 2009-2010 academic year. Differential diagnosis lists were scored for accuracy. Differences between groups were compared with nonparametric statistics, using an α = 0.05.
Seventy-eight third-year medical students (56.4% female) were evaluated. For 2 stations, more than half of the medical students had the correct diagnosis on the differential diagnosis list (p < 0.0001). For 1 station, less than half of the medical students had the correct diagnosis on the differential diagnosis list (p = 0.0001). There were no differences in the service evaluation scores and the number of correct differential diagnosis lists for the students (p = 0.91).
Third-year medical students are generally accurate with the ability to diagnosis adult patients with acute abdominal pain after performing a history and physical examination. Additionally, surgical service faculty and resident assessments of a student's ability to analyze data do not correspond with OSCE performance. We recommend some changes that might lead to improved grading for third-year medical students in the surgical clerkship.
在外科实习中，使用基于李克特量表的评分来评估医学生生成鉴别诊断列表的能力，其评分者间信度较差。这一重要的临床技能在美国医师执照考试（USMLE）第二步临床技能考试中进行测试。
我们假设，在 3 站式客观结构化临床考试（OSCE）中，进行重点病史采集和体格检查后，外科实习的三年级医学生会准确诊断出患有急性腹痛的成年患者。其次，我们希望验证假设，即学生数据分析能力的服务评估与 OSCE 表现并不相关。
在这项回顾性研究中，我们从 2009-2010 学年收集了 3 站式 OSCE 和医学生实习评估中的三年级医学生鉴别诊断列表。对鉴别诊断列表的准确性进行评分。使用非参数统计比较组间差异，α 值设定为 0.05。
共评估了 78 名三年级医学生（56.4%为女性）。对于 2 个站点，超过一半的医学生在鉴别诊断列表上有正确的诊断（p < 0.0001）。对于 1 个站点，不到一半的医学生在鉴别诊断列表上有正确的诊断（p = 0.0001）。学生的服务评估分数和正确鉴别诊断列表的数量之间没有差异（p = 0.91）。
三年级医学生在进行病史采集和体格检查后，通常能够准确诊断出患有急性腹痛的成年患者。此外，外科服务教师和住院医师对学生数据分析能力的评估与 OSCE 表现不相关。我们建议进行一些改变，以提高外科实习中三年级医学生的评分。
