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The Mental Status Exam: An Online Teaching Exercise Using Video-Based Depictions by Simulated Patients.

ABSTRACT: Introduction:The mental status exam (MSE) is a structured approach to gathering a patient's behavioral and cognitive information. Analogous to the physical exam, it provides a template to collect clinical data in a systematic fashion. The MSE is a core competency of undergraduate medical education (UME) and an entrustable professional activity in clinical psychiatry. Methods:We developed video clips of simulated patients depicting three adults respectively diagnosed with schizophrenia, obsessive-compulsive disorder, and bipolar disorder. We used three short video clips per condition to demonstrate an incremental number of psychiatric signs and symptoms. We used the nine video clips as calibrated stimuli for learners to identify components of the MSE using an online tool. Results:We piloted this online exercise among 37 volunteer students. Experienced learners performed better than novice ones on overall identification of MSE components (p <.001). Specifically, they were able to identify elements of the MSE following an ABC-STAMPS (appearance, behavior, cooperation; and speech, thought process and content, affect, mood, perceptions, suicidality) rubric. Discussion:This video-based scoring tool was easy to implement in a UME setting and well received by students as a formative didactic exercise and educational complement.

SUBMITTER: Martin A

PROVIDER: S-EPMC7450674 | biostudies-literature | 2020 Aug

REPOSITORIES: biostudies-literature

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The Mental Status Exam: An Online Teaching Exercise Using Video-Based Depictions by Simulated Patients.

Martin Andrés A Jacobs Asaf A Krause Robert R Amsalem Doron D

MedEdPORTAL : the journal of teaching and learning resources 20200827

<h4>Introduction</h4>The mental status exam (MSE) is a structured approach to gathering a patient's behavioral and cognitive information. Analogous to the physical exam, it provides a template to collect clinical data in a systematic fashion. The MSE is a core competency of undergraduate medical education (UME) and an entrustable professional activity in clinical psychiatry.<h4>Methods</h4>We developed video clips of simulated patients depicting three adults respectively diagnosed with schizophr ...[more]

PMID: 32875093

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Project description:Evidence-based teaching practices are associated with improved student academic performance. However, these practices encompass a wide range of activities and determining which type, intensity or duration of activity is effective at improving student exam performance has been elusive. To address this shortcoming, we used a previously validated classroom observation tool, Practical Observation Rubric to Assess Active Learning (PORTAAL) to measure the presence, intensity, and duration of evidence-based teaching practices in a retrospective study of upper and lower division biology courses. We determined the cognitive challenge of exams by categorizing all exam questions obtained from the courses using Bloom's Taxonomy of Cognitive Domains. We used structural equation modeling to correlate the PORTAAL practices with exam performance while controlling for cognitive challenge of exams, students' GPA at start of the term, and students' demographic factors. Small group activities, randomly calling on students or groups to answer questions, explaining alternative answers, and total time students were thinking, working with others or answering questions had positive correlations with exam performance. On exams at higher Bloom's levels, students explaining the reasoning underlying their answers, students working alone, and receiving positive feedback from the instructor also correlated with increased exam performance. Our study is the first to demonstrate a correlation between the intensity or duration of evidence-based PORTAAL practices and student exam performance while controlling for Bloom's level of exams, as well as looking more specifically at which practices correlate with performance on exams at low and high Bloom's levels. This level of detail will provide valuable insights for faculty as they prioritize changes to their teaching. As we found that multiple PORTAAL practices had a positive association with exam performance, it may be encouraging for instructors to realize that there are many ways to benefit students' learning by incorporating these evidence-based teaching practices.

Project description:Cognitive scales are used frequently in geriatric research and practice. These instruments are constructed with underlying assumptions that are a part of their validation process. A common measurement scale used in older adults is the Folstein Mini Mental State Exam (MMSE). The MMSE was designed to screen for cognitive impairment and is used often in geriatric research. This paper has three aims. Aim one was to explore four potential threats to validity in the use of the MMSE: (1) administering the exam without meeting the underlying assumptions, (2) not reporting that the underlying assumptions were assessed prior to test administration, (3) use of variable and inconsistent cut-off scores for the determination of presence of cognitive impairment, and (4) failure to adjust the scores based on the demographic characteristics of the tested subject. Aim two was to conduct a literature search to determine if the assumptions of (1) education level assessment, (2) sensory assessment, and (3) language fluency were being met and clearly reported in published research using the MMSE. Aim three was to provide recommendations to minimalize threats to validity in research studies that use cognitive scales, such as the MMSE. We found inconsistencies in published work in reporting whether or not subjects meet the assumptions that underlie a reliable and valid MMSE score. These inconsistencies can pose threats to the reliability of exam results. Fourteen of the 50 studies reviewed reported inclusion of all three of these assumptions. Inconsistencies in reporting the inclusion of the underlying assumptions for a reliable score could mean that subjects were not appropriate to be tested by use of the MMSE or that an appropriate test administration of the MMSE was not clearly reported. Thus, the research literature could have threats to both validity and reliability based on misuse of or improper reported use of the MMSE. Six recommendations are provided to minimalize these threats in future research.

Dataset Information

The Mental Status Exam: An Online Teaching Exercise Using Video-Based Depictions by Simulated Patients.

Publications

The Mental Status Exam: An Online Teaching Exercise Using Video-Based Depictions by Simulated Patients.

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