Context:
Mock examinations are commonplace in many academic settings and are offered as a study aid to students with the hope of lowering stress levels and increasing their preparedness for the actual exam. In contrast, mock exams are rarely offered by faculty in clinical training due to their expense and administrative burden (1). Students taking objective structured clinical examinations, (OSCEs), have been proven to benefit from participating in mock exams (2). However, this is something that has not been explored in the context of the Focused Exam Workshop (FEW). While OSCEs focus solely on biomechanical skills, the FEW allows students to choose which physical exams are important for gathering information pertinent to creating a diagnosis and writing a SOAP note. In this study, we assess the efficacy of providing first year medical students with a mock exam prior to taking their FEW. This will stress the importance of implementing peer organized mock examinations.

Our study objective is to draw correlations between mock Focused Exam Workshop participation and overall performance on the course examination including final score, student stress levels, and biomechanical performance. This study will create a fundamental basis for understanding the effectiveness of participating in mock exams as preparation for all physical and clinically based skill examinations.

Methods:
The students were offered a SOAP note workshop and provided with complete exams specific to PCOM-GA curriculum as preparatory work prior to testing. Mock exams were then performed virtually with second year students acting as standardized patients (SP) with prepared case presentations. Thirty first year students acting as the doctor were asked to join the virtual rooms at different times and then perform a History and Physical with their SP focusing around a specific chief complaint that the students were unaware of before beginning the exam. Instructions were given on how the mock exam process will be conducted but no other hints were given to students regarding the context of the exam. Following the history and physical exam, the students were asked to create a SOAP note within the 9 minute limit offered by the COMLEX Level 2 PE exam (3). These SOAP notes were graded based on course description and COMLEX Level – 2 PE guideline by the student’s respective SP before the data was compiled. We also asked students to provide us with feedback through a Google Form that was sent out after the actual FEW was completed, so that they could provide us with extra information regarding their state of mind and chief complaint preferences among other things. All of this data was compiled and analyzed before being compared to student’s actual FEW scores which were provided to us without any identifying information, as to preserve student anonymity. IRB approval was obtained through the committee at the Philadelphia College of Osteopathic Medicine Georgia Campus.

Results:
It was found that students who participated in the mock FEW scored an average of 20.9 ± 2.0 and 22.1 ± 2.0 out of a possible 25 total points on the real FEW offered by the clinical education faculty for the first and second term exams, respectively.  This was found to have a statistically significant difference (p-values of <0.0001 and 0.009 for each respective term found via student t-test) from those students who did not take the mock.  This group of students averaged grades of 19.1 ± 1.5 and 20.4 ± 3.3 for the first and second terms.  It was determined based on the self-completed surveys that approximately 65% of students who took the mock FEW experienced lowered stress levels for the real exam while 17% and 12% had the same levels of stress or no improvement at all, respectively.  It was also found that students who took the mock showed an increase in the number of hours spent preparing for the real exam as compared to the hours they spent preparing for the mock.  Their preparation hours increased from an average of 2.35 for the mock to 4.06 for the real exam.

Conclusion:
These results demonstrate that there are positive correlations between participation in mock Focused Exam Workshops (FEWs) and improved scoring on the real exam.  Analysis of the FEW provided by the school show a statistically significant difference in grades between the two groups being tested, those who did and did not partake in the mock.  Those who were involved with the mock scored an average of 1.8 points and 1.7 points higher on the first and second term exams respectively, this equates to over one-half of a letter grade.  It was also demonstrated through the completion of the post-exam survey that a vast majority of students (64.7%) had lower stress levels before the real exam than before the mock exam.  On average, these students also reported an increase in their preparation time for the real exam after partaking in the mock, with an increase of approximately 1.71 hours of study-time for the real exam as compared to the mock.  It is our recommendation that further study be completed to provide more statistical data with a larger population pool before definitive conclusions be drawn; however, these results are favorable for the administration of mock FEWs lead by peers.  Students-teaching-students allows for educational faculty to take a backseat and allow for the students to enrich each other’s educational experiences.