MedEd Research Corner Critical Assessment of Recent Literature H. Cindy Ko and Grace Charles PROGRAM DESCRIPTION: A 90-minute web-based module with three simulated clinical Standardized patient-narrated web-based learning modules encounters was narrated by an expert clinician and SP to explain improve students' communication skills on a high-stakes expected history-taking, physical examination, and communication clinical skills examination. skills behaviors. All 147 students were encouraged to review the Lee CA, Chang A, Chou CL, Boscardin C, Hauer KE. module one month before the CPX. J Gen Intern Med. 2011 Nov;26(11):1374-7. Epub 2011 Jul 16. PROGRAM EVALUATION: One hundred and six students (72%) viewed the web-based BACKGROUND: module. Students who watched the module performed significantly Use of web-based standardized patient (SP) modules is higher on the CPX communication score (+2.67%, p < 0.01) and associated with improved medical student history-taking and overall score (+2.12%, p = 0.03), even after controlling for USMLE physical examination skills on clinical performance examinations Step 1 and clerkship summary ratings. Use of the module did not (CPX), but a benefit for communication skills has not been shown. significantly affect history/physical examination scores (+1.89%, AIM: p = 0.12). We describe an innovative web-based SP module using detailed DISCUSSION: SP and faculty commentary to teach communication skills. Students who watched an optional web-based SP module prior to SETTING: the CPX performed higher than those who did not on A public medical school in 2008-2009. communication skills. The web-based module appears to be an effective CPX preparatory activity to enhance communication PARTICIPANTS: performance. Fourth-year medical students. ABSTRACT OF STUDY #1:
Critique of Study #1 H. Cindy Ko Standardized patient (SP) encounters are a common tool employed by medical schools to prepare students for clinical skill examinations and future patient interactions. The advent of web-based learning modules has provided a unique opportunity to enhance these traditional SP learning methods and increase the clinical competency of medical students. This current study aims to evaluate the effectiveness of a web-based teaching module on the communication skills scores of fourth year medical students on Clinical Performance Examinations (CPX). To supplement mandatory SP training 6 months prior to CPX, students were invited to view a web-based module one month before the examination. The module consisted of three separate 20 min videotaped student-SP encounters with narration and teaching commentary from a highly-trained SP and an experienced clinician. A majority of students (79% of those who watched) viewed the videos within the last 48 hours before their exam. Students who watched the video modules (n = 106) scored significantly higher in the communications skills
portion of the CPX compared to their classmates who did not watch (n = 41). The scores for history taking and physical exam scores were not significantly different between the two groups. Also, significantly fewer students in the group
may be an effective study tool for the communication skills portion of CPX. One of the major aims of a medical school is to develop a generation of well-trained and compassionate physicians. At the outset, the use of
The techniques of careful listening and effective communication are an intangible set of skills that are
only
acquired
and
learned
through
experience and feedback. who watched the module failed the CPX (n = 3), compared to those who did not watch (n = 7). The study controlled for baseline differences between the two groups by using Step 1 scores and a diverse set of clerkship ratings as covariates as part of the analysis. Additionally, the gender composition of those who watched the modules was consistent with that of the general class. The authors suggest that generalized feedback from web-based case vignettes 8
standardized patients in allows for the newly minted physicians to comfortably and reliably apply their clinical skill set. On a more global level, the overall preparedness and clinical skills of the individual graduate translate to a better reputation for the school. Thus, it is no surprise that medical schools are constantly searching for ways to improve teaching techniques in an effort to maximize the clinical readiness of their students.