Integrating Formative and Summative Clinical Skills Examinations to Promote Learning for Early Medical Students: A Mixed Methods Study.

Background: Medical educators aim to train students with high-quality clinical skills through the promotion of self-regulated learning and the development of lifelong learning skills. Formative clinical skills examinations (FCSE) allow for real-time learner-centered feedback and coaching which are key in promoting the development of expertise in early learners. This study assessed the impact of the integration of FCSE with learner-centered, real-time feedback and coaching based on an "educational plan-do-study-act" (PDSA) cycle on early medical students' experience and performance. Methods: A mixed methods study was designed to assess the integration of FCSE for first- and second-year medical students. FCSE consisted of linked stations: students gathered a history from a standardized patient (SP), performed a hypothesis-driven physical examination followed by real-time learner-centered feedback and coaching. Each student met with one faculty and one SP to reflect on their performance, identify areas for improvement, re-practice of skills, and identify a plan for ongoing practice improvement. Students were surveyed upon completion of formative and summative clinical skills examinations. Student communication and clinical reasoning performance were compared to historical controls. Results: Students reported that FSCE improved the learning environment and helped prepare them for subsequent summative clinical skills examinations. Students appreciated the opportunity for practice and real-time feedback and reported applying their take-home points on subsequent exams. Student longitudinal performance was not impacted by the transition to FSCE. Conclusion: While labor-intensive, FCSE with real-time feedback and coaching are an effective means of promoting learning and should be considered for integration early in medical school curricula.