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Year : 2017  |  Volume : 3  |  Issue : 1  |  Page : 74-76

Effects of educational activities in externship course on history taking and patient presentation skills

Department of Medical Education, Medical Education Research Center, Isfahan University of Medical Sciences, Isfahan, Iran

Date of Web Publication16-Jan-2017

Correspondence Address:
Mohammad Fakhari
Department of Medical Education, Medical Education Research Center, Isfahan University of Medical Sciences, Isfahan
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/2395-2296.179084

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Aim: Patient presentation skill is a core clinical skill in externship clinical education. This study is conducted to investigate the effects of externship clinical course on medical students' history taking and patient presentation. Methods: This pre-/post-quasi-experimental study is conducted on all 3rd year medical students (62 externs). The students' performance is assessed through a researcher-made checklist. The McNemar's test is used to compare the pre- and post-test item frequencies. Results: The findings reveal that most of the medical students addressed the chief complaint and present illness of patient in their patient history presentation. Frequencies of correct performance are below 70% in the posttest. None of the externs tried to perform physical examination. The McNemar's test results revealed that in the eleven items and subitems, the student performance improved significantly. Conclusion: Educational activity in externship courses could improve some items in medical student patient presentation performance; while medical students had moderate competency in the patient presentation. The findings here correspond to the finding in previous studies.

Keywords: Clinical training, history taking, medical education

How to cite this article:
Haghani F, Fakhari M. Effects of educational activities in externship course on history taking and patient presentation skills. Int J Educ Psychol Res 2017;3:74-6

How to cite this URL:
Haghani F, Fakhari M. Effects of educational activities in externship course on history taking and patient presentation skills. Int J Educ Psychol Res [serial online] 2017 [cited 2023 Jun 4];3:74-6. Available from: https://www.ijeprjournal.org/text.asp?2017/3/1/74/179084

  Introduction Top

Medical students have to acquire history taking, physical examination, clinical test interpretation, and patient presentation skills as the core clinical skills in their externship clinical education. Patient presentation is the main skill and general competency in clinical training. Patient presentation as a communication skill needs clinical knowledge and rhetorical ability that must be learned in a clinical course.[1] Patient presentation is a complex skill that helps medical students learn clinical reasoning skill, reflect on their performance, and gather organized clinical data. Patient presentation is an evaluation method in clinical education, adopted by clinical instructors in order to evaluate medical students' competencies and determine their learning deficiencies.[2]

Previous studies have revealed that the graduated medical student has low to moderate competency in presentation skills.[3],[4] Another study concluded that utilization of standardized patients in medical education had a little effect on history taking skills of medical students.[5] There does not exist any compelling research on effectiveness of clinical teaching on student performance. In externship clinical courses, the medical students are at the initial point of clinical encounter and maybe not have any previous actual clinical learning experience. This study is conducted to investigate the effects of externship clinical courses on the medical students' history taking and patient presentation skills.

  Methods Top

This is a quasi-experimental study on a single group accompanied with pre- and post-test. This study was conducted in an educational hospital managed by the Isfahan University of Medical Sciences in 2014. Third year medical students are enrolled in the externship course. This course is the initial point of the actual clinical encounter for undergraduate medical students. The externship course helps medical students integrate theoretical learning into clinical learning. Students are enrolled in multiple subgroups in the educational course based on the educational course plan. All medical students in an externship course introduced to the educational hospital are involved in this study. Every extern filled and signed the written consent to participate in this study. Exclusion criterion here was having 3 or more day's absence in this course. At the beginning and at the end of the course, every student passed an objective clinical exam as a pretest and posttest. All clinical examinations were performed in an outpatient clinic. Patient selection in this study was on random basis. Before pre- or post-tests, every student was given 30 min for patient assessment, history taking, physical examination, organization of clinical data, determination of differential diagnosis, and writing the treatment plan for one patient in an outpatient clinic. Every selected patient is assessed and examined by a single extern while other patients are assessed by interns or residents.

A researcher-made checklist is used to rate student performance in the objective clinical exam. These checklists consist of the following 18 items and sub items: Eleven for medical history (patient profile, chief complaint, present illness, past history, and review of systems), four for physical examination (vital signs, clinical examination), and one each for past clinical test results interpretation, differential diagnosis, and treatment plan. Some items contain sub items such as: Patient profile with three sub items, past history with five, and vital signs control with three. The researchers in this study used literature review and experts' guidance in developing and validating this checklist. The checklist is rated by a researcher who is an independent and overt observer in the examination room. This researcher observed the performance of every student and filled the boxes in the checklist based on the correct presentation of each items or subitems in patient presentation. The frequency of corrected item and subitem was compared by the McNemar's change test applied in SPSS for Windows, Version 16.0. (Chicago, SPSS Inc.) statistical software.

  Results Top

At the beginning of the study, 62 students participated in the externship course. Eight students were excluded due to an absence of more than 3 days. The attrition rate is about 13%. The students' age mean and standard deviation (SD) are 24.48 ± 0.88, respectively. The frequency of the male students' participation is 48%. The patients' age mean and SD is 49.16 ± 12.79, respectively. The frequency of the male patients is 65%. The multiple admissions of the patients in this study are 14%. There is no significant difference between age and gender of the externs who participated. In addition, there is no significant difference among age, gender, and rate of previous admission in the participated patients.

The frequency of positive findings is tabulated in [Table 1]. In the posttest, the findings revealed that all medical students have considered the chief complaint and present illness of the patient in the patient history presentation. About 80% of the externs addressed marital status, past disease history, clinical test results, and differential diagnosis items. About 50% of the externs addressed the past surgical history and treatment plan in the posttest results. None of the externs tried to perform physical examination. Nine percent of the students controlled the vital signs of the patients. The McNemar's test results indicate that some items and subitems such as patient profiles (subitems: age, marital status, and job), chief complaints, present illness, past history (subitems: past disease, drug history, and past surgical history), review of systems, past clinical test results, differential diagnosis, and treatment plan improved significantly [Table 1].
Table 1: Compare frequency of correct presented items and sub items between pretest and post test (n= 54)

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  Discussion Top

The results obtained in this study revealed that the educational activity through the externship course could improve some items on history taking and patient presentation skills. The findings revealed that most of the students did not get good or excellent grades in these skills. In most of the items, frequencies of correct performance were below 70% in the posttest. It indicates that medical students had moderate competency in patient presentation at the posttest.

The findings in this study correspond to that of previous studies.[3],[4],[6],[7] Haber and Lingard found that the patient presentation is learned through trial and error learning approach in the clinical course. They argue that instructor feedback on patient presentation had provided little guidance for the students.[1]

Some patient presentation items are general in all clinical domains such as the patient profile, chief complaint, and present illness. While some items such as the differential diagnosis or treatment planning are dependent on specific clinical knowledge. Considering the obvious that the medical students in externship course are at the initial stage, where the academic knowledge is just integrated into clinical knowledge.[8] For this reason, they may not acquire excellent grades in some items.

The physical examination may pose a potential threat to patient safety and instructors must consider to ethical codes of clinical practice. Clinical instructors and medical students must obtain explicit verbal consent from patients before students perform physical examination. That too only for educational purposes and the student must perform the skills under the supervision of clinical instructor. Furthermore, every patient has a right to restrict the number of students who present at the bedside and visit him or her.[9] It should be mentioned that in the educational hospitals, multiple levels of the medical students such as residents and interns must master performing patient physical examination and it may put some restrictions on extern's clinical learning experiences. In addition, some medical students may experience anxiety in clinical field[10] and this may lead to their occasional inactivity in physical examination practice.

Vital sign control is an essential part of medical assessment while not all medical students did so. In an observational study conducted on residents' and interns' performance, it is found that they did not control patients' vital sign well.[7] In another study, it is revealed that very few students control vital signs of simulated patients.[6]


The focus of this study is on the frequency of some items in student performance based on the designed checklist with no assessment on the quality of performance. Intervening variables such as instructor performance and environmental elements are not considered in this study.

  Conclusion Top

Educational activity in externship course could improve some items of medical student's performance in history taking and patient presentation skills. Further studies are required to confirm these findings in other educational hospital and clinical settings.

Ethical consideration

This study is performed in accordance with the Declaration of Helsinki and subsequent revisions and approved by the Ethics Committee at the Isfahan University of Medical Sciences. Every patient signed written consent to participate. The researchers respected the participants' confidentiality. The researchers collected and saved the pre- and post-test examination sheets after completion. The extern's performance data is not applied in the final course evaluation.


The authors are grateful to all medical instructors and students who participated in this study.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

  References Top

Haber RJ, Lingard LA. Learning oral presentation skills: A rhetorical analysis with pedagogical and professional implications. J Gen Intern Med 2001;16:308-14.  Back to cited text no. 1
Onishi H. Role of case presentation for teaching and learning activities. Kaohsiung J Med Sci 2008;24:356-60.  Back to cited text no. 2
Changiz T, Fakhari M, Jamshidian S, Zare S, Asgari F. Systematic review of studies in the field of competencies of new or soon to be-graduate general physicians in Iran. Strides Dev Med Educ 2015;12:325-43.  Back to cited text no. 3
Kahooei M, Askari Majdabadi H. The quality survey of medical students and assistants practice in history taking and physical examination of patients. Koomesh 2002;3:45-52.  Back to cited text no. 4
Saboori M, Jafari F, Monajemi A. The effect of employing standardized patient on history taking skills of medical students. Iran J Med Educ 2010;10:276-83.  Back to cited text no. 5
Morgan PJ, Cleave-Hogg D, De Sousa S, Tarshis J. Identification of gaps in the achievement of undergraduate anesthesia educational objectives using high-fidelity patient simulation. Anesth Analg 2003;97:1690-4.  Back to cited text no. 6
Sharma S. A single-blinded, direct observational study of PGY-1 interns and PGY-2 residents in evaluating their history-taking and physical-examination skills. Perm J 2011;15:23.  Back to cited text no. 7
Prince KJ, Boshuizen HP, van der Vleuten CP, Scherpbier AJ. Students′ opinions about their preparation for clinical practice. Med Educ 2005;39:704-12.  Back to cited text no. 8
Kalantri S. Ethics in medical education. Indian J Anaesth 2003;47:435-6.  Back to cited text no. 9
  Medknow Journal  
Doyal L. Closing the gap between professional teaching and practice: A policy can help protect students from being asked to behave unethically. Br Med J 2001;322:685.  Back to cited text no. 10


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