Student performance problems in medical school clinical skills assessments.

BACKGROUND: Though most medical schools administer comprehensive clinical skills assessments to identify students who have not achieved competence, the types of problems uncovered by these exams have not been characterized.

METHOD: The authors interviewed 33 individuals responsible for remediation after their schools' comprehensive assessments, to explore their experience with the problems students demonstrate and strategies for and success with remediation.

RESULTS: Respondents perceived that technique problems in history taking and physical examination were readily correctable, but that poor performance resulting from inadequate knowledge or poor clinical reasoning ability was more difficult to ameliorate. Interpersonal skill deficiencies, which often manifested as detachment from the patient, and professionalism problems attributed to lack of insight, were most refractory to remediation.

CONCLUSIONS: Poor performance in comprehensive assessments often indicates underlying deficiencies in cognitive ability, communication skills, or professionalism. The challenge of remediating these deficiencies late in medical school calls for earlier identification and intervention.