Pilot of an Evaluation Tool in the Pediatric Clerkship to Improve Observation and Feedback.

Proposal to the Academy of Medical Educators
Anda Kuo, MD.

Background
The effective education and evaluation of medical students during their clinical rotations poses several challenges. In order for medical students to gain the necessary skills to practice medicine they require direct interactions with real patients. However, 3rd and 4th year medical students often are not observed and assessed by their supervisors during their patient interactions . While medical students gave the core pediatric clerkship at the University of California San Francisco (UCSF) an overall high score in 2001-2002, the clerkships three lowest scores were in the areas of direct observation, teaching of physical findings, and feedback . Similarly, in comparison to other Accreditation Council for Graduate Medical Education medical schools, the UCSF pediatric clerkship received a higher overall rating but did less well than the national average in the areas of observation and feedback . This deficiency in the medical students' assessment is multifactorial but is likely aggravated by the absence of an appropriate clinical assessment tool, as well as the many competing demands on preceptors' time.

At present, there is no structured method of observing and giving "real-time" feedback to medical students during their clerkships at the University of California San Francisco (UCSF) with the exception of the recent implementation of the mini-CEX (Clinical Evaluation Exercise) in the core internal medicine rotation. The mini-CEX consists of a single observed focused history and physical examination followed by immediate feedback and requires approximately 30 minutes in its entirety . This type of encounter is likely to be difficult to implement in the outpatient setting where there is higher volume, more rapid turnover and briefer patient interactions in comparison with the inpatient setting. In addition, with faculty members undertaking more responsibilities, a 30 minute observation tool may not be feasible.

We propose to pilot a clinical observation tool, the Structured Clinical Observation (SCO), in the core pediatric clerkship at UCSF. The SCO is designed for the outpatient setting and has been successfully implemented and in the pediatric outpatient rotation at Jefferson Medical College . The SCO consists of multiple, brief medical student-patient encounters where the supervisor observes a specific clinical skill, such as history taking or a segment of the physical exam. The observation is followed by immediate feedback and, in total, requires approximately 5 minutes. The SCO program is based upon multiple assessments and may allow for more feedback and greater opportunity for improvement than a "single-use" observation tool .

Goals of Project
The overall goal of this project is to increase medical student clinical skills in the pediatric clerkship via increased preceptor observation and feedback of medical student-patient interactions. A critical aspect of this project is to develop a plan that will ensure that the SCO will be readily integrated into the curriculum and sustained at other clerkship sites

For further information, please contact:
Anda Kuo, MD: AKuo@sfghpeds.ucsf.edu