- Loma Linda, California, United States
Nancy Heine
Loma Linda University, Clinical Skills Education Center, Faculty Member
It is increasingly difficult to provide adequate clinical training for new dietetics graduates. Dietetic students obtain clinical experience by visiting patients and viewing their charts in hospital settings but rarely counsel them. To... more
It is increasingly difficult to provide adequate clinical training for new dietetics graduates. Dietetic students obtain clinical experience by visiting patients and viewing their charts in hospital settings but rarely counsel them. To examine the change in nutrition and dietetic students' perceived readiness to practice after completing three Objective Structured Clinical Examinations (OSCE). 37 students (mean age 26.6±5.4 yrs, 95% female) from the Schools of Public Health and Allied Health Professions enrolled in a medical nutrition therapy course. Using a pre-post test design, 37 students completed the first 3 weeks of the laboratory section of the course at the medical center, followed by 3 weeks of OSCE. OSCE stations included reviewing a chart, counseling a standardized patient, and discussing findings with other healthcare professionals. Students answered the Perceived Readiness for Dietetic Practice questionnaire before and after the OSCE. OSCE significantly improved stu...
Research Interests:
Purpose To examine validity evidence of local graduation competency examination scores from seven medical schools using shared cases and to provide rater training protocols and guidelines for scoring patient notes (PNs). Method Between... more
Purpose
To examine validity evidence of local
graduation competency examination
scores from seven medical schools using
shared cases and to provide rater training
protocols and guidelines for scoring
patient notes (PNs).
Method
Between May and August 2016, clinical
cases were developed, shared, and
administered across seven medical
schools (990 students participated).
Raters were calibrated using training
protocols, and guidelines were
developed collaboratively across sites to
standardize scoring. Data included scores
from standardized patient encounters
for history taking, physical examination,
and PNs. Descriptive statistics were used
to examine scores from the different
assessment components. Generalizability
studies (G-studies) using variance
components were conducted to estimate
reliability for composite scores.
Results
Validity evidence was collected for
response process (rater perception),
internal structure (variance components,
reliability), relations to other variables
(interassessment correlations), and
consequences (composite score). Student
performance varied by case and task.
In the PNs, justification of differential
diagnosis was the most discriminating
task. G-studies showed that schools
accounted for less than 1% of total
variance; however, for the PNs, there
were differences in scores for varying
cases and tasks across schools, indicating
a school effect. Composite score
reliability was maximized when the PN
was weighted between 30% and 40%.
Raters preferred using case-specific
scoring guidelines with clear pointscoring
systems.
Conclusions
This multisite study presents validity
evidence for PN scores based on
scoring rubric and case-specific scoring
guidelines that offer rigor and feedback
for learners. Variability in PN scores
across participating sites may signal
different approaches to teaching clinical
reasoning among medical schools.
To examine validity evidence of local
graduation competency examination
scores from seven medical schools using
shared cases and to provide rater training
protocols and guidelines for scoring
patient notes (PNs).
Method
Between May and August 2016, clinical
cases were developed, shared, and
administered across seven medical
schools (990 students participated).
Raters were calibrated using training
protocols, and guidelines were
developed collaboratively across sites to
standardize scoring. Data included scores
from standardized patient encounters
for history taking, physical examination,
and PNs. Descriptive statistics were used
to examine scores from the different
assessment components. Generalizability
studies (G-studies) using variance
components were conducted to estimate
reliability for composite scores.
Results
Validity evidence was collected for
response process (rater perception),
internal structure (variance components,
reliability), relations to other variables
(interassessment correlations), and
consequences (composite score). Student
performance varied by case and task.
In the PNs, justification of differential
diagnosis was the most discriminating
task. G-studies showed that schools
accounted for less than 1% of total
variance; however, for the PNs, there
were differences in scores for varying
cases and tasks across schools, indicating
a school effect. Composite score
reliability was maximized when the PN
was weighted between 30% and 40%.
Raters preferred using case-specific
scoring guidelines with clear pointscoring
systems.
Conclusions
This multisite study presents validity
evidence for PN scores based on
scoring rubric and case-specific scoring
guidelines that offer rigor and feedback
for learners. Variability in PN scores
across participating sites may signal
different approaches to teaching clinical
reasoning among medical schools.
INTRODUCTION: Objective Structured Clinical Examinations (OSCEs) are valuable teaching tools in various disciplines including nutrition. OSCEs increase students’ confidence, improve their communication and counseling skills, and can... more
INTRODUCTION: Objective Structured Clinical Examinations
(OSCEs) are valuable teaching tools in various disciplines
including nutrition. OSCEs increase students’ confidence,
improve their communication and counseling skills,
and can predict clinical strength and identify weaknesses
prior to clinical placement. This study explored the impact
of three OSCE experiences with nutrition students and
evaluated the use of this type of formative assessment.
METHODS: Eleven female students with mean age 27.5±7.0
yrs enrolled in a medical nutrition therapy course completed
three focus groups, ranging from 2 to 6 participants
each, after the completion of three OSCE sessions. DATA
ANALYSIS: Two independent reviewers used interpretative
phenomenological analysis to analyze verbatim transcriptions.
RESULTS: Five themes emerged: bridge to clinical
practice, a comprehensive learning tool, realistic experience,
student challenges, and curriculum considerations.
CONCLUSION: OSCE is an accepted tool by nutrition students
and provides a memorable comprehensive learning
experience. Students found OSCEs to be more realistic and
authentic than hospital visits, and the interprofessional
activities made the experience more holistic. The lack of
preparation was the most challenging part of OSCE. The
OSCE improved students’ confidence and bridged the gap
to clinical placement, and students recommended to continue
using it as part of the curriculum. J Allied Health 2016;
45(1):20–26.
(OSCEs) are valuable teaching tools in various disciplines
including nutrition. OSCEs increase students’ confidence,
improve their communication and counseling skills,
and can predict clinical strength and identify weaknesses
prior to clinical placement. This study explored the impact
of three OSCE experiences with nutrition students and
evaluated the use of this type of formative assessment.
METHODS: Eleven female students with mean age 27.5±7.0
yrs enrolled in a medical nutrition therapy course completed
three focus groups, ranging from 2 to 6 participants
each, after the completion of three OSCE sessions. DATA
ANALYSIS: Two independent reviewers used interpretative
phenomenological analysis to analyze verbatim transcriptions.
RESULTS: Five themes emerged: bridge to clinical
practice, a comprehensive learning tool, realistic experience,
student challenges, and curriculum considerations.
CONCLUSION: OSCE is an accepted tool by nutrition students
and provides a memorable comprehensive learning
experience. Students found OSCEs to be more realistic and
authentic than hospital visits, and the interprofessional
activities made the experience more holistic. The lack of
preparation was the most challenging part of OSCE. The
OSCE improved students’ confidence and bridged the gap
to clinical placement, and students recommended to continue
using it as part of the curriculum. J Allied Health 2016;
45(1):20–26.
Research Interests:
It is increasingly difficult to provide adequate clinical training for new dietetics graduates. Dietetic students obtain clinical experience by visiting patients and viewing their charts in hospital settings but rarely counsel them.... more
It is increasingly difficult to provide adequate clinical training for new dietetics graduates. Dietetic students obtain clinical experience by visiting patients and viewing their charts in hospital settings but rarely counsel them. OBJECTIVE: To examine the change in nutrition and dietetic stu-dents' perceived readiness to practice after completing three Objective Structured Clinical Examinations (OSCE). SUBJECTS: 37 students (mean age 26.6±5.4 yrs, 95% female) from the Schools of Public Health and Allied Health Professions enrolled in a medical nutrition therapy course. METHODS: Using a pre-post test design, 37 students completed the first 3 weeks of the laboratory section of the course at the medical center, followed by 3 weeks of OSCE. OSCE stations included reviewing a chart, counseling a standardized patient, and discussing findings with other healthcare professionals. Students answered the Perceived Readiness for Dietetic Practice questionnaire before and after the OSCE. RESULTS: OSCE significantly improved stu-dents' mean readiness to practice their role as clinical dieti-tians (4.9±2.5 vs 5.8±1.9, p=0.03). There was a significant improvement in the professional role (p=0.04) and charting (p=0.01). Students improved in all areas, but not all areas reached statistical significance. Seventy-six percent of students found the OSCE to be superior to the medical center experience, and 78% of students agreed that collaboration with other healthcare professionals helped prepare them for the dietetic role. CONCLUSION: The OSCE experience improved students' perceived clinical skills. The OSCE format can provide a realistic patient experience for dietetic students to develop their patient evaluation and counseling skills. J Allied Health 2015; 44(3):208–214.
Research Interests:
Research Interests:
Background The frequency and nature of standardised patient (SP) recording errors during clinical performance examinations (CPX) have an effect on case scores and ultimately on pass ⁄ fail decisions. Purpose To determine the effect of SP... more
Background The frequency and nature of standardised patient (SP) recording errors during clinical performance examinations (CPX) have an effect on case scores and ultimately on pass ⁄ fail decisions. Purpose To determine the effect of SP recording errors on case scores. Methods Standardised patients completed checklists immediately after each encounter. To determine checklist accuracy, multiple reviewers developed a checklist key for each student encounter studied. The total errors, the net errors, the errors of commission and omission and error rates by competency skill were analysed. Results The frequency of errors in history taking was greater than in physical examination, and the majority of errors were made in the students' favour. Summing the errors of commission and omission decreased the effect of total errors on student scores. Conclusions High levels of SP recording accuracy are achievable. When errors occur, the net effect is usually in the students' favour.
Background: The accuracy of standardized patients (SPs) as recorders is an ongoingconcern in medical education. Consistent feedback from an expert observer during a clinical examination might enhance the SPs’ accuracy in completing... more
Background: The accuracy of standardized patients (SPs) as recorders is an ongoingconcern in medical education. Consistent feedback from an expert observer during a clinical examination might enhance the SPs’ accuracy in completing checklists.
Purpose: To determine the frequency of feedback necessary to maximize SP checklist accuracy.
Method: Student checklists were completed after each encounter by the SPs. Varying levels of feedbackwere given to SPs by their trainers. To determine checklist accuracy level,multiple reviewers developed an answer key for each student encounter studied. Two hundred ninety-eight encounters were examined for agreement among 6,566
checklist items.
Results: Random feedback resulted in significantly higher levels of SP accuracy than no feedback. There was no significant difference between random and constant feedback.
Conclusions: This study suggests that random feedback given to SPs is sufficient to enhance SP checklist accuracy and should be part of implementation protocols in all required clinical performance examinations.
Teaching and Learning in Medicine, 11(3), 148–152
Purpose: To determine the frequency of feedback necessary to maximize SP checklist accuracy.
Method: Student checklists were completed after each encounter by the SPs. Varying levels of feedbackwere given to SPs by their trainers. To determine checklist accuracy level,multiple reviewers developed an answer key for each student encounter studied. Two hundred ninety-eight encounters were examined for agreement among 6,566
checklist items.
Results: Random feedback resulted in significantly higher levels of SP accuracy than no feedback. There was no significant difference between random and constant feedback.
Conclusions: This study suggests that random feedback given to SPs is sufficient to enhance SP checklist accuracy and should be part of implementation protocols in all required clinical performance examinations.
Teaching and Learning in Medicine, 11(3), 148–152
Research Interests:
Research Interests:
Research Interests:
ABSTRACT Background: The accuracy of standardized patients (SPs) as recorders is an ongoing concern in medical education. Consistent feedback from an expert observer during a clinical examination might enhance the SPs' accuracy in... more
ABSTRACT Background: The accuracy of standardized patients (SPs) as recorders is an ongoing concern in medical education. Consistent feedback from an expert observer during a clinical examination might enhance the SPs' accuracy in completing checklists. Purpose: To determine the frequency of feedback necessary to maximize SP checklist accuracy. Method: Student checklists were completed after each encounter by the SPs. Varying levels of feedback were given to SPs by their trainers. To determine checklist accuracy level, multiple reviewers developed an answer key for each student encounter studied. Two hundred ninety-eight encounters were examined for agreement among 6,566 checklist items. Results: Random feedback resulted in significantly higher levels of SP accuracy than no feedback. There was no significant difference between random and constant feedback. Conclusions: This study suggests that random feedback given to SPs is sufficient to enhance SP checklist accuracy and should be part of implementation protocols in all required clinical performance examinations.