Validity, reliability and feasibility of a new observation rating tool and a post encounter rating tool for the assessment of clinical reasoning skills of medical students during their internal medicine clerkship: a pilot study.

Background: Systematic assessment of clinical reasoning skills of medical students in clinical practice is very difficult. This is partly caused by the lack of understanding of the fundamental mechanisms underlying the process of clinical reasoning.

Methods: We previously developed an observation tool to assess the clinical reasoning skills of medical students during clinical practice.

Observable phenomena that reveal medical students' clinical reasoning ability during expert assessment of their history taking: a qualitative study.

Background: During their clerkships, medical students are meant to expand their clinical reasoning skills during their patient encounters. Observation of these encounters could reveal important information on the students' clinical reasoning abilities, especially during history taking.

Methods: A grounded theory approach was used to analyze what expert physicians apply as indicators in their assessment of medical students' diagnostic reasoning abilities during history taking.

Student performance of the general physical examination in internal medicine: an observational study.

Background: Many practicing physicians lack skills in physical examination. It is not known whether physical examination skills already show deficiencies after an early phase of clinical training. At the end of the internal medicine clerkship students are expected to be able to perform a general physical examination in every new patient encounter.

A core physical examination in internal medicine: what should students do and how about their supervisors?

Background: Performance of a focused physical examination will induce a high cognitive load for medical students in the early phase of the clinical clerkships.

Aim: To come to a workable and clinically applicable standard physical examination for medical students to be used in every new patient in the daily clinical practice of internal medicine.

Method: A questionnaire held among physicians that supervise students during the clerkship of internal medicine in one Dutch training region.

['You may go ahead and get undressed now'].

For an experienced physician, it is common practice that the patient undresses for a physical examination. Medical students and young doctors can be more restrained. Unfamiliarity, feelings of shame and fear of being accused of sexual intimidation can prevent them from having the patient undress.

Segmental and global subclasses of class IV lupus nephritis have similar renal outcomes.

Whether renal outcomes differ between the segmental and global subclasses of diffuse proliferative (class IV) lupus nephritis is unknown. In this meta-analysis, we searched the literature in MEDLINE, EMBASE, five registries of clinical trials, and selected cohort studies and randomized, controlled trials that used the 2003 International Society of Nephrology and Renal Pathology Society classification of lupus nephritis in adult patients. Our endpoint was the composite of doubling of serum creatinine concentration or ESRD.