Department of General Surgery, Washington University in St. Louis, MO.
Department of General Surgery, Washington University in St. Louis, MO.
Surgery. 2022 Mar;171(3):590-597. doi: 10.1016/j.surg.2021.11.005. Epub 2021 Dec 8.
Oral examinations are not consistently included in third-year medical student clerkships. When included, they are often unstructured, leaving room for variations in difficulty or scoring. Previous research has demonstrated differences in clinical grade achievement, with underrepresented in medicine students receiving significantly lower grades than White students.
We designed a structured oral examination for third-year medical students on the surgery clerkship. Students completed 2 oral examination scenarios and were evaluated on their ability to complete a history and diagnostic workup, interpret laboratory and imaging results, and devise a treatment plan. Scores from our examination were compared to previous, unstructured oral examination scores and to student demographics. Students and faculty were surveyed regarding their experience.
Third-year medical students demonstrated strong knowledge of multiple surgical diseases. The greatest number of errors occurred in treatment planning (P < .001). Third-year medical students receiving honors clerkship grades achieved higher percentages of correct items on their oral examination. (94.8% vs 90.4%) (P = .02). Evaluation of prior unstructured oral examinations found underrepresented in medicine students received lower scores than White students (P = .04). After implementation of our structured examination, no difference was seen between the scores of underrepresented in medicine and White students (P = .99).
We implemented a standardized oral examination for third-year medical students on the surgery clerkship with student and faculty satisfaction and demonstrated the ability to determine domains of knowledge weakness. The application of our structured oral examination helped to address nonspecific grading practices and eliminate oral examination grade differences between underrepresented in medicine and White students.
口腔考试并不总是包含在三年级医学生的实习中。当包括在内时，它们往往是无结构的，为难度或评分的变化留下了空间。以前的研究表明，临床成绩存在差异，医学专业的学生成绩明显低于白人学生。
我们为三年级医学生的外科实习设计了一种结构化的口腔考试。学生完成了 2 个口腔考试情景，并根据他们完成病史和诊断性检查、解释实验室和影像学结果以及制定治疗计划的能力进行评估。我们的考试成绩与之前的非结构化口腔考试成绩和学生人口统计学数据进行了比较。学生和教师对他们的经验进行了调查。
三年级医学生对多种外科疾病有很强的了解。治疗计划中错误最多（P<.001）。获得荣誉实习成绩的三年级医学生在口腔考试中答对的项目比例更高（94.8%比 90.4%）（P=.02）。对以前的非结构化口腔考试的评估发现，医学专业的学生得分低于白人学生（P=.04）。在实施我们的结构化考试后，医学专业和白人学生的分数之间没有差异（P=1.00）。
我们在外科实习中为三年级医学生实施了标准化的口腔考试，学生和教师都很满意，并证明了确定知识薄弱领域的能力。我们的结构化口腔考试的应用有助于解决非特定的评分实践，并消除医学专业和白人学生之间的口腔考试成绩差异。
