Board 392 - Research Abstract Perceived Levels of Clinical Skills among Fourth Year Medical Students Before and After a Clinical Skills Capstone Course (Submission #598)

Introduction/Background The era of patient safety and implementation of milestones in graduate medical education has reignited discussion regarding whether graduating medical students possess the skills expected of entering residents.1-4 Recent literature suggests the milestones will ultimately translate into undergraduate medical education to help bridge the gap between student preparedness and residency expectations.5-6 In an effort to inform current curriculum, reinforce patient safety and standardize clinical experiences for a new medical school’s first graduating class, a simulation-based capstone course was developed focused on safety, procedures and clinical scenarios likely encountered in early residency. Objectives paralleled key topics in patient safety and ACGME milestones.7-9 The purpose of this study was to evaluate whether there was any change in perceived levels of clinical abilities among fourth year medical students as a result of the simulation-based capstone. The researchers hypothesized student’s perceived levels of clinical abilities would improve at the Conclusion of the course. Methods Thirty three fourth year medical students participated in the three day capstone one week prior to graduation. The capstone consisted of 10 scenarios incorporating high fidelity simulators, task trainers and standardized patients. Students completed the same anonymous pre and post-surveys. The 18 question survey assessed confidence levels in a variety of skills (writing orders, communication, patient handoffs, recognizing emergencies, initiating management, calling consults, team skills, procedures and ECG interpretation). Responses were based on a 4-point Likert Scale. A total of 32 and 25 students completed the pre and post-surveys respectively. Responses were analyzed in SPSS . P-values below 0.05 were considered statistically significant. IRB approval was obtained. Results An independent sample T-test revealed statistically significant differences in scores between pre-survey [mean= 2.5944, SD=0.47107] and post-survey [mean=3.1661, SD=0.39507] [T(34) 3.945, P<0.001 ). While all items showed improvement in perceived level of clinical ability, the mid-P and Fisher’s exact tests showed Results for 13 of the 18 items and 12 of the 18 items were statistically significant, respectively. A comparison of response rates between pre and post-survey anchors yielded an increase from 58.5% to 84.8% for respondents who indicated “agree” and “strongly agree.” Responses to the “disagree” and “strongly disagree” anchors decreased from 40.4% to 15%. Post survey data indicated less variability in perception of skills among respondents at 0.395 when compared to 0.471 for the pre-survey. Conclusion A simulation-based capstone was developed in an effort to ensure medical students are prepared with the skills expected of entering residents. Results showed improved confidence level in all items. The top ten items with the most significant improvement related to procedures, writing orders, patient hand-offs, team skills and initial management of a deteriorating patient key skills that new residents will most likely encounter. Three of the five survey items that did not show significant improvement were items students rated as confident in the pre-survey. Two of these items did not reveal high pre-test confidence scores and did not change significantly. The noted variability in responses on the pre-survey when compared to the post-survey may in part be due to differences in the amount of exposure to certain skills throughout clerkship years. Limitations included sample size and inability to link individual pre- and post-survey Results given the anonymous nature of the survey. Results of this study will drive further curricular analysis and help launch the development of a longitudinal, standardized simulation curriculum with emphasis on deliberate practice and skill assessment. Future research will include evaluating the impact of this capstone after students complete their first three months of residency. The authors look forward to the completion of the ACGME milestone project to define residency expectations and facilitate their integration into undergraduate medical education. References 1. Hall K, Schneider B, Abercrombie S, Gravel Jr. J, Hoekzema G, Kozakowski S, Mazzone M, Shaffer T, Wieschaus M: Hitting the Ground Running: Medical Student Preparedness for Residency Training. Annals of Family Medicine 2011; 9: 375. 2. Dickson G, Chesser A, Woods N, Krug N, Kellerman R: Family Medicine Residency Program Director Expectations of Procedural Skills of Medical School Graduates. Family Medicine2013; 45: 392-399. 3. Lypson M, Frohna J, Gruppen L, Wooliscroft J: Assessing Residents’ Competencies at Baseline: Identifying the Gaps. Academic Medicine 2004; 79: 564-570. 4. Raymond M, Mee J, King A, Haist S, Winward M: What New Residents Do During Their Initial Months of Training. Academic Medicine 2011; 86: S59-S62. 5. Nasca T, Philibert I, Brigham T, Flynn T: The Next GME Accreditation System - Rationale and Benefits. The New England Journal of Medicine 2012; 366: 1051-1056. 6. Carraccio C, Burke A: Beyond Competencies and Milestones: Adding Meaning Through Context. Journal of Graduate Medical Education 2010; 2: 419-422. 7. Green M, Aagaard E, Caverzagie K, Chick D, Holmboe E, Kane G, Smith C, Iobst W: Charting the Road to Competence: Developmental Milestones for Internal Medicine Residency Training. Journal of Graduate Medical Education 2009; 1: 5-20. 8. Association of American Medical Colleges: Teaching for Quality: Integrating Quality Improvement and Patient Safety Across the Continuum of Medical Education. https://www.aamc.org/initiatives/cei/te4q/. Accessed July 25, 2013. 9. World Health Organization: WHO Patient Safety: Curriculum Guide for Medical Schools. http://www.who.int/patientsafety/education/curriculum/EN_PSP_Education_Medical_Curriculum/en/index.html. Accessed July 25, 2013. Disclosures None.