Department of Internal Medicine, Yale School of Medicine, 789 Howard Avenue, New Haven, CT, USA.
Department of Pediatrics, Yale School of Medicine, New Haven, CT, USA.
BMC Med Educ. 2023 Jul 13;23(1):504. doi: 10.1186/s12909-023-04424-9.
With the elimination in 2021 of the United States Medical Licensing Examination Step 2 Clinical Skills test, it is incumbent upon U.S. medical schools to develop local validated assessments of clinical reasoning. While much attention has been paid to summative exams for graduating students, formative exams for pre-clerkship students have not been well studied.
We applied the University of Illinois at Chicago College of Medicine (UIC-COM) Patient Note (PN) Scoring Rubric to templated PNs written by 103 pre-clerkship students for two cases in an objective structured clinical examination (OSCE) at the Yale School of Medicine. The rubric consists of four section scores (Documentation, Differential Diagnosis, Justification, and Workup, each scored 1 to 4) and a composite score (scaled 23 to 100). We calculated item discrimination for each section score and Cronbach's alpha for each case. We surveyed students about their experience writing the templated PN.
Mean Documentation, Differential Diagnosis, Justification, Workup, and composite scores for case A were 2.16, 1.80, 1.65, 2.29, and 47.67, respectively. For case B, the scores were 2.13, 1.21, 1.60, 1.67, and 40.54, respectively. Item discrimination ranged from 0.41 to 0.80. Cronbach's alpha for cases A and B was 0.48 and 0.25, respectively. A majority of the students felt that the exercise was useful and appropriate to their level of training.
Despite performing poorly, pre-clerkship students found the note-writing task beneficial. Reliability of the scoring rubric was suboptimal, and modifications are needed to make this exercise a suitable measure of clinical reasoning.
随着 2021 年美国医师执照考试第二阶段临床技能考试的取消，美国医学院有责任开发针对临床推理的本地验证评估。尽管人们对毕业学生的总结性考试给予了很多关注，但对预科学生的形成性考试却没有得到很好的研究。
我们将伊利诺伊大学芝加哥医学院（UIC-COM）的患者笔记（PN）评分量表应用于耶鲁大学医学院客观结构化临床考试（OSCE）中两个病例的 103 名预科生编写的模板 PN。该量表由四个部分的分数组成（文档、鉴别诊断、理由和检查，每个分数为 1 到 4）和一个综合分数（范围为 23 到 100）。我们为每个部分分数计算了项目区分度，为每个病例计算了克朗巴赫α系数。我们调查了学生对编写模板 PN 的经验。
病例 A 的平均文档、鉴别诊断、理由、检查和综合分数分别为 2.16、1.80、1.65、2.29 和 47.67。病例 B 的分数分别为 2.13、1.21、1.60、1.67 和 40.54。项目区分度范围从 0.41 到 0.80。病例 A 和 B 的克朗巴赫α系数分别为 0.48 和 0.25。大多数学生认为该练习对他们的培训水平有用且合适。
尽管预科生表现不佳，但他们发现书写任务有益。评分量表的可靠性不理想，需要进行修改，使这项练习成为衡量临床推理的合适方法。
