Department of Surgery, Texas Tech University Health Sciences Center, El Paso, Texas 79905, USA.
J Surg Educ. 2013 Jan-Feb;70(1):68-75. doi: 10.1016/j.jsurg.2012.07.005. Epub 2012 Aug 28.
Medical students in surgical clerkships must gain surgical knowledge while doing clinical rotations. We developed a self-learning program, which is case based, the Case Review Question (CRQ) system. Our hypothesis was that students who used CRQs would score higher on the summative test, Surgery NBME (National Board of Medical Examiners).
The setting is a surgical clerkship in a Liaison Council for Medical Education (LCME) approved Medical School, with summative examination using the NBME shelf examination in Surgery. Each CRQ document is a series of 20 to 25 questions based on cases. The cases are a paragraph, with pertinent medical facts and extra facts as distracters. The students are encouraged to use these questions to guide study. Students must come to a review session to hear the answers and a discussion. We review the NBME Surgery shelf examination scores taken before and after this program was initiated, along with changes in rotation group size, call schedule type, and other changes.
CRQs, review sessions, and call schedule changes improved scores. NBME examination average rose from 77.12 to 82.01 (p = 0.004) after the CRQ program was initiated. Call schedule revision improved scores: intermittent call NBME score was 80.98, whereas night float schedule mean NBME was 84.66 (p < 0.001). During night float call, the CRQ program was already in effect, so that there is no non-CRQ program comparison group. Students scored higher in the second semester, throughout the study. First semester students scored a mean of 79.11, whereas second semester students scored 84.195 (p < 0.001). By the end of the study, there were no failures on the NBME examination, even in the first semester. The factors of presence of the CRQ program, review sessions, call schedule type, and which semester were all significant in a correlation matrix against NBME scores and in a regression analysis (p < 0.001).
The CRQ program of case-based self-study was associated with higher scores on the NBME shelf examination, as a summative test of medical knowledge in surgery.
外科实习医学生在临床轮转过程中必须获得外科知识。我们开发了一个基于案例的自学项目，即案例复习问题（CRQ）系统。我们的假设是，使用 CRQ 的学生在总结性考试（外科 NBME）中的得分会更高。
该研究设置在医学教育联络委员会（LCME）认可的医学院的外科实习中，使用 NBME 外科架式考试作为总结性考试。每个 CRQ 文档都是基于案例的 20 到 25 个问题的系列。案例是一段文字，其中包含相关的医学事实和额外的事实作为干扰项。鼓励学生使用这些问题来指导学习。学生必须参加复习课，以听取答案和讨论。我们回顾了在启动该项目前后的 NBME 外科架式考试成绩，以及轮转组规模、值班时间表类型和其他变化。
CRQ、复习课和值班时间表的变化提高了分数。在启动 CRQ 项目后，NBME 考试平均成绩从 77.12 提高到 82.01（p=0.004）。值班时间表的修改提高了分数：间歇性值班的 NBME 分数为 80.98，而夜间值班的平均 NBME 分数为 84.66（p<0.001）。在夜间值班期间，CRQ 项目已经生效，因此没有非 CRQ 项目对照组。学生在整个研究过程中，第二学期的得分更高。第一学期的学生平均得分为 79.11，而第二学期的学生得分为 84.195（p<0.001）。在研究结束时，甚至在第一学期，也没有人在 NBME 考试中不及格。CRQ 项目的存在、复习课、值班时间表类型以及学期这四个因素在与 NBME 分数的相关矩阵和回归分析中都是显著的（p<0.001）。
基于案例的自学的 CRQ 项目与 NBME 架式考试的更高分数相关，作为外科医学知识的总结性考试。
