Department of Orthopaedic Surgery, University of Wisconsin-Madison, 1685 Highland Ave, Madison, WI, 53705, USA.
Department of General Surgery, Western Michigan University Homer Stryker MD School of Medicine, Kalamazoo, MI, USA.
BMC Med Educ. 2024 Mar 1;24(1):211. doi: 10.1186/s12909-024-05184-w.
Components factoring into general surgery clerkship grades vary by institution, and while evaluators attempt to remain unbiased when evaluating medical student performance, subjectivity and implicit bias remain an issue. Our institution recently implemented a case-based structured oral examination to provide the general surgery clerkship director objective insight into students' clinical reasoning skills. We hypothesized that medical students believe this exam, along with graded clinical documentation and the Observed Standardized Clinical Encounter (OSCE), are fair assessments and increase students' awareness of their clinical reasoning skills.
A survey was sent to third-year medical students in the classes of 2023 and 2024 at our institution who had completed their general surgery clerkship. Students rated five grading assessments (i.e., preceptor evaluations, the oral examination, clinical documentation, the OSCE, and the shelf exam) on fairness and the ability of the assessment to give them insight into their clinical reasoning on a five-point Likert scale 1-5 (with 1 = Strongly Agree, 5 = Strongly Disagree).
One hundred and ten of 162 (67.9%) students responded to the survey. The shelf examination was the most highly regarded assessment tool followed by the oral examination. Seventy-three percent agreed or strongly agreed that the oral exam was a fair assessment, and 80% agreed or strongly agreed that it gave them insight into their clinical reasoning skills. Alternatively, only 41.8% of students agreed or strongly agreed that preceptor evaluations were fair assessments and 42.7% agreed or strongly agreed that it gave them insight into their clinical reasoning.
Third-year medical students on a general surgery clerkship favor the shelf examination and a case-based oral examination over other assessment tools regarding fairness and perception of their clinical reasoning. This type of examination can provide general surgery clerkship directors with additional objective data to assess medical students more fairly and improve students' clinical reasoning.
外科实习成绩的因素因机构而异，尽管评估者在评估医学生表现时试图保持不偏不倚，但主观性和隐含偏见仍然是一个问题。我们的机构最近实施了基于案例的结构化口头考试，以便为普通外科实习主任提供学生临床推理技能的客观见解。我们假设医学生认为这次考试以及分级临床记录和观察标准化临床遭遇（OSCE）是公平的评估，可以提高学生对自己临床推理技能的认识。
向我们机构 2023 年和 2024 年的三年级医学生发送了一份调查，他们已经完成了普通外科实习。学生们根据公平性和评估能力，对五项评分评估（即导师评估、口头考试、临床记录、OSCE 和架子考试）进行了五分制的评价（1-5，1=强烈同意，5=强烈不同意）。
162 名学生中有 110 名（67.9%）对调查做出了回应。架子考试是最受重视的评估工具，其次是口头考试。73%的人同意或强烈同意口头考试是公平的评估，80%的人同意或强烈同意它让他们了解自己的临床推理技能。相比之下，只有 41.8%的学生同意或强烈同意导师评估是公平的评估，只有 42.7%的学生同意或强烈同意它让他们了解自己的临床推理。
普通外科实习的三年级医学生更喜欢架子考试和基于案例的口头考试，而不是其他评估工具，因为它们涉及公平性和对他们临床推理的看法。这种类型的考试可以为普通外科实习主任提供额外的客观数据，以便更公平地评估医学生，并提高学生的临床推理能力。
