PURPOSE Patient-centered care is one of the most important factors of high-quality medical care. Medical educators have been increasingly interested in education for patient-centered care. This study was conducted to guide such education by assessing the patient-centeredness of medical students in a real patient encounter and a standardized patient encounter on the clinical performance examination (CPX).
METHODS During the first semester of 2010 and 2011, fourth-year medical students in a clinical clerkship interviewed outpatients who visited the Department of Family Medicine. The interviews were videotaped, 25 of which were selected for study. We searched the 25 students' CPX videotapes that were recorded in the same year for comparison. The patient-centeredness of the students was assessed by measure of patient-centered communication (MPCC).
RESULTS The inter-rater reliability of the MPCC was 0.89 when measuring real patient encounters. MPCC scores of 25 students were very low for both real patients (mean, 28.8; range, 8.2~53.1) and for standardized patients (mean, 27.5; range, 8.2~52.7), and there was no significant difference between two groups. The component 1 MPCC scores were significantly higher for real patient encounters compared with those of CPX encounters (0.28 vs 0.18, p=0.0001). The component 2, 3 MPCC scores of two groups were not different each other.
CONCLUSION Medical educators must emphasize the importance of exploring a patient's illness and social background and involving them in making a diagnosis and treatment plan for patient-centered care. They should give students more opportunities to interview real patients and diversify scenarios for standardized patients.
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PURPOSE Recently, the clinical practice examination (CPX) using standardized patients has been introduced into several specialty certifying examinations in Korea. The purpose of this paper was to determine the correlation of a resident's performance on the CPX with the comprehensive written multiple-choice question (MCQ) examination on the certifying examination for family medicine.
METHODS The subjects of this study were 1,023 residents who completed the 1st and 2nd certifying examination for family medicine between 2009 and 2011. We determined the correlation between the total scores and 4 domain scores (history taking, physical examination, patient education, and patient-physician interaction) on the CPX with the MCQ scores of the 1st written test and 2nd slide examination and the correlation between the total CPX score and scores on the CPX domains.
RESULTS The correlation between CPX score with each MCQ examination (0.21~0.45 with 1st written MCQ, 0.15~0.33 with 2nd slide MCQ) was lower than that between each MCQ examination (0.46~0.59). The CPX score on patient education did not correlate with the 1st written and 2nd MCQ scores.
The CPX scores on history taking and physical examination correlated slightly with the 1st written MCQ scores. The global ratings of preceptor examiners had the highest correlation (r=0.68~0.82) with the total CPX scores.
CONCLUSION Considering the mild correlation of CPX scores with each MCQ examination, the CPX is more likely to measure other qualities, such as critical thinking and communication skills.
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PURPOSE Evaluation of clinical skills and attitude including development of dynamic patient-doctor relationship is important in board examination (BE). Korean Neurological Association (KNA) has introduced clinical performance examination (CPX) utilizing standardized patients (SP) to BE in 2007. In this study, the authors describe the 3-year experience of CPX in BE through 2009.
METHODS To implement CPX session in BE, KNA developed CPX workshop for BE attendees and members of grading committee.
CPX sessions in BE consisted of two model scenarios mimicking neurological patients in clinical practice. The total score and itemized scores of CPX sessions were compared with other areas of BE, and scores from each year were also compared.
RESULTS Scores from CPX sessions were significantly correlated with BE step II. Among the itemized scores of CPX sessions, clinical items including history taking and physical examination were significantly correlated with scores from other areas of BE. However, scores from global assessment from SP were strongly associated with patient-doctor relationship, history taking, and patient education.
CONCLUSION Our experiences suggest that CPX utilizing SP is a useful tool to assess the clinical skills in BE. In order to produce clinically well qualified neurologists, more efforts should be made to develop cases and to improve assessment tools for CPX.
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PURPOSE During the high-stake examinations such as OSCE (Objective structured clinical examination) or CPX (clinical performance exam), test security is generally accepted as a major concern for test validity. This study was conducted to investigate the effect on examinee' s scores of repeated, serial administrations of essentially the same standardized patient (SP) -based performance exam. METHODS: A performance-based examination using eight SP cases was administered to 123 senior medical students at Hanyang University School of Medicine. Students were randomly assigned to one of 16 groups of 8 students each. Three groups were tested serially each day, requiring 5 days for the complete administration of the examination. We compared the mean scores of the five groups of the examinees tested on different days with ANOVA and linear trends with multiple regression analyses. RESULTS: For both checklist scores and written scores during the interstation work, the mean scores of the first day groups were significantly lower compared to subsequent groups. And, there were slight linear trends in the scores over the five days. Scores related to case-specific history taking, information sharing, and clinical courtesy were significantly affected by the sharing of information between students. Scores related to patient satisfaction, physical exam, and physician-patient interaction were not influenced by the same pattern of behaviour. CONCLUSION: Test security may be violated during SP-based performance exams even though the checklists are not accessible to the examinees. It would be desirable for the test-givers to prepare alternative forms of cases for maintaining the validity of SP-based performance exams.
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