A new method for the assessment of patient safety competencies during a medical school clerkship using an objective structured clinical examination

INTRODUCTION: Patient safety is seldom assessed using objective evaluations during undergraduate medical education. OBJECTIVE: To evaluate the performance of fifth-year medical students using an objective structured clinical examination focused on patient safety after implementation of an interactive program based on adverse events recognition and disclosure. METHODS: In 2007, a patient safety program was implemented in the internal medicine clerkship of our hospital. The program focused on human error theory, epidemiology of incidents, adverse events, and disclosure. Upon completion of the program, students completed an objective structured clinical examination with five stations and standardized patients. One station focused on patient safety issues, including medical error recognition/disclosure, the patient-physician relationship and humanism issues. A standardized checklist was completed by each standardized patient to assess the performance of each student. The student's global performance at each station and performance in the domains of medical error, the patient-physician relationship and humanism were determined. The correlations between the student performances in these three domains were calculated. RESULTS: A total of 95 students participated in the objective structured clinical examination. The mean global score at the patient safety station was 87.59 ± 1.24 points. Students' performance in the medical error domain was significantly lower than their performance on patient-physician relationship and humanistic issues. Less than 60% of students (n = 54) offered the simulated patient an apology after a medical error occurred. A significant correlation was found between scores obtained in the medical error domains and scores related to both the patient-physician relationship and humanistic domains. CONCLUSIONS: An objective structured clinical examination is a useful tool to evaluate patient safety competencies during the medical student clerkship

“Extensão Médica Acadêmica”: healthcare humanization and clinical training of medicine, nutrition and physical therapy students from the School of Medicine of University of São Paulo

A Extensão Médica Acadêmica (EMA) foi fundada em 1998 na FMUSP visando à formação de médicos que valorizam o exame clínico e o relacionamento humano. É um projeto de voluntariado atualmente organizado por estudantes de medicina, fisioterapia e nutrição da USP. O EMA é sustentado por três pilares: ensino, assistência e pesquisa. O projeto é realizado aos sábados em dois bairros carentes da cidade de São Paulo, e tem como objetivo oferecer um atendimento ambulatorial gratuito de qualidade, que priorize cuidados em saúde e humanização na relação médico-paciente. Os pacientes são atendidos por alunos e os casos são discutidos com profissionais de saúde, e durante a semana são realizadas reuniões com todos os membros do projeto, na Faculdade de Medicina da USP, contribuindo para a consolidação e aprofundamento dos conceitos em saúde. Este modelo de ensino complementa os estudos em sala de aula, pois permite o desenvolvimento de habilidades geralmente pouco exploradas durante o início da graduação tradicional. O EMA incentiva seus alunos a valorizarem a relação médico-paciente desde o primeiro ano da graduação. Assim, o projeto tem êxito em reunir pessoas dispostas a lidar com pacientes, aprender sobre saúde e ensinar outros estudantes. Como resultado, muitos de seus membros continuam a participar do projeto após o término da faculdade, tornando-se orientadores comprometidos a passar adiante o conhecimento adquirido durante sua prática profissional.The Academic Medical Extension (EMA) is a volunteer project of the School of Medicine of University of São Paulo organized by students of Medicine, Physical Therapy and Nutrition of University of São Paulo. It was founded in 1998 in order to provide a better academic developmentto students who value physical examination and human relations, besides providing to students in the beginningof graduation an early contact with patients and promotingan exchange of information between those three areas of health. EMA is sustained by three pillars: assistance, education and research, thus constituting an alternative to community-based education and assistance with a focus on humanization. The project is carried in two regions in the city of São Paulo and aims to offer these needy populations a free ambulatory care with quality, promote health and prevention. On Saturdays, undergraduate students see the patients and discuss the clinical case with a health professional;once a week, they attend a meeting with their group, which includes students of the three areas of health. During this meeting, the students report the clinical case and are assisted by other students to conduct the case and teach what they’ve learnt about the patient, collaborating with the establishment and deepening of the concepts in health. The project seeks to encourage their students since the first year of college to value the physician-patient relationship. Thus, it brings together people willing to work without the intention to earn a profit, but to learn more about health and to teach other students. As a result, members still participate in the project after graduation, as doctors committed to pass on their experience and knowledge

Performance markers on the admission exam for candidates to both basic areas and direct access specialties from 2009 to 2016

Introdução: Múltiplas estratégias de avaliação podem ser utilizadas em exames de seleção. É importante a compreensão de como as características pessoais podem influenciar na performance de cada tipo de avaliação. Nosso estudo avaliou a associação entre as características pessoais (sexo, ano de graduação, programa de residência de interesse) e da escola médica de graduação (ano de fundação da escola, localização, privado/pública) com a performance em oito anos do exame de admissão de residência médica de acesso direto Hospital das Clínicas da Universidade de São Paulo. Metodologia: Foram analisados 19.699 candidatos que realizaram as questões dissertativas de respostas curtas (DRC) e 5.475 candidatos que realizaram tanto os DRC quanto a avaliação de habilidades em estilo OSCE (Objective Structured Clinical Examination). Para melhor comparação, as principais análises foram realizadas no último grupo. As notas dos candidatos foram padronizadas em cada ano utilizando z-escores. Utilizamos modelos de regressão logística ordinal para verificar se (a) o desempenho na prova DRC; (b) o desempenho na prova OSCE e (c) a diferença no desempenho entre as provas estavam associados a características individuais e/ou da escola de origem. Resultados: Nos modelos ajustados principais, candidatos do sexo masculino (odds ratio [OR]:1,36; 95% intervalo de confiança [95% IC]:1,23-1,50), graduado no mesmo ano da avaliação (OR:1,61; 95% IC:1,45-1,80), de escolas fundadas antes de 1953 (OR:1,91; 95% IC:1,70-2,15), públicas (OR:2,48; 95% IC:2,16-2,84) situadas em cidades capitais (OR:1,96; 95% IC:1,74-2,21) tiveram performance melhor nos DRC. Candidatos graduados no mesmo ano da avaliação (OR:1,33; 95% IC:1,20-1,48), de escolas antigas (OR:1,83; 95% IC:1,63-2,05), públicas (OR:1,84; 95% IC:1,61-2,10) situadas em capitais (OR:1,49; 95% IC:1,33-1,67) também tiveram melhor performance na prova OSCE, porém, neste caso, a performance não foi afetada pelo sexo do candidato. Após ajuste para o desempenho na prova DRC, candidatos de escolas antigas fundadas antes de 1953 (OR:1,47; 95% IC:1,31-1,66) e públicas (OR:1,19; 95% IC:1,04-1,36) tiveram desempenho melhor na prova OSCE comparado à prova DRC. Conclusões: Foram encontradas diferenças significativas na performance dos candidatos na prova tipo DRC e OSCE de acordo com as características pessoais e da escola médica de graduação. Candidatos que se graduaram no mesmo ano da avaliação, de escolas antigas, públicas e situadas em capitais tiveram melhor performance tanto em DRC quanto em OSCEContext: Multiple strategies of evaluation are used in high-stake exams. It is important to understand which personal characteristics influence the performance of each test strategy. We aimed to study the association between personal (sex, year of graduation, residency program of interest) and medical school (year of medical school foundation, medical school legal status and medical school location) characteristics with test performance in Hospital das Clínicas of Faculdade de Medicina da Universidade de São Paulo, during an eight-year period. Methods: We analyzed data from 19,699 candidates who presented to the short-answer question (SAQ) tests and 5,475 candidates who presented to both SAQ and the Objective Structured Clinical Examination like (OSCE-like) test. For better comparison, main models considered data from the latter. We standardized candidates\' scores within each year to corresponding z-scores. We built ordinal logistic regression models checking if (a) SAQ score, (b) OSCE-like score and (c) the difference in performance between tests was associated to personal and/or medical school characteristics. Results: In main adjusted models, candidates of male sex (odds ratio [OR]:1.36; 95% confidence interval [95%CI]:1.23-1.50), graduated in the same year of the test (OR:1.61; 95% CI:1.45-1.80), funded before 1953 (OR:1.91; 95% CI:1.70-2.15), public schools (OR:2.48; 95%CI:2.16-2.84) in state capitals (OR:1.96; 95% CI:1.74-2.21) had better SAQ performance. Candidates graduated in the same year of the test (OR:1.33; 95% CI:1.20-1.48), from older (OR:1.83; 95% CI:1.63-2.05), public schools (OR:1.84; 95% CI:1.61-2.10) in state capitals (OR:1.49; 95%CI:1.33-1.67) also had better OSCE-like test performance, but, in this case, performance did not differ by sex. When adjusting by the SAQ performance, candidates from schools funded before 1953 (OR:1.47; 95% CI: 1.31-1.66) and public schools (OR:1.19; 95% CI: 1.04-1.36) had better performance on OSCE like test comparing to SAQ test. Conclusions: We found significant differences in candidates\' performances in SAQ and OSCE-like tests according to personal and medical school characteristics. Candidates who graduated in the same year of the test, from older, public schools in state capitals had better performance scores in both SAQ and OSCE-like test