title: Differential diagnosis in a 3-station acute abdominal pain objective structured clinical examination (OSCE): a needs assessment in third-year medical student performance and summative evaluation in the surgical clerkship.
abstract: BACKGROUND
  There is poor interrater reliability in the assessment of a medical student's ability to generate a differential diagnosis list using Likert-based scales in the surgical clerkship. This important clinical skill is tested on the United States Medical Licensing Examination Step 2 Clinical Skills Examination.
  
  
  OBJECTIVE
  We hypothesize that third-year medical students in the surgical clerkship will be able to accurately diagnose adult patients with acute abdominal pain after performing a focused history and physical examination in a 3-station Objective Structured Clinical Examination (OSCE). Second, we want to test our hypothesis that service assessments of a student's ability to analyze data will not correspond with OSCE performance.
  
  
  METHODS
  In this retrospective study, third-year medical student differential diagnosis lists from a 3-station OSCE and medical student clerkship assessments were collected from the 2009-2010 academic year. Differential diagnosis lists were scored for accuracy. Differences between groups were compared with nonparametric statistics, using an α = 0.05.
  
  
  RESULTS
  Seventy-eight third-year medical students (56.4% female) were evaluated. For 2 stations, more than half of the medical students had the correct diagnosis on the differential diagnosis list (p < 0.0001). For 1 station, less than half of the medical students had the correct diagnosis on the differential diagnosis list (p = 0.0001). There were no differences in the service evaluation scores and the number of correct differential diagnosis lists for the students (p = 0.91).
  
  
  CONCLUSIONS
  Third-year medical students are generally accurate with the ability to diagnosis adult patients with acute abdominal pain after performing a history and physical examination. Additionally, surgical service faculty and resident assessments of a student's ability to analyze data do not correspond with OSCE performance. We recommend some changes that might lead to improved grading for third-year medical students in the surgical clerkship.
authors.affiliation: University of Pittsburgh School of Medicine, University of Pittsburgh Medical Center, Department of Surgery, Pittsburgh, Pennsylvania 15213, USA. falconej@upmc.edu
authors.forename: John L
authors.initials: JL
authors.lastname: Falcone
authors.forename: Gregory A
authors.initials: GA
authors.lastname: Watson
mesh_terms: D000006:Abdomen, Acute / Q000175:diagnosis; D015746:Abdominal Pain / Q000175:diagnosis*; D000208:Acute Disease; D000328:Adult; D002982:Clinical Clerkship / Q000458:organization & administration*; D002983:Clinical Competence; D003937:Diagnosis, Differential; D004504:Education, Medical, Undergraduate / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008487:Medical History Taking; D020380:Needs Assessment; D010808:Physical Examination / Q000592:standards*; D015397:Program Evaluation; D012189:Retrospective Studies; D012577:Schools, Medical; D013337:Students, Medical; D055815:Young Adult