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Pilot application and Comparative Study between inter-raters in Clinical Performance Examination (CPX) of Ankle Sprain

Article information

J Korean Med. 2024;45(3):112-121
Publication date (electronic) : 2024 September 1
doi : https://doi.org/10.13048/jkm.24042
Minjeong Kimorcid_icon
Department of Acupuncture & Moxibustion Medicine, College of Korean Medicine, Sangji University
Correspondence to: Minjeong Kim, Department of Acupuncture & Moxibustion Medicine, College of Korean Medicine, Sangji University, 83 Sangjidae-ro, Wonju, Gangwon-do, 26338, Republic of Korea, Tel: +82-33-741-9289, Fax: +82-33-741-9141, E-mail: goodykmj@hanmail.net
Received 2024 July 15; Revised 2024 August 18; Accepted 2024 August 23.

Abstract

Objectives

The purpose of this study is to analyze the evaluation results and score deviation between interraters after performing ankle sprain CPX.

Methods

Ankle sprain CPX was performed on fourth-year students in the Department of Korean Medicine. A student standardized patient(SSP) filled out the 50-point PPI questionnaire.

Results

Ankle sprain CPX final score was 28.20 ± 1.40. Evaluation items showed low scores in the following order: performance time, physical examination, and past and social history check. The “physical examination” accounted for the largest proportion of the score deviation between interraters. In PPI, the lowest score was “effective questioning”, and the highest scores were “listening” and “empathy”.

Conclusions

We hope that follow-up research will be conducted to develop objective and reliable CPX evaluation standards and scoring checklists in the future.

Keywords: Ankle Sprain; Clinical performance examination; Patient-physician interaction; Korean medical education
Fig. 1

History taking in ankle sprain CPX

Fig. 2

Measuring ankle circumference in ankle sprain CPX

General characteristics of study subjects

Result of ankle sprain CPX and inter-rater variations (Details)

Result of ankle sprain CPX and inter-rater variations (Main category)

Results of PPI questionnaire

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Appendices

Appendix 1 발목 염좌 CPX 평가 기준표

Appendix 2 Patient-Physician Interaction(PPI)

Article information Continued

Fig. 1

Fig. 1

History taking in ankle sprain CPX

Fig. 2

Fig. 2

Measuring ankle circumference in ankle sprain CPX

Table 1

General characteristics of study subjects

Characteristics Subgroups n (%) Total
Sex Male 23 (54.8) 42
Female 19 (45.2)
Age 20–29 yrs 40 (95.24) 42
30–39 yrs 2 (4.8)
≥40 yrs 0 (0.0)

Table 2

Result of ankle sprain CPX and inter-rater variations (Details)

Classification Details Score Mean±SD Inter-rater Variation Occurrence(n)
Attitude Self-introduction and patient confirmation 1 1±0 0
History Taking Chief complaint 1 1±0 0
Check onset 1 1±0 0
Attitude Empathize 1 0.91±0.27 1
History Taking Present illness 1 0.93±0.24 1
Cause of onset 1 0.91±0.28 3
Rating pain intensity (NRS) 1 0.97±0.16 3
Chronic instability 1 0.96±0.18 1
Past and social history 1 0.78±0.41 4
Review of systems 1 0.97±0.14 0
Attitude Pulse and tongue diagnosis 1 0.94±0.22 4
Inspection description and consent 1 0.97±0.14 3
Hand sanitization 1 0.83±0.36 7
Physical Examination Inspection(gait) 1 0.97±0.16 0
Inspection(bruise and edema) 1 0.99±0.08 1
Diagnosis of the exclusion of a fractures and palpation of damaged ligaments 2 1.69±0.46 6
Measurement of ankle circumference 2 1.19±0.27 1
Check the range of motion of the ankle(dorsi flexion/extension) 2 1.80±0.39 14
Check for ankle ligament instability(anterior drawer test/posterior drawer test /talar tilt test) 3 2.55±0.67 12
Patient Education Description of test results and diagnosis 1 1±0 0
Prognosis Description 1 1±0 0
Treatment plan 1 0.95±0.20 1
Management of lifestyle and exercise 1 1±0 0
Attitude Open-ended questions and answers 1 0.97±0.16 0
Execution Time Within 10 minutes 1 0.81±0.38 2
Total score 30 28.20±1.40

Table 3

Result of ankle sprain CPX and inter-rater variations (Main category)

Classification Score Mean Achievement rate (%) Inter-rater Variation Occurrence (Percentage%)
Attitude 6 5.69 94.87 15(19.48)
History Taking 8 7.58 94.81 12(15.58)
Physical Examination 11 10.12 92.07 47(61.03)
Patient Education 4 3.96 99.03 1(1.29)
Execution Time (10 min) 1 0.83 83.33 2(2.59)
Total 30 28.20 100 77(100)

Table 4

Results of PPI questionnaire

Num Item Score Mean S.D. p-value
1 The doctor asked questions effectively. 10 9.52 1.08 0.10*
2 The doctor listened to me carefully. 10 9.83 0.58 0.10*
3 The doctor tried to understand my position. 10 9.83 0.62 0.11†
4 The doctor explained things in an easy-to-understand manner for the patient. 10 9.71 0.74 0.35‡
5 The doctor tried to build a good rapport with me. 10 9.76 0.90 0.29$
Total 50 48.86 3.22
*

1 vs 2,

†

3 vs 1,

‡

4 vs 1,

$

5 vs 1