Can medical schools rely on clerkships to train students in basic clinical skills?

Remmen, Roy; Derese, Anselme; Scherpbier, Albert J.J.A.; Denekens, Joke; Hermann, Ingeborg; Vleuten, Cees van der; Royen, Paul Van; Bossaert, Leo

doi:10.1046/j.1365-2923.1999.00467.x

Cited by 134 publications

(120 citation statements)

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“…However, feedback from tutors in the traditional clinical coaching program one year prior to the intervention and also from the emailed survey of the tutors at the Control site during the study, showed many tutors lacked the confidence to coach outside their area of expertise, even though they were not required to teach them at a sub-speciality level (Régo 2005). Under these circumstances, it is possible that the intended curriculum is not always covered, particularly when students' learning is not augmented by skills laboratory training, or when students do not believe the acquisition of certain skills to be ''compulsory'' (Remmen et al 1999) (an issue resolved at The University of Queensland a year before the intervention).…”

Section: Discussionmentioning

confidence: 99%

“…Researchers in a number of different countries (Remmen et al 1998;Seabrook 2004) have found that students' acquisition of basic clinical skills suffer because of their limited (supervised) hands-on experience. Simply exposing students to clinical work is insufficient, and the extent to which the ''intended'' curriculum is congruent with the ''curriculum in action'' is questionable (Remmen et al 1999).…”

Section: Introductionmentioning

confidence: 99%

“…Clinicians may be willing to teach, but teaching duties may be neglected because of ''heavy service, time constraints, noisy wards and uncooperative patients'' (Ahmed & El-Bagir 2002). Additionally, teaching quality is inconsistent even within the same disciplines so that students have highly individualistic learning experiences which a number of researchers report, may or may not include the coverage of all syllabi within the clinical skills curriculum (Sachdeva et al 1995;Remmen et al 1999, Ahmed & El-Bagir 2002.…”

Section: Introductionmentioning

confidence: 99%

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Using a structured clinical coaching program to improve clinical skills training and assessment, as well as teachers’ and students’ satisfaction

et al. 2009

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Introduction: The ability to deliver the traditional apprenticeship method of teaching clinical skills is becoming increasingly more difficult as a result of greater demands in health care delivery, increasing student numbers and changing medical curricula. Serious consequences globally include: students not covering all elements of clinical skills curricula; insufficient opportunity to practise clinical skills; and increasing reports of graduates' incompetence in some clinical skills. Methods: A systematic Structured Clinical Coaching Program (SCCP) for a large cohort of Year 1 students was developed, providing explicit learning objectives for both students and paid generalist clinical tutors. It incorporated ongoing multi-source formative assessment and was evaluated using a case-study methodology, a control-group design, and comparison of formative assessment scores with summative Objective Structured Clinical Examination (OSCE) scores. Results: Students demonstrated a higher level of competence and confidence, and the formative assessment scores correlated with the Research students' summative OSCE scores. SCCP tutors reported greater satisfaction and confidence through knowing what they were meant to teach. At-risk students were identified early and remediated. Discussion: The SCCP ensures consistent quality in the teaching and assessment of all relevant clinical skills of all students, despite large numbers. It improves student and teacher confidence and satisfaction, ensures clinical skills competence, and could replace costly OSCEs.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Using a structured clinical coaching program to improve clinical skills training and assessment, as well as teachers’ and students’ satisfaction

et al. 2009

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“…Because research had shown that old curriculum students had a lack of clinical skills competence (Remmen et al 1999), clinical skills training changed completely. Clinical and communication skills training now start in year 1, where old curriculum students received limited formal training in years 4 and 5, but had to learn their skills mainly through internships.…”

Section: Educational Backgroundmentioning

confidence: 99%

Evaluating the effectiveness of curriculum change. Is there a difference between graduating student outcomes from two different curricula?

et al. 2009

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Background: Changing a curriculum raises the question whether the results, new curriculum student outcomes, are different from old curriculum student outcomes. Aims: To see whether different curricula produce different outcomes, we compared test and questionnaire results of two cohorts. We wanted to know if there is a difference on knowledge and skills test results, and on the number of times students practiced their skills during their final internships. Method: We used two validated test instruments: the Dutch Progress Test (PT) and the Objective Structured Clinical Examination (OSCE). For reporting their skills practice, we asked students of both cohorts to fill out a basic skills questionnaire. Results: We found no significant difference between both cohorts on the results of their knowledge test and their report on skills practice. On the OSCE, students from the new curriculum cohort scored significantly higher than old curriculum students. Conclusion: Curriculum change can lead to improvements in graduating students' outcome results.

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“…[1][2][3][4][5] Curriculum that is cost effective, evidence-based, and culturally sensitive is a critical consideration throughout the world but even more so in developing countries where there are severe human and financial resource limitations. [6][7][8] By 2012, pre-clinical medical skills training had been introduced into other African nations, however a literature search failed to report on cost-effective curriculum or evidence-based methodology.…”

Section: Introductionmentioning

confidence: 99%

Impact of a pre-clinical skills course with Peer Assisted Learning (PAL) on preparedness and confidence levels of medical students in Africa

Snyder

Chisenga

2017

han-j-cjgh

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Background: Many benefits of pre-clinical medical skills training have been documented in technologically advanced nations, and in the past decade these courses have been introduced to developing countries. Curriculum that can prepare and build confidence in medical students must be cost effective, evidence-based, and culturally sensitive in places where there are severe resource limitations. In 2013, an initial pre-clinical skills course without assessments was introduced to medical students in Zambia. Later that year, a more developed course was launched to a second cohort integrating Peer Assisted Learning (PAL) and assessments. These trainers were prepared in advance with instructions in standardized skills, learning theory, effective feedback techniques, and use of rubrics to insure good inter-rater reliability in teaching and assessments. Methods: A quantitative study surveyed 108 students utilizing convenience sampling and a written questionnaire. Data collected compared preparedness and confidence in performing clinical skills of the intervention cohorts with the control group (medical students who preceded pre-clinical skills training). Results: Preparedness responses increased from 36.1% of the students in the control group to 90.9% in the intervention group who had been exposed to the PAL course with assessments (p value <0.001). Student confidence levels in history taking, physical exam skills, procedures, and the application of critical thinking skills diagnostically also showed improvement from 11.5-29.5% range in the control group to 77.3-86.4% range in the PAL cohort (p value <0.001). Conclusions: Exposure to pre-clinical training program especially utilizing PAL with assessments had a positive impact on the sense of preparedness and confidence levels for medical students beginning their clinical training years at the University of Zambia. Integration of PAL influenced academic development, clinical procedural standardization, appropriate curriculum additions, transitional support, and program sustainability. PAL may have beneficial application extending to basic science lab instruction in resource limited environments. Recommendation for future research would be integration of qualitative triangulation and reduction of variables in confidence data reporting.

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Can medical schools rely on clerkships to train students in basic clinical skills?

Cited by 134 publications

References 13 publications

Using a structured clinical coaching program to improve clinical skills training and assessment, as well as teachers’ and students’ satisfaction

Using a structured clinical coaching program to improve clinical skills training and assessment, as well as teachers’ and students’ satisfaction

Evaluating the effectiveness of curriculum change. Is there a difference between graduating student outcomes from two different curricula?

Impact of a pre-clinical skills course with Peer Assisted Learning (PAL) on preparedness and confidence levels of medical students in Africa

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