Integrating Formative and Summative Clinical Skills Examinations to Promote Learning for Early Medical Students: A Mixed Methods Study

Background Medical educators aim to train students with high-quality clinical skills through the promotion of self-regulated learning and the development of lifelong learning skills. Formative clinical skills examinations (FCSE) allow for real-time learner-centered feedback and coaching which are key in promoting the development of expertise in early learners. This study assessed the impact of the integration of FCSE with learner-centered, real-time feedback and coaching based on an "educational plan-do-study-act" (PDSA) cycle on early medical students' experience and performance.Methods A mixed methods study was designed to assess the integration of FCSE for first- and second-year medical students. FCSE consisted of linked stations: students gathered a history from a standardized patient (SP), performed a hypothesis-driven physical examination followed by real-time learner-centered feedback and coaching. Each student met with one faculty and one SP to reflect on their performance, identify areas for improvement, re-practice of skills, and identify a plan for ongoing practice improvement. Students were surveyed upon completion of formative and summative clinical skills examinations. Student communication and clinical reasoning performance were compared to historical controls.Results Students reported that FSCE improved the learning environment and helped prepare them for subsequent summative clinical skills examinations. Students appreciated the opportunity for practice and real-time feedback and reported applying their take-home points on subsequent exams. Student longitudinal performance was not impacted by the transition to FSCE.Conclusion While labor-intensive, FCSE with real-time feedback and coaching are an effective means of promoting learning and should be considered for integration early in medical school curricula.