1. Does Predominately Interviewing or Observing Required Patient Encounters Affect Year III Clinical Psychiatry Exam Results? By Staci Becker, RN, MS; Robert J. Pary, MD Southern Illinois University School of Medicine INTRODUCTION It is highly unusual for any medical school to provide uniform clinical experiences. Almost all clerkships emphasize learning by encountering patients on the wards and in the clinics. The number of patients that students encounter can vary tremendously. Another factor is student related. Some students are very active and will seek out these clinical experiences. Others are fairly passive and can pass a clerkship without pursuing many clinical encounters. The varying factors influencing the student-patient encounters prompted the LCME to take action. The LCME specified in its ED-2 standard that clerkships must: 1) Identify the number and types of patients to be encountered 2) Specify the degree of student involvement 3) Monitor and verify that these encounters occur 4) Adjust the clerkship for each student to ensure that all students have the desired clinical experience To meet this standard, a Required Patient Encounter Card System (RPE) was implemented to track student experiences in a six week psychiatry clerkship. The card system was developed by the faculty at an annual educational retreat to bring the clerkship into compliance with the LCME’s educational standard, ED-2. Data has been collected on whether students meet the required patient encounters through interview, partial interview or observation. OBJECTIVE To determine if students’ performance is significantly different on end of clerkship exams depending on whether they were primarily observers or interviewers during required patient encounter. METHODOLOGY A Required Patient Encounter Card System (RPE) was implemented to track student experiences in a six week psychiatry clerkship. Data has been collected on whether students meet the required patient encounters through interview, partial interview or observation. RESULTS Required patient encounter data was analyzed using the following outcome measures: NBME subject exam scores, clinical exam patient findings, clinical exam patient H&P checklists and a patient satisfaction checklist. During the initial data analysis a significant inverse relationship between the subject examination and percent of encounters observed (r= -0.60; p=0.0002). This relationship was not sustained when the data from the second half of the year was added. IMPLICATIONS During the initial analysis, the clerkship decided to set a maximum percentage of required patient encounters that are observed. The clerkship has set a requirement that no more than 7 of the 18 required encounters can be observed. Because the relationship was not sustained after analyzing the entire year, we have decided to collect an additional year of data. Southern Illinois University School of Medicine Department of Psychiatry P.O. Box 19642 Springfield, IL 62794-9642 Telephone: (217) 545-7668 Fax: (217) 545-2275 E-mail: sbecker@siumed.edu rpary@siumed.edu SymptomsIn-pt %Out-pt %SPTotal Partial InterviewInterviewObserveTotal ADHD3146.3%3450.7%23.0%671116.4%2232.8%3450.7%67 Anxiety9648.2%9246.2%115.5%1994221.1%7236.2%8542.7%199 ID8261.7%5138.3%00.0%1332921.8%5138.3%5339.8%133 Mal Adap4770.1%1826.9%23.0%671725.4%2232.8%2841.8%67 Mood10275.0%2719.9%75.1%1361611.9%6749.6%5238.5%135 Psychotic9670.6%3928.7%10.7%1363324.3%4230.9%6144.9%136 Sub Use14470.2%4522.0%167.8%2052311.2%9144.4%9144.4%205 Suicidal11284.2%107.5%118.3%1332015.0%6548.9%4836.1%133 OVERALL71066.0%31629.4%504.6%107619117.8%43240.2%45242.0%1075 Rotations 1-4 %Interview%Partial%Observed Shelf Test0.46 0.22 -0.60 0.00720.20910.0002 Findings-0.01 0.08 -0.04 0.94270.64290.8464 Checklist-0.03-0.150.12 0.85110.41310.5054 Patient Satisfaction 0.00 0.06 -0.03 0.98860.75260.8671 Rotations 5-8 %Interview%Partial%Observed Shelf test-0.23-0.01 0.27 0.18640.95890.1214 Findings-0.010.22-0.15 0.93910.20930.3917 Checklist-0.510.50 0.20 0.00220.00280.2571 Patient Satisfaction -0.14-0.02 0.17 0.44610.93220.351