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Background: Direct observation of medical trainees by their supervisors with actual patients is essential for trainees to develop clinical skills competence. Despite the many available tools for direct observation of trainees by supervisors, it is unclear how educators should identify an appropriate tool for a particular clinical setting and implement the tool to maximize educational benefits for trainees in a manner that is feasible for faculty. Aims and methods: Based on our previous systematic review of the literature, we provide 12 tips for selecting and incorporating a tool for direct observation into a medical training program. We focus specifically on direct observation that occurs in clinical settings with actual patients. Results: Educators should focus on the existing tools for direct observation that have evidence of validity. Tool implementation must be a component of an educational program that includes faculty development about rating performance, providing meaningful feedback, and developing action plans collaboratively with learners. Conclusions: Educators can enhance clinical skills education with strategic incorporation of tools for direct observation into medical training programs. Identification of a psychometrically sound instrument and attention to faculty development and the feedback process are critical to the success of a program of direct observation. [ABSTRACT FROM AUTHOR]

To determine the feasibility of oral case presentation (OCP) encounter cards as a tool for formative evaluation, to estimate the reliability and validity of the ratings when used in a medicine clerkship, and to examine whether the use of OCP encounter cards improves students' OCP skills. Randomized controlled study. Medicine core clerkship at a U.S. medical school. Students enrolled in the medicine core clerkship ( n=164) from January to December of 2003 were randomly assigned to receive weekly feedback using OCP encounter cards rating nine presentation compentencies or receive usual feedback. Mean OCP ratings were correlated with multiple summative assessments. Performance on an end-of-clerkship OCP was compared between intervention and control groups. Eighty percent of cards were completed. The mean OCP rating averaged over 9 competencies was 7.7 (SD=0.8) on a 9-point scale. Standard error of ratings was 0.3. OCP ratings were correlated with inpatient evaluations ( r=.58), inpatient ratings of presentation skills ( r=.43), and final grades ( r=.40). Final OCP performance was similar for the intervention and control groups (7.0 vs 7.2, P=.09). OCP encounter cards are a novel and feasible tool to assess clerkship students' oral case presentation skills. OCP card ratings are reproducible, and validity is suggested by their correlation with multiple markers of performance. However, encounter cards did not improve performance on summative oral presentations. [ABSTRACT FROM AUTHOR]

This personal view about medical student self-feedback is based on personal experiences as a third-year medical student with insights from a director of undergraduate medical education for a department of medicine. We highlight the importance of adult-learning theory in the clinical arena, and suggest that the application of self-regulated learning theory during clinical clerkships may contribute to increased student engagement and partnership in learning. [ABSTRACT FROM AUTHOR]

Two letters to the editor and a response are presented regarding the article "Tools for Direct Observation and Assessment of Clinical Skills of Medical Trainees: A Systematic Review," by J. R. Kogan and colleagues published in a 2009 issue.

Assesses the validity of a tool developed to grade patient write-ups, which provide information about a student's ability to collect information, identify and evaluate problems, demonstrate clinical reasoning, develop management plans and communicate through a written record. Usefulness of write-up evaluation forms with the observation of improvement in students' performances following feedback; Support for validity by correlations with other summative assessment measures.

Background: Despite similar performance metrics, women medical trainees routinely self-assess their own skills lower than men. The phenomenon of a "confidence gap" between genders, where women report lower self-confidence independent of actual ability or competency, may have an important interaction with gender differences in assessment. Identifying whether there are gender-based differences in how confidence is mentioned in written evaluations is a necessary step to understand the interaction between evaluation and the gender-based confidence gap., Objective: To analyze faculty evaluations of internal medicine (IM) residents for gender-based patterns in the use of iterations of "confidence.", Design: We performed a retrospective cohort study of all inpatient faculty evaluations of University of Pennsylvania IM residents from 2018 to 2021. We performed n-gram text-mining to identify evaluations containing the terms "confident," "confidence," or "confidently." We performed univariable and multivariable logistic regression to determine the association between resident gender and references to confidence (including comments reflecting too little confidence), adjusting for faculty gender, post-graduate year (PGY), numeric rating, and service., Subjects: University of Pennsylvania IM residents from 2018 to 2021., Key Results: There were 5416 evaluations of IM residents (165 women [51%], 156 men [49%]) submitted by 356 faculty members (149 women [51%]), of which 7.1 % (n=356) contained references to confidence. There was a significant positive association between the mention of confidence and women resident gender (OR 1.54, CI 1.23-1.92; p<0.001), which persisted after adjustment for faculty gender, numeric rating, and PGY level. Eighty evaluations of the cohort explicitly mentioned the resident having "too little confidence," which was also associated with women resident gender (OR 1.66, CI 1.05-2.62; p=0.031)., Conclusion: Narrative evaluations of women residents were more likely to contain references to confidence, after adjustment for numerical score, PGY level, and faculty gender, which may perpetuate the gender-based confidence gap, introduce bias, and ultimately impact professional identity development., (© 2022. The Author(s), under exclusive licence to Society of General Internal Medicine.)

Background: Recent literature has suggested racial disparities in Alpha Omega Alpha Honor Medical Society (AΩA) selection and raised concerns about its effects on the learning environment. Internal reviews at multiple institutions have led to changes in selection practices or suspension of student chapters; in October 2020, the national AΩA organization provided guidance to address these concerns., Objective: This study aimed to better understand student opinions of AΩA., Design: An anonymous survey using both multiple response option and free response questions., Participants: Medical students at the Perelman School of Medicine at the University of Pennsylvania., Main Measures: Descriptive statistics and logistic regressions were used to examine predictors of student opinion towards AΩA. Free responses were analyzed by two independent coders to identify key themes., Key Results: In total, 70% of the student body (n = 547) completed the survey. Sixty-three percent had a negative opinion of AΩA, and 57% felt AΩA should not exist at the student level. Thirteen percent believed AΩA membership appropriately reflects the student body; 8% thought selection processes were fair. On multivariate analysis, negative predictors of a student's preference to continue AΩA at the student level included belief that AΩA membership does not currently mirror class composition (OR: 0.45, [95% CI: 0.23-0.89]) and that AΩA selection processes were unfair (OR: 0.20 [0.08-0.47]). Self-perception as not competitive for AΩA selection was also a negative predictor (OR: 0.44 [0.22-0.88]). Major qualitative themes included equity, impact on the learning environment, transparency, and positive aspects of AΩA., Conclusions: This single-institution survey demonstrated significant student concerns regarding AΩA selection fairness and effects on the learning environment. Many critiques extended beyond AΩA itself, instead focusing on the perceived magnification of existing disparities in the learning environment. As the national conversation about AΩA continues, engaging student voices in the discussion is critical., (© 2022. The Author(s), under exclusive licence to Society of General Internal Medicine.)

Unlabelled: PHENOMENON: Medical students receive much of their inpatient teaching from residents who now experience restructured teaching services to accommodate the 2011 duty-hour regulations (DHR). The effect of DHR on medical student educational experiences is unknown. We examined medical students' and clerkship directors' perceptions of the effects of the 2011 DHR on internal medicine clerkship students' experiences with teaching, feedback and evaluation, and patient care., Approach: Students at 14 institutions responded to surveys after their medicine clerkship or subinternship. Students who completed their clerkship (n = 839) and subinternship (n = 228) March to June 2011 (pre-DHR historical controls) were compared to clerkship students (n = 895) and subinterns (n = 377) completing these rotations March to June 2012 (post-DHR). Z tests for proportions correcting for multiple comparisons were performed to assess attitude changes. The Clerkship Directors in Internal Medicine annual survey queried institutional members about the 2011 DHR just after implementation., Findings: Survey response rates were 64% and 50% for clerkship students and 60% and 48% for subinterns in 2011 and 2012 respectively, and 82% (99/121) for clerkship directors. Post-DHR, more clerkship students agreed that attendings (p =.011) and interns (p =.044) provided effective teaching. Clerkship students (p =.013) and subinterns (p =.001) believed patient care became more fragmented. The percentage of holdover patients clerkship students (p =.001) and subinterns (p =.012) admitted increased. Clerkship directors perceived negative effects of DHR for students on all survey items. Most disagreed that interns (63.1%), residents (67.8%), or attendings (71.1%) had more time to teach. Most disagreed that students received more feedback from interns (56.0%) or residents (58.2%). Fifty-nine percent felt that students participated in more patient handoffs. INSIGHTS: Students perceive few adverse consequences of the 2011 DHR on their internal medicine experiences, whereas their clerkship director educators have negative perceptions. Future research should explore the impact of fragmented patient care on the student-patient relationship and students' clinical skills acquisition.

Purpose: To determine the feasibility, reliability and validity of the mCEX when used to evaluate medical students' clinical skills in a medicine core clerkship., Method: In 2002, students were required to complete nine mCEX during their medicine clerkship. Mean mCEX scores were correlated with exam scores and course grades., Results: 89% of targeted mCEX were completed. The reproducibility coefficient for eight mCEX was.77. Mean mCEX scores were significantly correlated with exam scores (r =.22; p =.004), inpatient (r =.43; p <.0001), outpatient (r =.35; p <.0001), and final course grades (r =.19; p =.014)., Conclusions: These data support the feasibility, reproducibility, and validity of the mCEX in evaluating medicine clerkship students' clinical skills.