One hundred eighty-nine student surveys (27%) were undeliverable, owing to temporary addresses provided. Of the undeliverable surveys, 113 were re-sent because a current address was provided by the post office. Data are based on responses from 17 deans, 35 experts, 70 OGME directors, and 220 students. Thirty-one percent (22) of the OGME directors who completed the survey were from family medicine programs, 12% (8) were from internal medicine, 10% (7) were from obstetrics and gynecology, and 5% (4) were from pediatrics. Ten percent (7) of the OGME respondents were directors of medical education (DMEs) at their institutions, 14% (10) directed other programs (specified on the survey as cardiology, sports medicine, dermatology, orthopedics, surgery, neuromusculoskeletal medicine, or simply as “other”), and 13% (9) directed more than one program. The selected experts had an average of 10.4 years of private clinical practice experience. Most experts had direct experience with the population of students for whom clinical skills standards will be set, with an average of 9.2 years of working directly with fourth-year osteopathic medical students.
Table 1 presents the percentages of fourth-year students (or interns) who respondents felt had adequate skill levels in various areas of clinical expertise. With the possible exception of history taking and physical examination, the deans were more confident in students' skills than OGME directors. The biggest disparity of opinion is in the area of student skill levels in delivering OMT. The percentages of fourth-year students or interns with adequate skills in OMT as rated by deans, experts, OGME directors, and the students themselves are 93%, 64%, 58%, and 67%, respectively. A small number of survey respondents felt that all students had the clinical skills necessary for graduate medical training. Most respondents, however, suggested that some do not.
The students' judgments of their peers were closer to those of the OGME directors than those of the deans. Unlike the deans, there were no skill areas where students, on average, felt that more than 90% of fellow students had adequate clinical skills. The students were most confident in the areas of history taking and use of the SOAP (subjective, objective, assessment, and plan) note form, where they felt that 89% and 88% had adequate skills, respectively. Students suggested that approximately 85% of fellow students had adequate skills in physical examination, and 84% had sufficient physician-patient communication skills. Students felt that only two thirds of fourth-year students would be prepared for delivering OMT in osteopathic graduate medical training.
In comparison with the deans and the students, the OGME directors were the most stringent group. The participating OGME directors felt that approximately 80% of interns had adequate skills in physical examination, the SOAP note form, and physician-patient communication. Among the skills listed, OGME directors were most confident in the ability of interns to take patient histories. Similar to the students, OGME directors were also uncertain of the ability of interns to provide OMT to their patients. According to this group, only 58% of interns have adequate levels of mastery in this skill area.
The experts had judgments that were most in agreement with the OGME directors. Experts felt that approximately 80% of the students had adequate skills in history taking, physical examination, and the SOAP note form and that only 74% of students had sufficient skills in physician-patient communication. Similar to the other groups, experts were least confident in students' OMT skills; 64% of students had adequate OMT skills, according to the expert group.
There was a range of rates among the four groups, especially between the deans and the other three groups. Many experts, OGME directors, and students listed relatively small percentages in some skill categories (eg, minimum scores in some areas were as low as 5%). In contrast, the minimum score given by the deans was 60% in physician-patient communication and exceeded 70% in all other categories. The maximum percentages given in
Table 1 demonstrate that in every group, there were individuals who felt that 95% to 100% of the students had adequate skills. Some respondents felt that 100% of students had adequate clinical skills in all five skill areas. Thirty-five percent of the deans recorded 100% for all five skill categories, compared with 6% of the OGME directors, 4% of the students, and none of the 35 experts.
The level of agreement between groups for the expected and acceptable pass rates (
Table 2) was higher than for the clinical skills. All respondents felt that a minimum of 79% to 88% of students taking the test for the first time would pass, and a maximum of 94% to 98% would pass. Similar to the clinical skills ratings, the mean minimum expected pass rates by OGME directors and experts were lower than those reported by deans and students.
Experts, OGME directors, and students felt that a lower pass rate was acceptable (82%, 79%, and 80%, respectively). Deans, however, felt that a minimum pass rate of 90% was acceptable. The groups were closer in agreement on the mean maximum pass rates (95%–98%).