Formative Assessment by Direct Observation of Clinical Skills on the OB/GYN Clerkship Rotation

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To determine the impact of requiring that medical students be observed taking a history or performing a pelvic examination by a physician during their OB/GYN clerkship rotation.


One of the LCME standards for accreditation of a medical school is having physicians directly observe medical students in their clinical activities in order to provide formative feedback. Since 2009, 29.7–52.9% of each class of Manitoba medical graduates report having been observed taking a history on their OB/GYN clerkship rotation; 45.2–70.4% for observed physical examination.


Clerks are surveyed on the last day of their OB/GYN rotation to determine the number of observed histories and/or pelvic examinations. In September 2015, observed histories and pelvic examinations became a rotation requirement. A mini-CEX tool was developed and included in the student's logbook to facilitate documentation and provide feedback. The reported number of observed histories and pelvic examinations are compared before and after implementation of this process.


Thirty-five percent of 69 students surveyed before implementation report having been observed performing a history by a physician. This rose to 64% (of 28 students) following implementation. All of them report being observed performing a pelvic examination, before and after, however only 53% documented this on the assessment tool.


The number of observed histories has increased however there is room for further improvement. This may require additional faculty education and/or scheduled assessment for some students. The number reporting an observed pelvic examination continues to be 100% but improved documentation of this must be encouraged.

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