Advertisement

Medical Science Educator

, Volume 26, Issue 3, pp 481–489 | Cite as

Use of Large-Group Patient Rounds to Characterize Pre-clerkship Medical Students’ Ability to Perform Three Entrustable Professional Activities

  • N. R. Chamberlain
  • P. S. Sexton
  • M. R. Hardee
  • R. W. Baer
Original Research

Abstract

The pre-clerkship years of medical school focus on providing a foundation in the basic health sciences. Students then build on this foundation to perform clinical skills that include the American Association of Medical College’s entrustable professional activities (AAMC EPAs) targeted at day 1 of residency. A variety of educational experiences that link competencies with AAMC EPAs are needed. We used large-group physician-mentored patient rounds (PMPRs) to assess the development of three AAMC EPAs in pre-clerkship second year medical students. We focused on (1) prioritizing a differential diagnosis (AAMC EPA 2), (2) ordering diagnostic tests (AAMC EPA 3), and (3) prescribing treatments (AAMC EPA 4). We designed the PMPR described here to follow a COPD patient through history-taking, physical examination, ordering diagnostic tests, and prescription of treatments. The exercise was administered to 158 students during weekly half-hour sessions across 5 weeks. Student assignments focused on AAMC EPAs 2, 3, and 4. Student responses were collected, summarized, and shared back with critical physician appraisal of the “aggregate student thinking.” Students generally produced appropriate differential lists (AAMC EPA 2) but often exhibited naïve approaches. Students also tended to order too many and inappropriate diagnostic tests. The physician guidance resulted in students ordering fewer and more appropriate diagnostic tests (AAMC EPA 3) as the exercise progressed. Students also developed generally appropriate treatment plans (AAMC EPA 4), but a few students prescribed potentially dangerous medications which became teaching points. Large-group PMPR is an effective method for assessment of pre-clerkship medical students’ ability to perform AAMC EPAs and provides a valuable opportunity to nurture the clinical skills that are foundational to those entrustable professional activities that should be achieved before day 1 of residency.

Keywords

Entrustable professional activities Clinical reasoning Large group physician mentored patient rounds Clinical skills Pre-clerkship medical students 

Notes

Acknowledgments

We would like to thank the anonymous patients who generously agreed to come before a class of medical students and share their medical stories with the hope of contributing to the next generation of high quality practitioners. We would also like to acknowledge the efforts of our students as they work toward becoming those practitioners.

References

  1. 1.
    Aschenbrener CA, Englander R (2013) Core entrustable professional activities for entering residency—faculty and learners’ guide. In: Assoc. Am. Med. Coll. https://members.aamc.org/eweb/upload/Core EPA Faculty and Learner Guide.pdf
  2. 2.
    ten Cate O, Scheele F. Competency-based postgraduate training: can we bridge the gap between theory and clinical practice? Acad Med. 2007;82:542–7.CrossRefGoogle Scholar
  3. 3.
    Englander R, Flynn T, Call S, et al. Toward defining the foundation of the MD degree. Acad Med. 2016. doi: 10.1097/ACM.0000000000001204.Google Scholar
  4. 4.
    Chen HC, van den Broek WES, ten Cate O. The case for use of entrustable professional activities in undergraduate medical education. Acad Med. 2015;90:431–6.CrossRefGoogle Scholar
  5. 5.
    Bliss M. The great American doctor. William Osler: a life in medicine. New york: Oxford University Press; 1999.Google Scholar
  6. 6.
    Hebert RS, Wright SM. Re-examining the value of medical grand rounds. Acad Med. 2003;78:1248–52.CrossRefGoogle Scholar
  7. 7.
    Englander R, Carraccio C. From theory to practice: making entrustable professional activities come to life in the context of milestones. Acad Med. 2014;89:1321–3.CrossRefGoogle Scholar
  8. 8.
    R Core Team (2015) R: a language and environment for statistical computing. https://www.r-project.org/.
  9. 9.
    Wahls SA. Causes and evaluation of chronic dyspnea. Am Fam Physician. 2012;86:173–80.Google Scholar
  10. 10.
    Karnani NG, Reisfield GM, Wilson GR. Evaluation of chronic dyspnea. Am Fam Physician. 2005;71:1529–37.Google Scholar
  11. 11.
    Vestbo J, Hurd SS, Agustí AG, et al. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: GOLD executive summary. Am J Respir Crit Care Med. 2013;187:347–65.CrossRefGoogle Scholar
  12. 12.
    Frank JR, Snell LS, ten Cate O, et al. Competency-based medical education: theory to practice. Med Teach. 2010;32:638–45.CrossRefGoogle Scholar
  13. 13.
    Dean B, Schachter M, Vincent C, Barber N. Causes of prescribing errors in hospital inpatients: a prospective study. Lancet (Lond Engl). 2002;359:1373–8.CrossRefGoogle Scholar
  14. 14.
    Diette GB, Dalal AA, D’Souza AO, Lunacsek OE, Nagar SP. Treatment patterns of chronic obstructive pulmonary disease in employed adults in the United States. Int J Chron Obstruct Pulmon Dis. 2015;10:415–22.Google Scholar
  15. 15.
    Peterson MC, Holbrook JH, Von Hales D, Smith NL, Staker LV. Contributions of the history, physical examination, and laboratory investigation in making medical diagnoses. West J Med. 1992;156:163–5.Google Scholar
  16. 16.
    Miglioretti DL, Smith-Bindman R. Overuse of computed tomography and associated risks. Am Fam Physician. 2011;83:1252–4.Google Scholar
  17. 17.
    Miyakis S, Karamanof G, Liontos M, Mountokalakis TD. Factors contributing to inappropriate ordering of tests in an academic medical department and the effect of an educational feedback strategy. Postgrad Med J. 2006;82:823–9.CrossRefGoogle Scholar
  18. 18.
    Winkens R, Dinant G-J. Evidence base of clinical diagnosis: rational, cost effective use of investigations in clinical practice. BMJ. 2002;324:783.CrossRefGoogle Scholar
  19. 19.
    Plapp FV, Essmyer CE, Byrd AB, Zucker ML. How to successfully influence laboratory test utilization. Clin Leadersh Manag Rev. 2000;14:253–60.Google Scholar
  20. 20.
    Bates DW, Cullen DJ, Laird N, Petersen LA, Small SD, Servi D, Laffel G, Sweitzer BJ, Shea BF, Hallisey R (1995) Incidence of adverse drug events and potential adverse drug events. Implications for prevention. ADE Prevention Study Group. JAMA 274:29–34Google Scholar
  21. 21.
    Dovey SM, Phillips RL, Green LA, Fryer GE. Types of medical errors commonly reported by family physicians. Am Fam Physician. 2003;67:697.Google Scholar
  22. 22.
    Kuo GM, Phillips RL, Graham D, Hickner JM. Medication errors reported by US family physicians and their office staff. Qual Saf Health Care. 2008;17:286–90.CrossRefGoogle Scholar
  23. 23.
    Garbutt JM, Highstein G, Jeffe DB, Dunagan WC, Fraser VJ. Safe medication prescribing: training and experience of medical students and housestaff at a large teaching hospital. Acad Med. 2005;80:594–9.CrossRefGoogle Scholar
  24. 24.
    Pearson S, Smith AJ, Rolfe IE, Moulds RFW, Shenfield GM. Intern prescribing for common clinical conditions. Adv Health Sci Educ Theory Pract. 2000;5:141–50.CrossRefGoogle Scholar
  25. 25.
    Harding S, Britten N, Bristow D. The performance of junior doctors in applying clinical pharmacology knowledge and prescribing skills to standardized clinical cases. Br J Clin Pharmacol. 2010;69:598–606.CrossRefGoogle Scholar

Copyright information

© International Association of Medical Science Educators 2016

Authors and Affiliations

  • N. R. Chamberlain
    • 1
    • 2
  • P. S. Sexton
    • 1
  • M. R. Hardee
    • 1
  • R. W. Baer
    • 1
  1. 1.Kirksville College of Osteopathic MedicineA.T. Still University of Health SciencesKirksvilleUSA
  2. 2.Department of MicrobiologyA.T. Still University of Health SciencesKirksvilleUSA

Personalised recommendations