Documenting clinical performance problems among medical students: feedback for learner remediation and curriculum enhancement

Figures & data

Table 1 Pilot test faculty rater agreement

1A. Medical interview: technique problems		Rater agreement (N=10 faculty) (%)
1	Required elements are missing	82
2	Approach lacks structure or order	77
3	Approach lacks flow or transitions	76
4	Did not use clarifying questions or follow-up on positive responses	63
5	Little or no use of open-ended questions	63
6	Rushed through data gathering; did not use available time	83
1B. Medical interview: cognitive problems
1	Inadequate history to rule out other possible diagnosis	72
2	Premature closure of diagnostic options	71
3	Inadequate characterization of social history	78
4	Inadequate characterization of family history	83
5	Inadequate characterization of problem/symptom dimensions	77
6	Inadequate characterization of past medical history	73
7	Inadequate characterization of chief complaint	73
8	Medical interview covered areas not indicated by the case	90
2A. Physical examination: technique problems		Rater agreement (N=10 faculty)
1	Required elements are missing	78
2	For physical examination elements performed technique was poor	73
3	Examined patient over gown	90
4	Approach lacks structure or order	72
5	Rushed through examination; did not use available time	76
2B. Physical examination: cognitive problems
1	Inadequate data gathering to rule out other possible diagnosis	64
2	Employed examination maneuvers not indicated by the case	75
3. Professionalism		Rater agreement (N=10 faculty)
1	Student did not introduce self to patient	93
2	Treated SP as diagnostic problem rather than person with feelings and concerns	80
3	Student did not wash hands	85
4	Poor verbal and non-verbal communication (emotional distance)	84
5	Student dressed inappropriately or casually	98
4. Overall assessment: failure of clinical encounter		70

Table 2 Prevalence of performance problems among M3 students

			Prevalence by case
		Problem prevalence (%)	Case 1 (%)	Case 2 (%)	Case 3 (%)	Probability
1A. Medical interview: technique problems
1	Required elements are missing	25	18	44	0	.007
2	Approach lacks structure or order	16	0	29	5	.029
3	Approach lacks flow or transition	15	0	29	0	.006
4	Did not use clarifying questions or follow-up on positive responses	10	0	5	17	NS
5	Little or no use of open-ended questions	7	0	18	5	NS
6	Rushed through data gathering; did not use available time	2	0	12	0	NS
1B. Medical interview: cognitive problems
1	Inadequate history to rule out other possible diagnosis	60	85	73	33	NS
2	Premature closure of diagnostic options	41	79	43	12	.001
3	Inadequate characterization of social history	38	21	74	6	.001
4	Inadequate characterization of family history	35	25	57	5	.002
5	Inadequate characterization of problem/symptom dimensions	23	8	29	22	NS
6	Inadequate characterization of past medical history	17	8	26	11	NS
7	Inadequate characterization of chief complaint	6	0	22	0	.022
8	Medical interview covered areas not indicated by the case	1	8	0	0	NS
			Prevalence by case
		Problem prevalence	Case 1	Case 2	Case 3	Probability
2A. Physical examination: technique problems
1	Required elements are missing	69	91	57	82	NS
2	For physical examination elements performed technique was poor	41	60	36	29	NS
3	Examined patient over gown	30	33	30	35	NS
4	Approach lacks structure or order	26	11	38	21	NS
5	Rushed through examination; did not use available time	14	14	15	6	NS
2B. Physical examination: cognitive problems
1	Inadequate data gathering to rule out other possible diagnosis	69	91	62	71	NS
2	Employed examination maneuvers not indicated by the case	10	14	10	6	NS
3. Professionalism		Prevalence (%)	Prevalence by case
			Case 1 (%)	Case 2 (%)	Case 3(%)	Probability
1	Student did not introduce self to patient	33	29	30	41	NS
2	Treated SP as diagnostic problem rather than person with feelings and concerns	4	7	0	5	NS
3	Student did not wash hands	4	0	10	5	NS
4	Poor verbal and non-verbal communication (emotional distance)	2	7	0	0	NS
5	Student dressed inappropriately or casually	0	0	0	0	NS
4. Overall assessment: failure of clinical encounter		74	100	64	76	.040
Sample size: number of clinical encounters		82	11	18	16

I . MEDICAL INTERVIEW