title: Voluntary attendance of small-group brainstorming tutoring courses intensify new clerk's "excellence in clinical care": a pilot study.
abstract: BACKGROUND
  Clerkship provides a unique way of transferring the knowledge and skills gathered during medical school's curriculum into real-ward clinical care environment. The annual program evaluation has indicated that the training of clerks in diagnostic and clinical reasoning skills needed to be enhanced. Recently, "clinical excellence" program have been promoted in our institution to augment the excellence in clinical care of new clerks. Current study aims to evaluate whether this pilot program improve the "clinical excellence" of new clerks.
  
  
  METHODS
  In a pilot study, groups of new clerks in years 2013 and 2014 voluntarily attended either a small-group brainstorming course or a didactic classroom tutoring courses as part of their 3-month internal medicine clinical rotation block. A third group of new clerks did not join either of the above courses and this group served as the control group. Pre-block/post-block self-assessment and post-block 5-station mini-Objective Subjective Clinical Examinations (OSCEs) were used to evaluate the effectiveness of these two additional courses that trained diagnostic and clinical reasoning skills.
  
  
  RESULTS
  Overtime, the percentages of new clerks that attended voluntarily either the small-group brainstorming or classroom tutoring courses were increased. Higher post-block self-assessed diagnostic and clinical reasoning skill scores were found among individuals who attended the small-group brainstorming courses compared to either the didactic group or the control group. In a corresponding manner, the small-group brainstorming group obtained higher summary OSCEdiagand OSCEreasonscores than either the didactic group or control group. For all basic images/laboratory OSCE stations, the individual diagnostic skill (OSCEdiag) scores of the small-group brainstorming group were higher than those of the didactic group. By way of contrast, only the clinical reasoning skill (OSCEreason) scores of the basic electrocardiogram and complete blood count + biochemistry OSCE station of thesmall-group brainstorming group were higher than those of the didactic group. Among the small-group brainstorming group, clerks with higher cumulative learning hours (>30-h) had significant higher OSCEdiagand OSCEreasonscores (>400) than those with less cumulative learning hours.
  
  
  CONCLUSIONS
  Our pilot study provides a successful example of the use of a small-group tutoring courses for augmenting the diagnostic and clinical reasoning skills of new clerks. The positive results obtained during the initial 2-year long pilot "clinical excellence" program have encouraged the formal implementation of this course as part of the clerkship curriculum.
authors.affiliation: Department of Medical Education, Yilan, Taiwan.|Department of Medicine, National Yang-Ming University, Taipei, Taiwan.
authors.forename: Ling-Yu
authors.initials: LY
authors.lastname: Yang
authors.affiliation: Division of Clinical Skills Training, Yilan, Taiwan.|Department of Medicine, National Yang-Ming University, Taipei, Taiwan.
authors.forename: Chia-Chang
authors.initials: CC
authors.lastname: Huang
authors.affiliation: Department of Medicine, Division of General Medicine, Yilan, Taiwan.|Camillians Saint Mary's Hospital Luodong, Yilan, Taiwan.|Department of Medicine, National Yang-Ming University, Taipei, Taiwan.
authors.forename: Hui-Chi
authors.initials: HC
authors.lastname: Hsu
authors.affiliation: Division of Clinical Skills Training, Yilan, Taiwan. yangyy@vghtpe.gov.tw.|Department of Medicine, Division of General Medicine, Yilan, Taiwan. yangyy@vghtpe.gov.tw.|Department of Medicine, National Yang-Ming University, Taipei, Taiwan. yangyy@vghtpe.gov.tw.
authors.forename: Ying-Ying
authors.initials: YY
authors.lastname: Yang
authors.affiliation: Department of Medicine, Division of General Medicine, Yilan, Taiwan.|Department of Medicine, National Yang-Ming University, Taipei, Taiwan.
authors.forename: Ching-Chi
authors.initials: CC
authors.lastname: Chang
authors.affiliation: Department of Medicine, Division of General Medicine, Yilan, Taiwan.|Department of Medicine, National Yang-Ming University, Taipei, Taiwan.
authors.forename: Chiao-Lin
authors.initials: CL
authors.lastname: Chuang
authors.affiliation: Department of Medicine, Division of General Medicine, Yilan, Taiwan.|Department of Medicine, National Yang-Ming University, Taipei, Taiwan.
authors.forename: Wei-Shin
authors.initials: WS
authors.lastname: Lee
authors.affiliation: Department of Medical Education, Yilan, Taiwan.|Department of Medicine, National Yang-Ming University, Taipei, Taiwan.
authors.forename: Jen-Feng
authors.initials: JF
authors.lastname: Liang
authors.affiliation: Department of Medical Education, Yilan, Taiwan.|Department of Medicine, National Yang-Ming University, Taipei, Taiwan.
authors.forename: Hao Min
authors.initials: HM
authors.lastname: Cheng
authors.affiliation: Division of Clinical Skills Training, Yilan, Taiwan.|Department of Medicine, Division of General Medicine, Yilan, Taiwan.|Department of Medicine, National Yang-Ming University, Taipei, Taiwan.
authors.forename: Chin-Chou
authors.initials: CC
authors.lastname: Huang
authors.affiliation: Taipei Veterans General Hospital, Yilan, Taiwan.|Department of Medicine, National Yang-Ming University, Taipei, Taiwan.
authors.forename: Fa-Yauh
authors.initials: FY
authors.lastname: Lee
authors.affiliation: Taipei Veterans General Hospital, Yilan, Taiwan.|Department of Medicine, National Yang-Ming University, Taipei, Taiwan.
authors.forename: Shung-Tai
authors.initials: ST
authors.lastname: Ho
authors.affiliation: Department of Medicine, National Yang-Ming University, Taipei, Taiwan.
authors.forename: Ralph
authors.initials: R
authors.lastname: Kirby
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D002982:Clinical Clerkship / Q000379:methods* / Q000592:standards*; D002983:Clinical Competence; D003479:Curriculum; D004521:Educational Measurement / Q000379:methods; D006801:Humans; D007396:Internship and Residency / Q000379:methods / Q000592:standards; D010865:Pilot Projects; D015397:Program Evaluation; D013337:Students, Medical / Q000523:psychology; D035141:Voluntary Programs
keywords: Clerkship; Clinical excellence; Diagnostic and clinical reasoning skills; Small-group brainstorming; Tutoring courses