Relationships between high-stakes clinical skills exam scores and program director global competency ratings of first-year pediatric residents

Responding to mandates from the Accreditation Council for Graduate Medical Education (ACGME) and American Osteopathic Association (AOA), residency programs have developed competency-based assessment tools. One such tool is the American College of Osteopathic Pediatricians (ACOP) program directors’ annual report. High-stakes clinical skills licensing examinations, such as the Comprehensive Osteopathic Medical Licensing Examination Level 2-Performance Evaluation (COMLEX-USA Level 2-PE), also assess competency in several clinical domains.The purpose of this study is to investigate the relationships between program director competency ratings of first-year osteopathic residents in pediatrics and COMLEX-USA Level 2-PE scores from 2005 to 2009.The sample included all 94 pediatric first-year residents who took COMLEX-USA Level 2-PE and whose training was reviewed by the ACOP for approval of training between 2005 and 2009. Program director competency ratings and COMLEX-USA Level 2-PE scores (domain and component) were merged and analyzed for relationships.Biomedical/biomechanical domain scores were positively correlated with overall program director competency ratings. Humanistic domain scores were not significantly correlated with overall program director competency ratings, but did show moderate correlation with ratings for interpersonal and communication skills. The six ACGME or seven AOA competencies assessed empirically by the ACOP program directors’ annual report could not be recovered by principal component analysis; instead, three factors were identified, accounting for 86% of the variance between competency ratings.A few significant correlations were noted between COMLEX-USA Level 2-PE scores and program director competency ratings. Exploring relationships between different clinical skills assessments is inherently difficult because of the heterogeneity of tools used and overlap of constructs within the AOA and ACGME core competencies

Bureaucracy and Wildlife: A Historical Overview

This paper provides a framework for understanding the Government\u27s position on many wildlife topics, including humane ethics. The Government\u27s historical role in wildlife conservation is traced to pertinent theories of bureaucracy. It is shown that Government involvement in wildlife conservation increased through successive stages of change because of interest group activity

Introducing Blended Learning to Medical Students in a Clinical Training Environment

Third year medical students typically learn through supervised patient interaction in a clinical setting, often based in academic or hospital-based training sites. As one of the five medical schools in the Philadelphia area, PCOM strives to find the best training sties for its students in a number of specialties. Due to the increasing number of students in the region as well as a decreasing number of available training sites (as a result of reduced hospitalization rates and lengths of stay), finding suitable training sites for students has been a challenge. In order to better meet the academic needs of our students, new educational models are required. These models need to address a number of key challenges. 1.Inconsistent clinical exposure to patients whose demographics and presenting problems vary by site. 2.Inconsistent training and quality of clinical preceptors at each of the clinical sites. 3.Insufficient clinic training sites to accommodate expanding class size.https://digitalcommons.pcom.edu/posters/1014/thumbnail.jp

Blended Learning Format for Pediatrics Clinical Rotation, Student Perspective

Introduction. Traditional medical educational models are shifting to incorporate learning technologies and online educational activities. Combining online and blended learning with the more traditional face-to-face clinical instruction appears to provide opportunity to engage leaners at remote clinical training sites. Objective. The purpose of this research study is to describe and evaluate the effectiveness of the blended-learning format for 3rd year medical students who participated in the pediatric blended learning supplement by investigating post-exercise survey responses, end-of-rotation examination (COMAT) scores and final course grades. Methods. Of the 264 third year students who completed the four-week clerkship in the 2014/15 academic year, 78 (29.5%) participated in the blended learning supplement and 186 (70.5%) participated in the traditional face-to-face course. Students in the study group were provided opportunity to complete a post-exercise survey regarding their experience with the blended learning format. The survey instrument included items specifically related to the online components of the course: 38 Likert-type items arranged in 10 sections with opportunity to provide open-ended comments for each section, as well as a 15-item adjective checklist. In addition, end-of-rotation examination (COMAT) scores and final course grades were compared between groups. Results. Overall students valued the blended learning experience. Of the 78 students in the study group, 53 completed the post-exercise survey (67.9% response rate). Of respondents, 88% agreed or strongly agreed with the statement “This was a practical learning experience,” and 85% agreed or strongly agreed with “The integration of eLearning and face-to-face learning helped me learn pediatrics.” Of respondents, 50% agreed or strongly agreed with the statement “I prefer this hybrid learning format to traditional face-to-face clinical rotations,” and 73% reported “The amount of work required for this course was appropriate.” Overall, 85% reported “I was satisfied with the overall learning experience.” A large number of comments (7/19 regarding “course format,” 8/19 regarding “overall experience,” and 3/14 regarding “open comments”) addressed desire to increase the amount of clinical exposure and face-to-face time with patients. Using a two-tailed t-test for analysis, no statistical differences were seen between control (traditional) and sample (blended learning) groups with regard to COMAT scores (p=0.321). Using a test for independence (using a chi squared distribution), final grades between groups were significantly different (p=0.015). Compared to the control group, more students in the blended learning group received a final grade of Honors. Conclusion. Results of this study support the use of blended learning in a clinical training environment. Students valued the blended learning approach, and while their end-of-rotation examination scores were not improved, they may have benefited from the blended learning supplement by receiving higher course grades. As more medical educators utilize blended learning, it is important to investigate the best balance between learning with technology and learning in a face-to-face setting. Online activities may enhance but should never fully replace face-to-face learning with real patients

Web-Based Objective Structured Clinical Examination with Remote Standardized Patients and Skype: Resident Experience

OBJECTIVE: Using Skype and remote standardized patients (RSPs), investigators sought to evaluate user acceptance of a web-based objective structured clinical examination (OSCE) among resident physicians. METHODS: After participating in four web-based clinical encounters addressing pain with RSPs, 59 residents from different training programs, disciplines and geographic locations completed a 52-item questionnaire regarding their experience with Skype and RSPs. Open-ended responses were solicited as well. RESULTS: The majority of participants (97%) agreed or strongly agreed the web-based format was convenient and a practical learning exercise, and 90% agreed or strongly agreed the format was effective in teaching communication skills. Although 93% agreed or strongly agreed they could communicate easily with RSPs using Skype, 80% preferred traditional face-to-face clinical encounters, and 58% reported technical difficulties during the encounters. Open-ended written responses supported survey results. CONCLUSION: Findings from this study expose challenges with technology and human factors, but positive experiences support the continued investigation of web-based OSCEs as a synchronous e-learning initiative for teaching and assessing doctor-patient communication. Such educational programs are valuable but unlikely to replace face-to-face encounters with patients. PRACTICE IMPLICATIONS: This web-based OSCE program provides physician learners with additional opportunity to improve doctor-patient communication

Correlation Between An Email Based Board Review Program and American Board of Pediatrics General Pediatrics Certifying Examination Scores

Objective To investigate the impact of a weekly email based board review course on individual resident performance on the American Board of Pediatrics (ABP) General Pediatrics Certifying Examination for pediatric residents and, specifically, residents with low ABP In-training Examination (ITE) scores. Methods Weekly board-type questions were emailed to all pediatric residents from 2004–2007. Responses to board-type questions were tracked, recorded, and correlated with ITE scores and ABP General Pediatrics Certifying Examination Scores. Results With regard to total number of questions answered, only total number of questions answered correctly had a significant positive correlation with standard board scores (n = 71, r = 0.24, p = 0.047). For “at risk” residents with ITE scores ≤ 200 (n = 21), number of questions answered in PL 3 year (r = 0.51, p = 0.018) and number of questions answered correctly for all PL years (r = 0.59, p = 0.005) had significant positive correlations with standard board scores. Conclusions Participating regularly in the email-based board review course, answering board style questions, and answering correctly to board style questions were associated with higher standard board scores. This benefit existed for all but was especially prominent among those with poor in-training examination scores

Perspectives of Dermatology Program Directors on the Impact of Step 1 Pass/Fail.

INTRODUCTION: The shift of Step 1 to Pass/Fail has generated several questions and concerns about obtaining residency positions among allopathic and osteopathic students alike. Determining the perspectives of Dermatology Program Directors in regards to post-Step 1 Pass/Fail is critical for students to better prepare for matching into dermatology. METHODS: After receiving Institutional Review Board (IRB) exemption status, the program directors were chosen from 144 Accreditation Council for Graduate Medical Education (ACGME) and 27 American Osteopathic Association (AOA) Dermatology programs using contact information from their respective online website databases. An eight-item survey was constructed on a three-point Likert scale, one free text response, and four demographic questions. The anonymous survey was sent out over the course of three weeks with weekly individualized reminder requests for participation. RESULTS: A total of 54.54% of responders had Letters of Recommendation in their top 3. Forty-five percent of responders had Completed Audition Rotation at Program in their top 3. And, 38.09% of responders had USMLE Step 2 CK Scores in their top 3. CONCLUSION: Approximately 50% of responders agreed that all medical students will have more difficulty matching dermatology. Based on the survey study, Dermatology program directors want to focus more on letters of recommendation, audition rotations, and Step 2 CK scores. Because each field seems to prioritize different aspects of an application, students should attempt to gain as much exposure to different fields such as through research and shadowing to narrow down their ideal specialties. Consequently, the student will have more time to tailor their applications to what residency admissions are looking for

Survey of Osteopathic Medical Students Regarding Physician Shadowing Experiences Before and During Medical School Training.

Introduction: Shadowing a physician is an observational experience which includes a student observing a licensed healthcare provider caring for patients. Shadowing is commonly done by students before and during medical school, but little is known about the nature or extent of these extra-curricular observational experiences. Objective: We hypothesized that shadowing experiences were common yet variable. We investigated the prevalence, nature, and perceived value of medical student experiences with shadowing physicians (both before and during medical school). Methods: This survey-based study was non-experimental with a cross-sectional convenience sample of osteopathic medical students about their shadowing experiences before and during medical school. The survey was sent to all matriculated osteopathic medical students (OMS1-4) for the 2017 to 2018 academic year from two medical schools: Philadelphia College of Osteopathic Medicine (PCOM) (1084 total students) and PCOM-Georgia (554 total students). The final survey instrument included three sections: demographics (6 questions), pre-medical shadowing experiences (21 questions), and medical student shadowing experiences (24 questions). Results: Respondents (357) identified themselves as OMS1 (96), OMS2 (89), OMS3 (73), OMS4 (95) and other (2, OMS5) with enrollment at PCOM-Philadelphia (242) and PCOM-Georgia (115). Among survey respondents, 339 (95.5%) reported shadowing a physician as a pre-medical student, and 110 (30.8%) reported shadowing (outside of their required clinical rotations) a physician during medical school. Requirements to participate were inconsistent; fewer than 50% of shadowing experiences required Health Insurance Portability and Accountability Act of 1996 (HIPAA) training, proof of vaccination, or purified protein derivative (PPD) documentation. In addition to observation, pre-medical and medical students, respectively, participated in history taking (44 [13%], 47 [42.7%]), physical examinations (45 [13.3%], 44 [40%]) and procedures (13, [3.8%], 20 [18.2%]) during their shadowing experiences. Motivations to participate in shadowing varied between pre-medical and medical student experiences, but both groups mentioned their desire to learn more about a particular discipline, obtain letters of recommendation, and gain patient care experience. Students recommended both pre-medical (273 [80.5%]) and medical school (93 [84.5%]) shadowing to future students. Conclusion: Shadowing remains a common and important tool for students to learn about patient care, medicine and careers. The nature of each shadowing experience and participation requirements are quite variable. Measures to ensure patient safety, confidentiality, liability and supervision are inconsistently applied. Promoting guidelines, as well as codes of conduct, for shadowing could serve as a helpful resource for students, academic advisors and supervising clinicians