Clinical skills remedial training for medical students

Context and setting The clinical performance examination (CPX) is an eight-station, high-stakes examination in which standardised patients (SPs) assess early Year 4 medical students' competence in clinical and communication skills. The CPX prepares students for the national licensing examination using SPs and ensures clinical competence prior to graduate medical training. Why the idea was necessary Each year, the CPX identifies students with severe deficiencies in history taking, physical examination or communication skills. Few remedial training programmes exist to help students improve their performance. What was done We developed a remedial training programme that incorporates diagnosis of learner problems, individual reflection, faculty feedback and supervised practice. After the CPX, students scoring ≥ 2 standard deviations (SD) below the class average in one or both skill domains (history taking and physical examination [H major areas for improvement (e.g. developing differential diagnoses and tailoring H and case-specific comments related to common presenting symptoms and signs (e.g. a complete pain history would also include aggravating and alleviating factors). Step 3 involves a one-to-one video review guided by the learning prescription and the student’s self-identified goals with a designated faculty member. In Step 4, students attend one or both evening workshops in H case-based skills exercises in which subsets of 2–3 students rotate between examination rooms with a faculty facilitator and an SP, and a whole-group concluding session to review learning goals. Evaluation of results and impact In 2007, 23 students completed and evaluated the remedial training programme. Using a 5-point scale (1 = poor, 5 = excellent), mean student ratings were: 3.32 for individual video review; 3.82 for learning prescription; 4.45 for faculty-precepted video review, and 3.91 for overall experience (SD 1.02). In narrative evaluations, students reported that the most helpful components of the programme included practising with SPs, learning to structure the encounter using differential diagnoses, receiving feedback from SPs and faculty in real time, and observing the different styles of other students in the small-group workshops. Our results show that students who require remedial training in clinical and communication skills appreciate individualised feedback and skills sessions with preceptors and SPs. Future studies should examine methods for early identification of students in need of remedial training and, importantly, investigate the impact of remediation on subsequent performance on the national licensing examination and actual clinical practice.