Qualitative differences between traditional and rural-longitudinal medical student OSCE performance.

BACKGROUND AND

OBJECTIVES

To ensure adequate observation, supervision, and mentoring of trainees, long-term preceptorships or apprenticeships are being reestablished in medical education. Equivalence in academic performance has been demonstrated between longitudinal students in the Rural Physician Associate Program (RPAP), who spend 9 months in a rural community during their third year of medical school, and their peers who complete their clerkships at different hospitals and clinics (traditional). We qualitatively reviewed the end of session Objective Structured Clinical Examination (OSCE) for both groups and compared their performances.

METHODS

The high and low performers on four OSCE scenarios (cough, dysuria in a teen, preventive care in an older male, medication reconciliation) for two cohorts of students: longitudinal (n=47) and traditional primary care clerkship students (n=60) were selected for review. These 16 videotapes were reviewed independently by three researchers. The themes and subthemes were discussed over four meetings.

RESULTS

Both high and low scoring longitudinal students demonstrated more consistent use of rapport building skills. Longitudinal students appeared to have an effective pattern in their patient interactions and were more rehearsed at explaining preventive care recommendations such as the pros and cons of the prostate-specific antigen (PSA) test. Traditional students displayed a more complete mastery of the adolescent interview and followed a mnemonic taught during lecture.

CONCLUSIONS

Qualitative assessment of OSCE data reveals information not captured in the quantitative scores. In this study, longitudinal students demonstrated better mastery of rapport building and content knowledge and had an effective routine to their patient encounters not evident in the traditional students' scenarios.