Terence Ma, University of Houston Tilman J. Fertitta Family College of Medicine
Karen Szauter, University of Houston Tilman J. Fertitta Family College of Medicine
Bich-May Nguyen, University of Houston Tilman J. Fertitta Family College of Medicine
Amber Zulfiqar, University of Houston Tilman J. Fertitta Family College of Medicine
Jamila Davison, University of Houston Tilman J. Fertitta Family College of Medicine
Andrea Vallevand, University of Houston Tilman J. Fertitta Family College of Medicine
Purpose
The Physicians, Patients and Populations course focuses on the development and understanding of clinical skills, physician-patient communication, and health systems science. Physical examination skills are taught, in small groups, by faculty-trained Physical Examination Teaching Associates (PETAs). Item analyses were employed to investigate whether clinical skills item-specific performance gaps could be identified to inform focused cohort and student-specific remediation sessions.
Methods
The clinical skills examination was administered three months into the curriculum. PETAs score checklist items as 2 (done correctly), 1 (done incorrectly) and 0 (not done). Ratings are transposed to 1 (correct) and 0 (incorrect/not done) for score calculation and item analysis. Analysis focused on item difficulty (percentage of students who performed the checklist item correctly) and item discrimination (how well an item differentiates between low and high-performing students). Two clinical skills stations, Abdomen/Pulses, and Heart/Lung, were selected for review.
Results
Scores from 66 first-year medical students were analyzed. The Abdomen/Pulses checklist has twenty-one items. Item difficulty ranged from 54.5% (palpate the spleen) to 100% (introduces self). Item discrimination ranged from 0.00 (introduces self) to 0.68 (palpate liver). Thirteen items (61.9%) had an item discrimination value of 0.21 or higher. The Heart/Lungs checklist has twenty items. Item difficulty ranged from 75.8% (palpate precordium) to 100% (introduces self). Item discrimination ranged from -0.05 (general palpation posterior thorax) to 0.47 (locate and palpate point of maximal impulse). Eleven items (55%) had an item discrimination value of 0.21 or higher.
Conclusion
Item analyses identified specific gaps, informing a remediation focus for both midrange and lower-performing students. Inspection of the data, with the “0’s” highlighted, emphasized multiple item deficiencies traversing the roster of lower-performing students. Items with poorer performance offer an opportunity for reflection on both curricular expectations and teaching techniques. Subsequent end-of-year assessment of these skills offers an opportunity to investigate performance gaps’ closure.