Efficiently teaching mental status examination to medical students
Brenda J Talley, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, MC 7792, San Antonio, Texas 78229, USA. Tel: 00 1 210 567 0085; Fax: 00 1 210 567 3483; E-mail: firstname.lastname@example.org
Context and setting
The ability to conduct a mental status examination (MSE) is an important clinical competency that medical students must achieve. We use an MSE format with five domains: Appearance, Mood, Sensorium, Intelligence and Thought. Teaching over 200 students how to interview a subject and write up an MSE is a labour-intensive faculty activity that is problematic in an era in which clinical teachers’ time is a very limited resource.
Why the idea was necessary
In the past, we taught the MSE by having clinical faculty members supervise groups of five or six students who conducted six face-to-face interviews with actual patients. Students wrote up an MSE based on each interview and submitted it to the instructor. This old instructional approach required approximately 1248 hours of clinical faculty time annually. Class size was increasing each year and thus problems in recruiting faculty members were likely to become even more acute.
What was done
We devised a new instructional approach that substituted videos of a psychiatrist interviewing an actual patient for three of the face-to-face actual patient interviews. Students viewed the videos online via a course management system (CMS), wrote up an MSE and submitted it to the course director via the CMS. All MSEs were checked for completion. A random sample of submitted MSEs were reviewed for construction. A reference standard MSE was released for review and correction by students once the assignment was completed. The sequence alternated between face-to-face and video interviews so each student completed six MSEs, three with actual patients and three with video interviews. The didactic portions of the course (54 hours) remained essentially the same.
Evaluation of results and impact
Three outcome variables were assessed at two time-points: (i) in the final year of the old instructional approach (n = 206 students), and (ii) in the second year of the new approach (n = 214 students). Results for the old and new approaches were then compared.
Mean examination scores based on 10 MSE questions with matched item stems were 85.2% (σ = 11.3) and 90.2% (σ = 9.4) in the old and new systems, respectively, reflecting a statistically significant difference (P < 0.01).
Student satisfaction with the course was assessed using a rating scale of 1–5 where 5 was positive. The statement ‘Feel prepared to begin third-year clerkship in psychiatry’ won ratings of 4.16 (σ = 0.68) and 4.53 (σ = 0.56) on the old and new approaches, respectively, indicating a statistically significant difference (P < 0.01). The statement ‘Overall, this was a good course in comparison with others’ gained ratings of 4.45 (σ = 0.58) and 4.50 (σ = 0.69) on the old and new approaches, respectively, reflecting no statistical difference. The total number of hours of faculty time required to conduct the course dropped from 1248 hours on the old system to 586 hours on the new system, reflecting a 53% decrease.
The improvement in mean examination scores partially reflects changes in the response options. Students viewed a video interview and then responded to 10 multiple-choice questions related to the MSE. The question stems remained the same for both years, but the response options were less subtle in the revised examination. Student satisfaction with the course was equivalent in both the old and new instructional approaches. Future course improvements will include producing numerous video patient interviews to deter students from ‘sharing’ their MSEs of the current videos.