Differential Diagnosis in a 3-Station Acute Abdominal Pain Objective Structured Clinical Examination (OSCE): A Needs Assessment in Third-Year Medical Student Performance and Summative Evaluation in the Surgical Clerkship

• DOI: 10.1016/j.jsurg.2011.02.012
• Publication Date: 2011-04-19T10:21:48Z
• Authors: John L. Falcone; Gregory A. Watson
• Keywords: Abdomen, Acute; Adult; Male; Students, Medical; 4. Education; Clinical Clerkship; Abdominal Pain; 3. Good health; Diagnosis, Differential; Young Adult; 03 medical and health sciences; 0302 clinical medicine; Acute Disease; Humans; Female; Clinical Competence; Medical History Taking; Physical Examination; Needs Assessment; Schools, Medical; Education, Medical, Undergraduate; Program Evaluation; Retrospective Studies

There is poor interrater reliability in the assessment of a medical student's ability to generate a differential diagnosis list using Likert-based scales in the surgical clerkship. This important clinical skill is tested on the United States Medical Licensing Examination Step 2 Clinical Skills Examination.We hypothesize that third-year medical students in the surgical clerkship will be able to accurately diagnose adult patients with acute abdominal pain after performing a focused history and physical examination in a 3-station Objective Structured Clinical Examination (OSCE). Second, we want to test our hypothesis that service assessments of a student's ability to analyze data will not correspond with OSCE performance.In this retrospective study, third-year medical student differential diagnosis lists from a 3-station OSCE and medical student clerkship assessments were collected from the 2009-2010 academic year. Differential diagnosis lists were scored for accuracy. Differences between groups were compared with nonparametric statistics, using an α = 0.05.Seventy-eight third-year medical students (56.4% female) were evaluated. For 2 stations, more than half of the medical students had the correct diagnosis on the differential diagnosis list (p < 0.0001). For 1 station, less than half of the medical students had the correct diagnosis on the differential diagnosis list (p = 0.0001). There were no differences in the service evaluation scores and the number of correct differential diagnosis lists for the students (p = 0.91).Third-year medical students are generally accurate with the ability to diagnosis adult patients with acute abdominal pain after performing a history and physical examination. Additionally, surgical service faculty and resident assessments of a student's ability to analyze data do not correspond with OSCE performance. We recommend some changes that might lead to improved grading for third-year medical students in the surgical clerkship.