Discussion
This pilot audit investigated students’ progress in clinical skills during a 9-week Internal medicine clerkship. Our study shows, that while students improved statistically significant in over OSCE scores during the second testing (92.2% vs. 89.5%, p<0.001), improved their history taking skills, they did not improve significantly in all the clinical skills execution. This bears the question of the levels of skill practice and necessity of the tested skill.
An important emphasis of clerkship in finishing medical students is to learn how to correctly acquire information on the treated patient. History taking scores were significantly improved, which is a consequence of frequent practice of the history taking skill as well as knowledge growth during clerkship. This improvement can also be explained by development of clinical reasoning skill. Clinical reasoning is understood as a complex process of sorting through information about a patient to arrive at a diagnosis and develop an appropriate treatment strategy.19–22 Understanding how clinical reasoning works is essential to efforts to prevent errors in clinical practice.22 Repeated clinical practice has been seen in studies as a fundamental to learning and acquiring expertise in clinical reasoning.19 Another possible explanation for improvement in clinical reasoning is better knowledge integration. Good clinical knowledge is required for integration of different aspects of a clinical situation. If students improve theoretical knowledge, they can better match the symptoms with a disease. Hence, they know which questions they should ask during history taking to arrive at a diagnosis.19
In addition to better scores on the second testing, reduction of time needed to complete each clinical skill implies that students have been practicing clinical skills during their clerkship. Studies in the performance of clinical skills have shown an improvement of performing clinical skills with repetition as well as improvement of time has been noted.23 Our results show that students needed less time to complete each clinical skill on the second testing.