Abstract:

Introduction:
The medical profession is legally regulated and the Degree in Medicine must guarantee the acquisition of certain competencies in its graduates. The following skills are mandatory: obtaining a clinical history with all the relevant information, performing a physical examination, and drawing up an initial diagnostic judgement and a reasoned diagnostic strategy.
Clinical simulation is used for competency training and assessment. Simulated patients (SPs) are actors trained to develop cases and assess trainees' performance in clinical and communication skills in a realistic and reproducible simulated environment. This allows us to control the difficulty of the cases and ensure the homogeneity of assessments.
The main objective of the study was to assess the acquisition of competences throughout the course in two different graduating years, which were compared with each other.

Methodology:
At the beginning and end of the 2021-22 academic year, a clinical scenario was developed. Students, had to attend a PS suffering from acute cholecystitis in a medical consultation and write his medical history. A total of 208 students from the Faculty of Medicine of the Francisco de Vitoria University took part in the study (96 students from 4th year and 112 from 5th year). The scenarios were videotaped and the evaluators analysed 85 items per student (48 from the consultation and 37 from the written clinical histories), distributed among 7 competencies (anamnesis, physical examination, communication, clinical judgement, prevention and health promotion, ethics, clinical history writing). To analyse each competency, a two-factor ART-ANOVA statistical model with repeated measures was used to evaluate the differences between courses, between time points and their interaction effect. The type I error considered was 0.05.

Results: In all competency domains, scores were significantly better at the end of the course for both graduating classes except for anamnesis and clinical judgement in 5th year students, which remained constant.
In the initial measurement, 5th graders scored significantly higher than 4th graders in all competences but in the final measure, scores were higher only in the competencies of communication, ethics and prevention. However, in anamnesis, physical examination, clinical judgement and history taking, the progression from grade 4 significantly outperformed grade 5 at the end of the year.
Analysing the differences by items, the 4th year students improved 62% of the anamnesis items, 87% in physical examination, 100% in prevention and ethics, 75% in communication and clinical judgement and 67% in medical history writing. The 5th year students improvements were lower: 19% in anamnesis, 67% in physical examination, 100% in prevention and ethics, 50% in communication, 50% in clinical judgement and 36% in medical history writing. In addition, 16% of the ítems in 5th year students worsened at the end of the year.
Both graduating classes appeared comparable as they did not show significant differences in their mean scores (p=0.2).

Conclusion:
4th and 5th year students seem to improve their patient care competences during the course in most of the competency domains involved. The improvements found among 4th year students may be due to the fact that the subject associated with the case is taught during this same year.

Keywords:

Learning outcomes, clinical simulation, competence assessment, simulated patient, medical education.