title: The Surgical Clerkship and Medical Student Performance in a Standardized Patient Case of Acute Cholecystitis.
abstract: BACKGROUND
  Although an Observed Structured Clinical Examination (OSCE) has been used to evaluate patient interaction and general knowledge competencies of third-year students during their required surgical clerkships, whether surgical clerkship experience predicts satisfactory performance with a surgical patient in an OSCE environment has not been investigated.
  
  
  OBJECTIVE
  We hypothesized that completion of the third-year surgery clerkship would improve student ability to diagnose acute cholecystitis and recognize the further need for hospital admission and treatment.
  
  
  METHODS
  An observational study design was used to determine student skills in evaluating a simulated surgical patient with abdominal pain from acute cholecystitis. The skills included key data gathering, physical examination, and information-sharing tasks.
  
  
  METHODS
  Tertiary care academic medical center.
  
  
  METHODS
  Performance was compared between a cohort of 101 medical students who had completed the third-year surgical clerkship and 72 who had not. A secondary analysis compared performance for 91 students who had completed their third-year clerkship in sites near the University of California, San Francisco School of Medicine, and 10 who did so at a regional campus geographically distant from the medical school.
  
  
  RESULTS
  Of the 173 students who participated in the OSCE, only 42% correctly identified the diagnosis of acute cholecystitis, though 71% did suggest the possibility of a biliary process to the standardized patient. Most of the students who identified the condition as acute cholecystitis or gallbladder-related process had completed their third-year surgical clerkship (odds ratio [OR] = 3.26). Students who completed their surgical clerkship were also better able to recommend appropriate treatment for the patient (OR = 2.35), and recommend admission to the hospital or emergency department (OR = 2.00). Approximately one-third (35.3%) of all students documented a positive Murphy's sign, but only 6.4% identified the triad of leukocytosis, fever, and a Murphy's sign as diagnostic of acute cholecystitis and the need for surgical intervention. Student performance on the clinical examination did not differ depending on whether the students completed their clerkship at a Bay Area or regional hospital.
  
  
  CONCLUSIONS
  Student recognition of the key physical examination and laboratory findings diagnostic of acute cholecystitis was low, but students were better able to recommend further treatment for a patient with acute cholecystitis after completing the third-year surgical clerkship. Our study reveals areas where surgical educators can improve medical student ability to accurately diagnose acute cholecystitis and evaluate acute abdominal processes.
authors.affiliation: School of Medicine, University of California, San Francisco, California.
authors.forename: Eric
authors.initials: E
authors.lastname: Low
authors.affiliation: Department of Surgery, University of California, San Francisco, California.
authors.forename: Robert
authors.initials: R
authors.lastname: Tessler
authors.affiliation: Department of Medicine, University of California, San Francisco, California.
authors.forename: Karen E
authors.initials: KE
authors.lastname: Hauer
authors.affiliation: Department of Medicine, University of California, San Francisco, California; Department Laboratory Medicine, University of California, San Francisco, California.
authors.forename: Andrew D
authors.initials: AD
authors.lastname: Leavitt
authors.affiliation: School of Medicine, University of California, San Francisco, California.
authors.forename: Bernie
authors.initials: B
authors.lastname: Miller
authors.affiliation: Department of Surgery, University of California, San Francisco, California. Electronic address: Maaj@maringeneral.org.
authors.forename: John
authors.initials: J
authors.lastname: Maa
mesh_terms: D041881:Cholecystitis, Acute / Q000175:diagnosis*; D002982:Clinical Clerkship; D002983:Clinical Competence; D003937:Diagnosis, Differential; D004504:Education, Medical, Undergraduate / Q000379:methods*; D004521:Educational Measurement; D006801:Humans; D010808:Physical Examination; D012495:San Francisco
keywords: Interpersonal and Communication Skills; Medical Knowledge; Patient Care; abdominal pain; medical student; regional campus; standardized patient; surgery clerkship