Effects of a supplementary final year curriculum on students’ clinical reasoning skills as assessed by key-feature examination

Figures & data

Table

Practice points

The final year of medical education is especially important in aiding the transition from students’ medical college years to their future professional career and in producing competent and reflective physicians by ensuring appropriate learning outcomes. A supplementary final year student curriculum in internal medicine including patient-centred learning and skills-training sessions significantly improved clinical reasoning skills as measured by a key-feature examination. Further research is needed to investigate the effects of a final year student curriculum on other measures assessing the performance of final year students on the ward.

Table 1.  Final year student curriculum at the University of Heidelberg

Topic of the week	Monday: Interactive seminar	Tuesday: Skills training session	Wednesday: Pharmacology seminar	Thursday: ECG seminar
Week 1: Introduction	Introduction week: ‘Essentials from admission to discharge’ (Nikendei et al. 2006)
Week 2: Ward round/frequently occurring problems	Basic principles: ward round	Ward round training (Nikendei et al. 2007a)	Sleep medication	Side-effects psychotropic drugs I
Week 3: Infections/antibiotics	Infections/focus search	Prescription and application of antibiotic drips	Antibiotics	Blocks
Week 4: Emergency medicine	Basic principles: Resuscitation	Mega-code training	Emergency medication	Cardiac arrhythmia
Week 5: Hypertension	Hypertensive derailment	I.V. application of antihypertensive drugs	Antihypertensive drugs	Cardiac hypertrophy
Week 6: Communication/depression and anxiety	Basic principles: Communication	Communication training (Kraus et al. 2006)	Psychotropic drugs	Side-effects psychotropic drugs II
Week 7: Kidney failure/dialysis	Acute kidney failure	Central venous catheter application	Dosing in chronic kidney failure	Electrolytes
Week 8: –	–	–	–	–

Notes: The curriculum commences with an introduction week and lasts for the duration of students’ 3-month clerkship. Examples of weekly topics and learning objectives for teaching sessions in weeks 1–7 for the experimental group of 49 final year students from the University of Heidelberg are presented below.

Table 2.  Topics of key-feature problems used in the examination and their distribution over defined sub-domains of internal medicine (%)

Sub-domain	Key-feature examination (%)	Swiss blueprint (%)
Rheumatology/immunology	6.7	13.0
General internal medicine/Psychosomatic medicine/alcoholism	16.0	20.0
Cardiology/angiology/hypertension	20.0	15.0
Endocrinology/nephrology	10.7	11.0
Gastroenterology	13.3	10.0
Oncology/infectiology	9.3	15.0
Pneumology/emergency medicine	24.0	16.0

Note: Swiss catalogue of learning objectives (Bloch & Burgi 2002) as reference for the weighting of internal medicine sub-domains.

Figure 1. Assessment scores for experimental (EG; n = 49) and comparison groups (CG; n = 25) pre- and post-intervention (0–75 points); means and 95% confidence interval. *Post hoc test revealed higher assessment sores in the experimental as compared to the comparison group in the post-intervention evaluation (p < 0.028), although the two groups showed no difference in pre-intervention assessment scores (p < 0.924).

Table 3.  Results of key-feature examination for experimental (n = 49) and comparison group (n = 25) pre- and post-intervention (0–75 points)

	Experimental group		Comparison group
Time of Assessment	M	SD	M	SD	p
Pre-curriculum evaluation	36.84	±6.91	36.64	±7.28	n.s.
Post-curriculum evaluation	44.00	±7.72	39.96	±6.43	<0.028

Notes: M = mean, SD = standard deviation, p = p-value of post hoc test results.

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