Goldberg Gabrielle R, Olvet Doreen M, Fiorino Elizabeth K, John Janice T
Northwell, New Hyde Park, NY USA.
Department of Science Education, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY USA.
Med Sci Educ. 2024 Jun 8;34(5):1037-1047. doi: 10.1007/s40670-024-02086-w. eCollection 2024 Oct.
Medical educators aim to train students with high-quality clinical skills through the promotion of self-regulated learning and the development of lifelong learning skills. Formative clinical skills examinations (FCSE) allow for real-time learner-centered feedback and coaching which are key in promoting the development of expertise in early learners. This study assessed the impact of the integration of FCSE with learner-centered, real-time feedback and coaching based on an "educational plan-do-study-act" (PDSA) cycle on early medical students' experience and performance.
A mixed methods study was designed to assess the integration of FCSE for first- and second-year medical students. FCSE consisted of linked stations: students gathered a history from a standardized patient (SP), performed a hypothesis-driven physical examination followed by real-time learner-centered feedback and coaching. Each student met with one faculty and one SP to reflect on their performance, identify areas for improvement, re-practice of skills, and identify a plan for ongoing practice improvement. Students were surveyed upon completion of formative and summative clinical skills examinations. Student communication and clinical reasoning performance were compared to historical controls.
Students reported that FSCE improved the learning environment and helped prepare them for subsequent summative clinical skills examinations. Students appreciated the opportunity for practice and real-time feedback and reported applying their take-home points on subsequent exams. Student longitudinal performance was not impacted by the transition to FSCE.
While labor-intensive, FCSE with real-time feedback and coaching are an effective means of promoting learning and should be considered for integration early in medical school curricula.
医学教育工作者旨在通过促进自主学习和培养终身学习技能，来培养具有高质量临床技能的学生。形成性临床技能考试（FCSE）能够提供以学习者为中心的实时反馈和指导，这对于促进早期学习者专业技能的发展至关重要。本研究基于“教育计划-执行-研究-行动”（PDSA）循环，评估了将FCSE与以学习者为中心的实时反馈和指导相结合，对早期医学生的体验和表现产生的影响。
设计了一项混合方法研究，以评估针对一年级和二年级医学生的FCSE整合情况。FCSE由一系列相连的站点组成：学生从标准化患者（SP）那里收集病史，进行基于假设的体格检查，随后接受以学习者为中心的实时反馈和指导。每个学生与一名教员和一名标准化患者会面，反思自己的表现，确定需要改进的领域，重新练习技能，并制定持续改进练习的计划。在完成形成性和总结性临床技能考试后，对学生进行了调查。将学生的沟通和临床推理表现与历史对照组进行了比较。
学生报告称，FCSE改善了学习环境，并帮助他们为后续的总结性临床技能考试做好了准备。学生们对有机会进行练习和获得实时反馈表示赞赏，并报告说他们在后续考试中应用了所学要点。向FCSE的转变并未影响学生的纵向表现。
虽然FCSE需要耗费大量人力，但带有实时反馈和指导的FCSE是促进学习的有效手段，医学院校课程应尽早考虑将其纳入。
