Background: Hospitalists routinely precept third year medical students on general internal medicine wards. One of the key patient care tasks for students is to present and interpret common laboratory test abnormalities. Formal training in interpreting routine diagnostic tests is lacking for students transitioning from preclinical to clinical years. We designed and implemented a module on interpreting and presenting common diagnostic tests during our transitioning to clerkship course for incoming 3rd year medical students.
Methods: This 50-minute session was co-developed and led by a 4th year medical fourth-year medical student who had recently completed clerkship rotations and a hospitalist clinician-educator. Kern’s 6 steps of curriculum development were followed to develop the educational objectives and evaluate the session. We used the primacy-recency effect framework to frame our session. This effect postulates that students best retain information presented at the beginning (prime-time 1) and end (prime-time 2) of a session, while the middle portion (down-time) is best suited to practicing information delivered during prime-time 1. During the first part of the session (prime-time 1), we first introduced and focused on 5 different sets of commonly encountered laboratory test values: complete blood count, basic metabolic panel, liver panel, prothrombin time/international normalized ratio, and urinalysis. For each test, it’s utility in the inpatient setting and most common causes of abnormalities were discussed. For downtime, 5 clinical vignettes with correlating abnormal laboratory values were then presented to students, each representing a potential scenario seen on the clerkship. The session concluded with a summary of important points and a Q&A time for questions. A handout was provided to students with summary points that could be used on rounds and patient presentations. Given the virtual nature of the curriculum in the setting of the COVID-19 pandemic, small group sessions were conducted via Zoom. A total of 195 students were divided into 5 small groups to attend the session. Students completed a pre- and post-session survey that measured their comfort level with interpreting common diagnostic laboratory values. Medical knowledge on interpreting common diagnostic tests was evaluated by a pre-and post-knowledge test.
Results: 195 students completed the pre-session survey, and 147 students completed the post-session survey. When comparing post-session to pre-session surveys, there was a significant increase in confidence in interpreting the five different sets of diagnostic tests (Table 1). On a 5-point Likert scale (1 being “excellent” and 5 being “do not repeat”), the module was rated at a value of 1.56, indicating a high level of participant satisfaction (N=146). The proportion of correct responses on the knowledge test increased from 43% (419/975) before the session to 78% (573/735) after the session (p < 0.0001).
Conclusions: A hospitalist and medical student co-led module based on sound educational principles significantly improved medical student knowledge and confidence in interpreting commonly encountered laboratory abnormalities on inpatient floors. Since much of the third year of medical school is spent in the inpatient setting, hospitalists skilled in educational theory and curriculum development are well suited to lead the development of course content for rising third year medical students.