The Influence of Peers on Medical Students Learning of Psychomotor Skills Necessary for Physical Examination

Leren van psychomotorische vaardigheden als deel van het lichamelijk onderzoek: invloed van peers Thesis to obtain the degree of Doctor from the Erasmus University Rotterdam by command of the rector magnificus CONTENTS Chapter 1 The influence of peers on medical students learning of psychomotor skills necessary for physical examination 9 Chapter 2 To observe or not to observe peers when learning physical examination skills; that is the question 31 Chapter 3 From see one do one; to see a good one do a better one: learning physical examination skills through peer observation 45 Chapter 4 The influence of peer feedback on the acquisition of physical-examination skills 59 Chapter 5 Characteristics of peer feedback influencing learning of physical examination psychomotor skills 77 Chapter 6 Learning physical examination in small groups: who wants to go first? 103 Chapter 7 Summary of main findings, implications for medical education and directions for further research 119 Appendices 145 Acknowledgements 187 Curriculum vitae 189 Author's publications 191 Chapter 1 The influence of peers on medical students learning of psychomotor skills necessary for physical examination Peer influence on psychomotor skills learning of physical examination 11 The physical examination (PE) is a core element of a physician's diagnostic decision-making process, 1 therefore potentially affecting medical care provided to patients. 2 Developing PE skills as early as possible during medical training and being able to maintain these skills is therefore of great importance. Although medical teachers view the development of skills needed to appropriately perform PE as a priority, this does not seem an easily achievable objective. A recent survey showed that a substantial proportion of American clerkship directors consider students to be inadequately prepared to perform PEs when they arrive for their clerkships. 3 Indeed, the students themselves shared this opinion. 4 This perception of inadequate preparation 5 is worrisome, specially because existing studies have not clearly established the best approach for mastery of the PE during preclinical training that would maximize retention for effective application during the clerkship. 6-8 Medical schools remain, therefore, faced with the challenge of developing effective strategies for teaching PE skills as a sine qua non to foster learning of clinical skills in broad sense at the undergraduate level. Mastering the PE necessitates the integration of many components such as knowledge of anatomy and physiology, psychomotor skills necessary to perform the appropriate manoeuvres and procedures, and, of course, clinical reasoning. The teaching of …