Participants
Among the 144 second year students, 52 students who did not take place in the interview practice were selected via a random numbers table and enrolled in the study. 27 of them were placed into the study group, while 25 took part in the control group. Students were informed of the purpose of the study and gave their consent to participate in the study. Ethics committee of Dokuz Eylul University Faculty of Medicine (DEUFM) has given the approval for the study.
Design
A randomized controlled trial was designed to compare the effects of different feedback methods on the performance of students.
The study was conducted with DEUFM second year students, in the first month of their academic year. Since 2001 the clinical skills program, which includes interviewing the patient, history taking, and performing physical examinations as well as recording skills, has been spread out over the first three years of medical school. The main goal of the clinical skills program is to successfully attain these skills in the preclinical period and to facilitate early contact with the patient. The curriculum consists of the basic perspectives and characteristics of interview and history taking in the first year, learning the skills based on systems in the second year and the synthesis of all these skills in the third year.
Instruments
The checklist which was used in the assessment was composed of two parts. The first part included 10 variables which evaluated communication skills, and the second part consisted of twelve variables which measured the components of the medical history in the form of a likert-like scale (Additional file 1). While evaluating communication skills and taking history, if the students omitted an item, the result was marked as "unsatisfactory", if the student had questioned only one subheading of each item, the result was marked as "borderline", while if the student had questioned more than one subheading of each item then it was marked as "satisfactory". For example, in "Facilitating skills" the seventh item of the communication scale contains various subheadings such as "Does he/she make eye contact? Is his/her speech clear?" etc. If the student did not use any of the facilitating skills noted, then the result was marked as "unsatisfactory." If he/she only made eye contact, but neglected the other steps, the result was marked as "borderline" and if he/she made eye contact and performed any other of the subheading the result was marked as "satisfactory". The reliability of the communication skills scale was acceptable in medium level (Cronbach's alpha = 0.77). The history taking scale was used in our education program which based on universally used and accepted steps of history taking.
The scenarios of the cases used in our study both related with pain. The first one was headache due to migraine and the second one was low back pain due to herniated disc.
Procedures
During the first interviews for both groups, assessors observed students and assessed them via a checklist. In the study group, however, in addition to this, the interviews were recorded on video tape. Finally, after the interviews, both student groups were asked to assess themselves using the same checklist. In the control group, the assessors gave only verbal feedback to the subjects. In the study group, on the other hand, feedback was given verbally but after the trainer and student watched the video recording together. After a period of 15 days, the students of both groups interviewed the patients again, however, this time the study group was not video recorded. Students were assessed again by the assessors, and assessed themselves using the same checklist. All subjects attended the same lectures and practices during this two week period.
All students enrolled in the study interviewed simulated patients in two-way mirrored rooms twice. Four family medicine department staff, permanently assigned assessors of clinical skills, made the observations. Interrater reliability was found as Kappa>0.90.
Data Analysis
22 variables were divided into several subscales. "Communication score" ranged between 0 - 12 and entailed greeting the patient, comforting and determining the level of communication, facilitating skills and using communication skills. "Ability of taking medical history score" ranged between 0 - 18 and included beginning with open ended questions and continuing with closed ended ones, constructing the history in sequence, guiding the patient and summarizing history episodes, determining the process and ending in an appropriate manner. "History of present illness score" ranged between 0 - 15 and included the variables of primary, secondary and tertiary story, the patient's perspective and the things that have been done about the illness. "Other history components score" ranged between 0 - 15 and involved the past medical history, present health condition, family history, personal and social history and reviewing of systems. "Total history score" was the summation of the above history scores plus the main complaint and the identification data. Total history score ranged between 0 - 33.
"Total score" was the sum arrived at by adding total history and total communication scores and ranged between 0 - 66.
The data was analyzed by SPSS 11.0 for windows Statistical Program. Descriptive statistics, and independent and dependent sampling t test was used for group comparisons. Statistical significance was tested at the level of p < 0.05.