A LUMP MODEL FOR MEDICAL STUDENTS’ CLINICAL EVALUATION

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S.A. Ademola,^1,2 A.I. Michael^1,2 A.O. Takure,^1,2 T.A. Lawal^1,2

1. Department of Surgery, Faculty of Clinical Sciences, College of Medicine. University of Ibadan, Ibadan, Nigeria.
2. Department of Surgery, University College Hospital, Ibadan, Nigeria.

Abstract

Introduction: Soft tissue masses are commonly encountered in surgical and general medical practice. The graduating medical student should therefore be competent in the physical examination of a lump. Paucity of real patients makes it paramount that models be used for teaching and evaluation. This study purposed to describe the perception of graduating medical students to the use of a low-cost lump model for Objective Structured Clinical Examination (OSCE).

Methods: This was a cross-sectional survey of final year medical students who participated in a surgery OSCE utilizing an innovative low-cost lump model.

Results: One hundred and sixty students undertook the OSCE examination while 130 (81.3%) students completed the survey questionnaire. One hundred and forty students (87.5%) passed (score ³ 5) the skills assessment using the lump model. The median age of the students who completed the questionnaire was 25 (range 24-27) years. There were more males N=84 (65.6%) than females N= 44 (34.4%). Two thirds (67.2%; n=84) of the students said the model simulated a true lump. Nearly all the students agreed that the signs of site (97.6%; n=127), size (97.6%; n=127), shape (95.4%; n=124) and transillumination (95.4%; n=124) were clearly demonstrable with the model. A lower proportion of agreements were seen with signs such as tenderness (64.6%; n=82), attachment (77.7%; n=80) and warmth (58.6%; n=75) while more students disagreed with pulsatility (51.5%; n=67)

Conclusion: The medical students had a positive perception to the use of the model. However, further refinements would be needed for more signs to be demonstrable.

Keywords: Lump model, Objective structured clinical examination, Simulation, Medical students

Introduction

Soft tissue masses are commonly encountered in surgical as well as general medical practice. The major identifying feature is the presence of a lump characterized by specific signs elicited on physical examination of the patient. While most of these masses are benign, it is crucial that malignant masses are identified early.^1,2 Examination of a lump is therefore a competency-based skill medical students must acquire. In addition, determination of possible causes of the lump based on the characteristic signs form the basis for examination of the students’ foundational knowledge of these common masses.

The Objective Structured Clinical Examination (OSCE) has become a core component of undergraduate and postgraduate medical education. It has been proven to be valid and reliable for the measurement or assessment of clinical competency. ^3–5 These competencies span knowledge, skills, and attitudes all of which the medical student is expected to become proficient in by the end of the training. Turner and Dankoski emphasized the importance of focused review of OSCE methods to improve its validity in measuring these core competencies.⁶ While the widespread use of OSCE attests to its importance, inherent potential breaches exist such as test security and validity of the examinations, which coordinators must intentionally seek to identify and address.^7–10 Additionally, evaluation of physical examination skills at OSCE stations needs to be examined periodically to ensure its validity.¹⁰

The OSCE methods have evolved from using real patients to standardized patients and models for demonstration of clinical competencies. Simulation based medical education is accepted in many countries.^11–13 Simulation with the use of mannequins in medical education ensure training on clinical skills and provide an avenue for repeated practice outside the clinical setting. Factory produced mannequins using materials such as silicone are of high fidelity. However, while the integration of high-fidelity mannequins into OSCE skill stations may be available in high resource settings, this is not feasible in low resource settings and the need to develop low-cost mannequins for teaching clinical skills is germane in the latter.^14–16 The innovative use of low cost readily available materials for development of mannequins in low resource settings ensures sustainability.

This study determines the pass rate of graduating medical students who used the innovative low-cost lump model for OSCE and describes their perception of the model.