Clinical Teaching and OSCE in Pediatrics

Med Educ Online [serial online] 2001;6:10. Available from URL
http://www.med-ed-online.org

Clinical Teaching and OSCE in Pediatrics

Sabri Kemahli, MD

Professor of Pediatrics

Departments of Pediatrics and Medical Education

Faculty of Medicine, Ankara University, Ankara, Turkey

Abstract - Emphasis is being given to early contact by medical students with patients, and cur-
ricula are being designed to address this trend. Although teaching of clinical skills mostly de-
pends on the traditional “apprenticeship” model, there is insufficient supervision of students
while they examine the patients. This leads to the lack of acquisition of good clinical skills and
some patient-student frustrations during examination by inexperienced students. The problem is
greater in pediatric departments. One way to overcome this is to observe the students while they
take a history and do a physical examination and to give them feedback. On the other hand, ob-
jective structured clinical examinations (OSCEs) should be used more in pediatric examinations
to make use of the steering effect such examinations have on student achievement. However,
OSCEs should not be the only student assessment tool, but should be complemented by other
examination methods.

Keywords: Objective structured clinical examination; pediatrics; clinical teaching; OSCE; as-
sessment

More and more medical schools around the
world are changing to problem-based or integrated
curricula in which clinical and basic sciences are
taught in an integrated way in the first years of medi-
cal school. In addition, many medical schools have
adopted courses such as “introduction to clinical sci-
ences,” “practice of medicine,” “doctor-patient” and
“introduction to clinical medicine” that expose the
medical students to patients and the community in the
early years of their training. Students usually have
their first experience with histories and doing physi-
cal examinations during this period. The bulk of
clinical training is, however, still left to clinical
clerkships, where clinical training and evaluation
continue to rely mostly on traditional methods. There
are problems in three areas of clinical teaching: (1)
lack of observation and opportunity to give feedback
to students when they make their first encounters
with patients; (2) the site of clinical training; and (3)
assessment. This article addresses these aspects of
clinical training and evaluation in clinical clerkships,
particularly in pediatrics.

Lack of Observation in Clinical Training

Clinical teaching has a long tradition in almost
every country and every medical school, with an em-
phasis on “bedside teaching’ as well as lectures. Dur-
ing a typical bedside teaching encounter the faculty
member asks the students about their findings and
also comments about the patient. Sometimes one stu-
dent is asked to perform a focused physical examina-
tion related to the patient’s condition. In the mean-
time a history is taken by the whole group to clarify
the uncertainties. The rounds are primarily an oppor-
tunity for the faculty to ask questions of the students
to see how they are progressing with regard to their
knowledge in that particular subject, but not necessar-
ily their clinical competencies.

There is nothing much wrong with this mode of
teaching, which is a form of “apprenticeship train-
ing,” other than the students usually are not observed
while taking a history and performing a complete
physical exam. This means there is no opportunity for
giving feedback to them. There is only time left for
students to take a detailed history and do a physical
exam and present it to the faculty. Another problem
is that in medical schools with large number of stu-
dents, the patients or the parents become bored with
giving their histories many times every day to differ-
ent groups of students and faculty. The situation is
even worse in pediatric wards. Parents are often upset
when the students examine their children in an inex-
perienced way. As faculty we anticipate this, know-
ing that students are present in wards to “learn and
practice.”

1   2   3   4   >   >>