Christopher Sumski
Children's Hospital of Wisconsin
Background/Objective(s): Physical exam skills require practice, incorporating repeated feedback from experts. Given the importance of practice and repeated exposure for physical exam skills, repeated formative assessments may have a key impact on skill development. There is limited literature on the role of formative feedback on physical exam teaching. This project created a physical exam workshop for pediatric interns and measured the effect of structured formative feedback on performance on an online assessment. Our hypotheses was that if pediatric interns were exposed to a cardiac physical exam teaching session, their performance on an online assessment will increase, and this increase in would be sustained longer and associated with higher performance if provided with repeated, structured formative feedback.
Design/Methods: Pediatric interns take part a cardiac physical exam teaching session at the beginning of a cardiology rotation. This session includes an interactive online assessment as a pre-workshop assessment and post-workshop assessment. Participants are then randomized to either complete the rest of the rotation without any change in the feedback or teaching methods, or complete their rotation with structured formative feedback from clinic attendings. Three months after participation, they retook the assessment. Non-parametric statistical analysis was conducted. Assessment scores were compared with Wilcoxon signed rank test. Control and intervention group scores compared with a Mann-Whitney U Test. All analysis generated in IBM® SPSS® 24.0.
Results: A total of 25 pediatrics residents participated. Mean score on the pre-workshop assessment was 54.1% with a standard deviation of 4.99%. Mean score on the post-workshop assessment was 71.2 with a standard deviation of 6.74%. The Wilcoxon Signed Ranks test yielded a p-value of <0.01, indicating a statistically significant difference between the pre-workshop and postworkshop assessments.The mean on the three-month assessment was 67% with a standard deviation o f8.26%.This was statistically different from the pre-workshop assessment (p<0.01) but not when compared to the post-workshop assessment (p=0.062). Utilizing the Mann-Whitney U-Test we found no significant difference between the control and intervention groups on the pre-workshop assessment (p=0.221) post-workshop assessment (p=0.436) or three month assessment (p=0.306).
Conclusion: This intervention instituted a physical exam workshop for all pediatric interns taking a required cardiology rotation. Participants were then split into control and intervention groups with the intervention group getting daily structured formative feedback. After three months all participants were then reassessed with an online examination. We found no statistical difference between the control group and the intervention group. We did, however, demonstrate an efficient and feasible method of implementing repeated, structured formative feedback in busy clinical setting.
