Retention of Knowledge and Clinical Skills by Medical Students: A Pro- spective, Longitudinal, One-Year Study Using Basic Pediatric Cardiology as a Model

Abstract

Background: Retention of early-taught knowledge and fundamental clinical skills, albeit essential in medical education, has not been extensively investigated. This study is aimed at assessing prospectively the retention of knowledge and skills related to communication with patients and the physical examination by fourth year medical students after an introductory course in basic pediatric cardiology. Methods: Three cohorts of fourth year medical students aged 21-26 years volunteered for the study. All students (N = 130) were assessed immediately after the teaching period and after six months (N = 42) and after one year (N = 21) later. Assessments included a 40 multiple-choice question (MCQ) test and an 8-station objective structured clinical examination (OSCE) focused on communication with patients, physical examination and interpretation of diagnostic tests (chest radio- graphs and electrocardiograms). Cases were portrayed by either real, rehearsed patients or standardized patients. Student performance was assessed by trained staff members using structured checklists. Results: For all aspects of knowledge assessed, scores obtained in the second and the third assessment were significantly lower than those verified in the first assessment. There were no significant differences between the three assessments re- garding overall clinical performance and data for communication with patients and physical examination. Concerning di- agnostic tests interpretation, scores obtained in the second and third assessment were significantly lower than those veri- fied in the first assessment. Paired analysis of the results obtained for the 21 students who took the three assessments showed similar results, except for a trend for improvement in clinical skills. Conclusions: Medical student retention of clinical sciences knowledge follows a pattern similar to that found in other scientific domains, characterized by progressive decay after initial acquisition. In contrast, fundamental clinical skills, such as communication with patients and physical examination are substantially retained, which could be ascribed to con- tinuous practice. These findings should be taken into account for devising instructional strategies for enhancing student knowledge and clinical skills maintenance.