Medical history taking was measured in each station. Case-specific checklists, completed by the standardized patient after each encounter, were used for scoring. These checklists consist of the relevant patient history questions that should be asked given the nature of the case and the chief patient complaint. A student's medical history taking score is the percentage of items attained. Physical examination skills were measured in 11 (of 12) of the stations. Case-specific checklists, completed by standardized patients following the encounters, were used for scoring. These checklist items reflect the maneuvers that a student should complete in doing a focused physical examination. A student's physical examination score is the percentage of items attained. The data gathering score for a given station is the percentage of the total history taking and physical examination items attained. Summary scores are obtained by averaging the skill scores over encounters.
Even though osteopathic diagnosis and treatment could be included with any of the cases, as part of this study, OMT was specifically assessed in three (25%) of the stations. Evaluations were done by an osteopathic physician in the examination room using the recently developed OMT assessment tool. This instrument has 15 items that can each be scored from 2 (done proficiently) to 0 (done incorrectly or not done). A score of 1 is given for actions that are done, but with hesitation, uncertainty, tentativeness, not performed optimally, etc. A candidate's total score for a given case can range from 0 to 30 on the raw score metric or 0 to 100 on the percent score metric. For stations in which OMT is assessed, the osteopathic clinical skills score is a combination (average) of the data gathering and OMT (converted to a percentage) scores. For stations in which OMT is not assessed, the osteopathic clinical skills score is the data gathering score.
Use of the SOAP (subjective, objective, assessment, plan) format to document findings from the patient encounter is common. Physicians document what the patient told them (chief complaint, history of present illness, past medical history), what they saw in the examination (significant positive and negative physical findings), the assessment (problem list, diagnoses), and the plan (treatment, further diagnostic tests). For the current investigation, the notes were scored for each category (S, O, A, and P) and globally by trained osteopathic physicians raters. Each note was scored for the subjective, objective, assessment, and plan portions on a 1 to 9 scale, with 1 to 3 being unacceptable and 7 to 9 being superior. Ratings of 4 to 6 were not labeled, but could be considered to represent performance that was better than unacceptable, yet less than superior. The SOAP mean score (range, 1 to 9) is the average of the four category ratings.
The biomedical/biomechanical domain encompasses osteopathic clinical skills and written communication (SOAP). The biomedical/biomechanical score is based on a weighted average of the osteopathic clinical skills (2/3 weight) and SOAP note (1/3 weight) scores. Values, on a percent score metric, can range from 0 to 100.
The humanistic domain includes physician-patient communication and physician-patient relationship skills. The standardized patients in each station evaluated these skills. The standardized patients use the global patient assessment instrument to rate the candidates across six relevant dimensions (clarity of questions, listening, explanation and summarization of information, respectfulness, empathy, and professionalism). Each dimension is rated on a scale of 1 to 9, where 1 to 3 denotes unacceptable performance and 7 to 9 signifies superior performance. The global patient assessment score for a given station is the mean of the six dimension scores.