Improving ward round skills.

BACKGROUND: Ward rounds represent an important task in clinical settings. Despite their importance, students show substantial deficits in ward round competencies (e.g. physical examination, drug prescription, documentation). Previously reported teaching methods such as ward round training with standardized patients or educational wards, however, are time-consuming and expensive. AIMS: To assess the effects of a structured on-ward supervision program for final-year students with specially trained supervising doctors focusing on ward round competencies. METHOD: A total of 36 medical students were randomly assigned to an intervention group (IG) and a control group (CG). During an eight-week-long training course, the intervention group (IG; n = 18) received structured ward round training while the control group (CG; n = 18) received on-ward training regarding how to take patient histories and perform physical examinations. Ward round competencies were assessed using simulated ward round scenarios with objective checklist ratings and standardized patient ratings. RESULTS: The IG achieved significantly more predefined learning goals compared to the CG. Standardized patient ratings did not differ significantly between groups. CONCLUSIONS: RESULTS provide evidence that the presented program is a feasible and efficient tool for teaching ward round skills at the bedside. Further research should focus on cost effectiveness compared to alternative models.

Short communication: final year students' deficits in physical examination skills performance in Germany.

BACKGROUND: The physical examination of patients is an important diagnostic competence, but little is known about the examination skills of final-year medical students. AIMS: To investigate physical examination skills of final-year medical students. METHODS: In a cross-sectional study, 40 final-year students were asked to perform a detailed physical examination on standardized patients. Their performances were video-recorded and rated by independent video assessors. RESULTS: Video ratings showed a mean success rate of 40.1 % (SD 8.2). As regards accompanying doctor-patient communication, final-year students achieved a mean of no more than 36.7 % (SD 8.9) in the appropriate use of the corresponding communication items. CONCLUSIONS: Our study revealed severe deficits among final-year medical students in performing a detailed physical examination on a standardized patient. Thus, physical examination skills training should aim to improve these deficits while also paying attention to communicative aspects.

[Evaluation of a structured, longitudinal training program for the preparation for the second state exam (M2) - a quantitative analysis]. / Evaluation eines strukturierten Prüfungsvorbereitungsprogramms für das 2. Staatsexamen (M2) nach Neuer Ärztlicher Approbationsordnung: Eine quantitative Analyse.

INTRODUCTION: The implementation of the amendment to the German medical licensing regulations ("Approbationsordnung") in 2002 led to a reduction in the number of state examinations from four to two exams, with the date of the second state exam being shifted to the end of the final clinical year. Students now face a double burden: on the one hand, they need to get ready for their future job, and on the other hand, they need to prepare for the state exam. This is why the Medical Faculty of Heidelberg introduced a preparation programme for the second state exam. The focus of this study was to evaluate the acceptance of the different modules of this programme and to compare the results against each other. METHODS: 39 students (15 male / 24 female; mean age 26.6 ± 1.9 years) took part in the exam preparation programme at the Medical University Hospital Heidelberg. Five different modules were implemented: an informational meeting, a key-feature written exam, case-based multiple-choice exams, a simulated practical examination and a simulated oral examination. Acceptance was measured using a six-point Likert scale (1=very good, 6=unsatisfactory and 1=I completely agree, 6=I completely disagree, respectively) RESULTS: The exam preparation programme as a whole was rated good: overall rating key-feature written exam 3.33 ± 1.17; case-based multiple-choice exams 2.61 ± 1.61; simulated practical exam 1.61 ± 0.54; simulated oral exam 1.55 ± 0.50. A comparison of the different modules demonstrated significantly better ratings for the practical and oral examinations than the case-based multiple-choice exams (p<0.001). DISCUSSION: The presented exam preparation programme is well accepted and facilitates the preparation for the second state exam, particularly with regard to the oral-practical examination.