Clinical skills training in a resource constrained medical school

Abstract

Context and setting Uganda is one of the world’s least developed countries. Makerere Medical School has neither an equipped skills laboratory nor designated trained personnel for teaching clinical skills. Makerere lacks the funds to construct and equip a skills laboratory and train the trainers. Training of clinical skills to medical students has been implemented traditionally during the clinical clerkships in Uganda. In 2003–04 a problem-based learning (PBL), student-centred medical undergraduate curriculum was introduced with the stated goal of early clinical exposure and training of clinical skills. Why the idea was necessary Early introduction of clinical skills was viewed to be beneficial, as these skills may take a significant time to develop. Moreover, early introduction of these skills would probably facilitate the integration of clinical and basic science knowledge. The objectives of the training were to develop competency in communication and history taking, as well as procurement of vital signs. What was done? A clinical skills training curriculum was developed through a number of meetings, and consultation workshops with institutional leaders and faculty. At these forums, consensus was reached regarding the objectives, format and content of the curriculum in order to match and maintain relevance between PBL cases and the skills training curriculum. Initial implementation of the clinical skills training took place during the 2nd semester of 2004. Students in the 1st and 2nd years received 2 clinical skills training sessions of 2 hour each over a period of 15 weeks; 1st-year skills in interpersonal communication and vital signs were taught using mini-lectures, demonstrations and role play, and 2nd-year skills covered interpersonal communication and general history-taking procedures. Teachers demonstrated skills to students, who in turn performed the procedure on their peers. A ratio of 1 teacher to 15 students was maintained. In order to determine the students’ perceptions of the programme, a questionnaire using a 5-point Likert scale was administered to 32 randomly selected 1st-year students from a population of 100. The teachers’ opinion on how to improve the curriculum and their enjoyment of the training were also elicited. Student assessment was not performed in this pilot programme, which was used to obtain data for assessment criteria. Evaluation of the results and impact All students and teachers indicated that they had enjoyed the training sessions. All the students surveyed agreed that the clinical skills programme was tailored to their knowledge level, that session objectives were clear and that teachers demonstrated the skills adequately. Students indicated concern about timely feedback, lack of equipment for learning and time for supervised practice. Faculty recommended improvement of the facilities and recruitment of more faculty to teach the course. This project demonstrated that early training in clinical skills is feasible in resource-limited environments. Moreover, training space may be upgraded as a result of the pilot.