Competence In Clinical Skills Research Articles

Development and Validation of a Comprehensive Nursing Competence Assessment Questionnaire (CNCAQ) to Determine the Perceived Clinical Competence of Nursing Graduates

Background: An assessment of the clinical competency of nurses at the time of their graduation is essential to get a fair estimate of their level of competence. It helps to lessen the burden on the healthcare system. A “Comprehensive Nursing Competence Assessment Questionnaire (CNCAQ)” has been constructed to fulfil this purpose. Aim: This study aims to develop and validate a CNCAQ to determine the perceived clinical competence of final-year nursing graduates who are about to graduate within three months from selected private and government nursing colleges in India. Methods: A mixed methodology was used and completed in two phases. In phase 1, along with an extensive literature review, focus group discussions, expert evaluation, and pretesting were done, in which 10 nursing experts participated. In phase 2, data were collected from 649 nursing graduates to establish the validity of the construct. The study period was from August to October 2022. Results: The developed CNCAQ has 36 items, comprising four sections: (a) conceptual knowledge and skill in routine nursing care; (b) skill in basic nursing procedures; (c) skill in advanced nursing procedures; and (d) assessment of infusion/transfusion-related nursing procedures. The overall reliability of the tool was 0.963, indicating its high reliability. Overall, there was no difference in clinical competency skills between female and male upcoming nursing graduates. However, statistically significant differences in basic nursing skills and advanced and analytical nursing skills were observed. Conclusions: Assessing nursing students’ competencies is crucial to ensure that they possess the necessary knowledge, skills, and attitudes to provide safe and effective patient care. The development and validation of a valid and reliable instrument for assessing nursing competencies are essential to evaluate nursing students’ clinical performance accurately. In the present research, a tool with a total of 36 items was used. It demonstrates high reliability; however, it needs to be applied to a larger population of nursing graduates with diverse backgrounds. Nurse educators and administrators can use it to assess the level of competence and, accordingly, a tailor-made induction program based on identified weak areas in theoretical and practical knowledge or skill can be developed. No patient’s were involved in the study. It involved developing a CNCAQ and validating it on a selected group of upcoming nursing graduates.

Evidence of learning in workplace-based assessments in a Family Medicine Training Programme.

Learning portfolios (LPs) provide evidence of workplace-based assessments (WPBAs) in clinical settings. The educational impact of LPs has been explored in high-income countries, but the use of portfolios and the types of assessments used for and of learning have not been adequately researched in sub-Saharan Africa. This study investigated the evidence of learning in registrars' LPs and the influence of the training district and year of training on assessments. A cross-sectional study evaluated 18 Family Medicine registrars' portfolios from study years 1-3 across five decentralised training sites affiliated with the University of the Witwatersrand. Descriptive statistics were calculated for the portfolio and quarterly assessment (QA) scores and self-reported clinical skills competence levels. The competence levels obtained from the portfolios and university records served as proxy measures for registrars' knowledge and skills. The total LP median scores ranged from 59.9 to 81.0, and QAs median scores from 61.4 to 67.3 across training years. The total LP median scores ranged from 62.1 to 83.5 and 62.0 to 67.5, respectively in QAs across training districts. Registrars' competence levels across skill sets did not meet the required standards. Higher skills competence levels were reported in the women's health, child health, emergency care, clinical administration and teaching and learning domains. The training district and training year influence workplace-based assessment (WPBA) effectiveness. Ongoing faculty development and registrar support are essential for WPBA.Contribution:This study contributes to the ongoing discussion of how to utilise WPBA in resource-constrained sub-Saharan settings.

Learning from Mistakes—Dental Students’ Learning Experiences from Adverse Clinical Events

Clinical training in the teaching practice is essential for developing patient-specific skills, yet the transition from preclinical to clinical training presents significant challenges for students. This study aimed to comprehend the challenges and issues faced by students at the onset of clinical training. It retrospectively investigated adverse events presented at the advanced dentistry course by third-year pre-doctoral students from classes 202A, 202B, and 202C during their initial ten months of clinical practice at the teaching institution. In this study, adverse events were defined as any undesirable experiences or incidents associated with a clinical treatment and administrative procedures. A total of 279 adverse events presented were categorized into eight disciplines: Treatment planning (TP), Operative (OP), Periodontics (PER), Endodontics (EN), Oral Surgery (OS), Fixed Prosthodontics (FP), Removable Prosthodontics (RP), and Patient Management (PM). The distribution of events was as follows: TP (11.5%), OP (17.7%), PER (13.1%), EN (6.9%), OS (6.2%), FP (24.2%), RP (5.0%), and PM (15.4%), with FP, OP and PM experiencing the highest rates of adverse events. The distribution pattern within the disciplines was consistent, and no statistical difference was observed. Across these disciplines, a lack of clinical skill competency was identified as a primary cause of adverse events. Other contributing issues included miscommunication, insufficient explanations to patients, a lack of administrative support, case complexity, and a deficit in diagnostic examinations and skills. The frequency of causes varied across the three classes, but no significant differences was noted in OP, FP and OS, in which over 80% of causes were related to clinical skill competency. Adverse events in clinical settings are frequent. Knowing these beforehand can aid students’ performance. Students should prepare thoroughly before clinical practice and understand common causes of errors. Educators should recognize the challenges inexperienced students encounter. Awareness of typical mistakes can enhance success in demanding clinical scenarios.

Evaluation of Student Expectations and Clinical Competence Skills Performance during Surgery Clerkship Programme: A Comprehensive Study

The existence of a good clerkship system and quality lecturers will undoubtedly enhance the medical students’ knowledge and skills that align with their competencies. This study aimed to evaluate the achievement of surgical competence based on the expectations of students following clinical clerkships in a surgical department. This study included medical students who participated in a clinical clerkship in the surgical department using a mixed method with a sequential explanatory design as a quantitative approach. Pre- and post-tests were also used to assess changes in student knowledge, qualitative results were obtained from focus group discussions (FGD), and standardised questionnaires were used to assess student skills expectations and achievements. The results showed a significant increase in students’ knowledge after participating in a clinical clerkship, with a mean difference of 3.94 [standard deviation (SD) = 10.67]. However, only three of the skills met students’ expectations during clinical clerkship. This was attributed to a lack of opportunities to practice the skills that students had acquired, the presence of too many students, limited time, and a shortage of practical placements in regional hospitals. Most students perceived the majority of lecturers as nurturing and proficient. However, some lecturers are often occupied with their commitment, resulting in infrequent student interactions. The clinical clerkship system for the Department of Surgery at the Faculty of Medicine, Hasanuddin University effectively enhanced student knowledge, but it needs to be improved to meet their skill expectations.

The effects of mentorship and educational videos on nursing students’ physical examination skills: a clinical audit

BackgroundPoor competence in clinical examination skills among nurses has been reported in practice, and there is a strong consensus that physical examination (PE) education must be improved. However, deficiencies cannot be resolved by theoretical training alone, and new training approaches are required to enable nursing students to perform PE accurately. This study aimed to determine and compare the effect of two new educational methods (mentorship and educational video methods) on the physical examination skills of Iranian nursing students.MethodsThis study was a clinical audit with three group pretest posttest design. Eligible nursing students were recruited through the census method and assigned to three groups (mentorship, educational videos, and control group) using permuted block randomization. Students were taught PE skills in three vital systems through three approaches (mentors, educational videos, and routine educational methods). Data were collected using a two-part instrument consisting of a demographic information questionnaire and a 32-item checklist for assessing the students’ skills in examining the respiratory system (10 items), cardiovascular system (13 items), and 12 cranial nerves (9 items). Data were analyzed using SPSS software version 16 and descriptive and analytical statistical tests.ResultsAt baseline, students in all groups scored less than half of the possible scores in all three systems, and the mean scores of the three groups were not statistically different (P > 0.05). After the intervention, the mean scores of students in the mentorship group increased significantly in all three systems (P < 0.001), whereas the mean scores of students in the educational video group and the control group did not change significantly (P > 0.05). Furthermore, after the intervention, the mean scores of the educational video group and the control group did not significantly differ in any of the three systems (P > 0.05). The ANCOVA showed that with posttest score as the covariate, PE skills in all three systems improved one week after the intervention in the mentor group compared to the control group and the educational video group. However, PE skills in all three systems did not improve one week after the intervention in the educational video group compared to the control group.ConclusionsThe mentorship method is more effective than the educational video and routine methods for teaching PE skills to nursing students. Nursing schools can use the mentor method in training nursing students, and it is recommended to revise the PE lesson unit in the nursing curriculum and exchange it from a purely theoretical-based unit to a mixture of theoretical and clinical-based training. Educational videos alone cannot improve nursing students’ PE skills; thus, if educational videos are used to teach clinical skills, it is necessary to hold hands-on sessions to provide feedback to students and correct their mistakes.

The Influence of Internship Year on Nursing Students’ Perceived Clinical Competence: A Multi-Site Study

This study aimed to explore the level of perceived clinical competence among undergraduate nursing students. This was a cross-sectional, comparative, study. Data were collected using the Clinical Competence Questionnaire. Study participants included fourth year and internship nursing students attending 1 of 39 public and private nursing programs in Saudi Arabia. A total of 244 nursing students completed the clinical competence questionnaire. Students reported the ability to perform some clinical skills in clinical settings under supervision. Intern students had higher clinical competence than fourth year students ( t = 2.792, p &lt; .01). Year of education (β = .148, p &lt; .05) and gender (β = .190, p &lt; .01) were statistically significant to the prediction of perceived clinical competence level. The internship year facilitates the translation of theory into practice, which eventually may improve students’ clinical competence skills. Improving perceived clinical competencies might improve actual clinical competencies. Lastly, more qualitative research studies are needed to investigate the decreased perceived clinical competencies among male students compared female students.

The Effect of Expert Patient Simulation on Clinical Judgment: A Quasi-Experimental Study.

Worldwide, quality education is one of the important tools to improve healthcare quality. Healthcare practitioners must be competent in their clinical judgement to meet clients' need. However, poor clinical judgment skill accounts for almost one-third of all patient problems in health care. Expert patient simulation has been used as a training method for clinical judgement skill. However, according to empirical studies, using expert patients to develop clinical judgement skill is unclear. The method is effective in one situation but not in another. To examine the effect of expert patient simulation on the clinical judgment skill of health science students of Mizan-Tepi University. A pre-test/post-test quasi-experimental design was used on 92 randomly selected samples from the graduating cohort of midwifery students. The research subjects who took part in the experiment were picked at random. Tools included the Creighton Competency Evaluation Instrument (C-CEI®), the Learning Satisfaction and Self-Confidence Questionnaire, and the Kolb Learning Style Inventory (LSI). The Wilcoxon-signed rank test was utilized to compare the self-confidence scores among intervention and control group of students, and the paired sample test was used to compare clinical judgment scores. Cohen's d was used to assess the effect size, and Spearman correlation was used to explore the association. Clinical decision-making ability and self-confidence measures revealed statistical and practical differences between before and after simulation. There was a mean difference of 2.28 (95% CI, 1.78, 2.79), t (45)=9.13, p 0.001, and an effect size of 1.3, p 0.001. A pre-and post-simulation self-confidence measure showed statistically significant improvement after simulation (W = 1, Z = -3.57, P 0.001). A moderately significant positive connection (r = 0.419, p 0.004) was also discovered. The study found that human expert patient simulation is a tremendous clinical training technique for improving students' clinical decision-making skill competency and self-confidence.

Clinical skill competency of nurse educators in Ethiopia: A cross-sectional observational study

Because the clinical skills of nurse educators in Ethiopia have not yet been determined, this study aimed to assess the clinical competence of nurse educators working in public higher education institutions. We administered a 10-station objective structured clinical examination (OSCE) to randomly chosen educators. Both global rating and checklists were used to score performance, and the Borderline Regression Method (BRM) was applied to determine competency status. A total of 207 educators participated, with a mean age of 31.6 years; 67 (32.36%) had no clinical experience before assuming the educator role. Using 3.47 [3.41-3.97, 95%CI] as reference and cut score, only 56 (27.05%) nurse educators were competent in the overall skill assessment. However, station-specific competence attainment ranged from 29.47% (Progress report assessment and maintenance fluid calculation) to 62.32% (Cardiac health history). The clinical competence of nurse educators in Ethiopia was found to be very low, posing serious challenges to the quality of nursing education. There is an urgent need to build the clinical skills of nurse educators. Moreover, policy support is needed to ensure mandatory prior and ongoing clinical practice.

Simulation-based education in classroom and clinical settings in sub-Saharan Africa: a systematic review

PurposeThe purpose of this systematic review was to explore the benefits and challenges in the implementation of simulation-based education (SBE) in the classroom and clinical settings in sub-Saharan Africa. The objectives of this systematic review were to identify the benefits of utilising SBE in the classroom and clinical practice in sub-Saharan Africa and to assess the challenges in the implementation of SBE in the classroom and clinical practice in sub-Saharan Africa.Design/methodology/approachFive databases were searched for existing English literature (Medline, CINAHL and Science Direct), including grey literature on the subject. Out of 26 eligible studies conducted in sub-Saharan Africa between 2014 and 2021, six studies that used mixed-methods design were included. Hawker et al.’s framework was used to assess the quality of the studies. Quantitative data were presented using descriptive and inferential statistics in the form of means and standard deviations while qualitative data were analysed and presented thematically.FindingsQuantitative findings showed that participants rated SBE highly in terms of teaching (93.2%), learning (91.4%) and skill acquisition (88.6%). SBE improved the clinical skill competency from 30% at baseline to 75% at the end. On the other hand, qualitative findings yielded themes namely: improved confidence and competence; knowledge acquisition and critical thinking; motivation and supervision; independent, self-paced learning; simulation equipment and work schedules; and planning and delivery of simulation activity. Pedagogical skills, competence and confidence are some of the elements that determine the feasibility of implementing SBE in the classroom and clinical settings.Practical implicationsSBE could help to bridge the gap between theory and practice and improve the quality of care provided by nurses. Simulation-based training is effective in improving the clinical skills of midwives and increasing their confidence in providing care. However, SBE trainees require motivation and close supervision in classroom settings if simulation is to be successfully implemented in sub-Saharan Africa. Furthermore, careful planning of scenarios, students briefing and reading of content prior to implementation facilitate effective simulation.Originality/valueWhile there may be a lack of literature on the use of SBE for training nurses and midwives in the developing world, there is growing evidence that it can be an effective way to improve clinical skills and quality of care. However, there are also significant challenges to implementing simulation-based training in resource-limited settings, and more research is needed to understand how best to address these challenges. This study fills this gap in the literature.

Trauma Skill Stations to Improve ED Staff Confidence and Engagement

Introduction:Particular skills are critical when participating in trauma response. Engagement and practice with these skills can help build staff confidence, however, ensuring competency across all staff can prove challenging. Establishing a training utilizing skill stations can positively affect staff experience and confidence measures on predetermined dates to capture all team members is a way to ensure confidence in skills vital for patient care in ED settings. Execution of the “skill station” exercises at measured intervals demonstrated improved confidence in trauma skills by ED staff. Exercises with specific skill-oriented practicum offer low-cost, dynamic training opportunities. Improving confidence and competence in critical trauma-related clinical skills directly improves patient outcomes.Method:Six trauma skill stations were created, aimed at specific skill-based practices. These measured skill competencies include arterial line setup, rapid blood infuser use, defibrillator use, chest tube management, pelvic binder application, and tourniquet application. Competency was reached when participants could effectively perform the skills through teach-back technique.Results:Qualitative feedback demonstrated that nurses felt more confident responding to a patient needing trauma interventions in an ED setting. Nursing staff were more engaged with trauma skills in their scope. All participants were able to appropriately and adequately teach-back the skill with 100% accuracy. Improved knowledge retention will be measured in future training sessions.Pre and post-tests could be utilized to demonstrate more dynamic results. This measurement tool will be utilized in the formal training process moving forward to capture baseline and improvement data more objectively.Conclusion:This low-cost and highly efficient method of strengthening novice nurses’ trauma skills competency and confidence can be utilized across various skills and departments. More confident nurses show improved readiness to respond to a patient in need of trauma interventions.

Introduction of Mini Clinical Evaluation Exercise as an Assessment Tool for M.B.B.S. Interns in the Department of Orthopaedics.

Mini-CEX helps in judicious use of competencies in authentic settings by simultaneously assessing clinical skills of trainees and providing feedback on their performance. As assessment of M.B.B.S. Interns for their competency in clinical examination skills in Department of Orthopaedics is lacking, this study is taken up to introduce Mini-CEX for M.B.B.S. Interns, by sensitising faculty and interns. A Quasi-experimental study was conducted during June to December 2020, among 60 interns posted in the Department of Orthopaedics. After obtaining IEC Clearance and written informed consent from the study participants, they were sensitised and exposed to five Mini-CEX clinical encounters involving examination of a patient with knee/other joint disorder in the Outpatient/Inpatient clinical setting, with eight faculty. The study tool used was Mini-CEX questionnaire developed by American Board of Internal Medicine (ABIM). Case specific feedback was provided to interns using sandwich technique. The reflections and perceptions of interns and faculty were obtained after completion of all Mini-CEX encounters. 96.7% encounters were conducted in OPD during first encounter. On an average, one Mini-CEX encounter lasted for 17min. Interns had an overall score for the various domains ranging from 5.38 to 5.58. Comparison of mean scores showed a statistically significant improvement (p value < 0.0001). All the assessors were satisfied with Mini-CEX as an assessment tool. Interns and faculty opined that Mini-CEX improves clinical examination skills and professional development as focus is on the outcome and learning process, with multiple sampling in a longitudinal manner.

Comparing the Perceptions of Reciprocal- and Near-Peer Objective Structured Clinical Examinations (OSCEs) in Medical Students.

The Objective Structured Clinical Examination (OSCE) is utilized by medical schools to assess students' competency in clinical skills. Literature has shown that first-year students who were tutored by fourth-year students (MS4s; near-peer) in practice OSCEs reported self-perceived improvement in OSCE skills. There is a lack of research regarding the effectiveness of first-year (MS1) pairs for reciprocal-peer practice OSCEs. This study aims to assess if virtual reciprocal-peer OSCEs provide comparable learning opportunities to virtual near-peer OSCEs. MS1 students were assigned to work with a near-peer or a reciprocal-peer for one week, and then switched protocols the second week. One student in each reciprocal-peer pair was assigned to act as a standardized patient (SP). Their partner took a history, interpreted physical exam findings, prepared a note, and gave an oral presentation. The pair then switched roles using a second case. The near-peer group followed the same procedure, without the reversal of roles. A total of 135 MS1s participated in the first week and 129 in the second week.Students agreed that working with a near-peer was more valuable than a reciprocal-peer in the following parameters: peer feedback (N=113, 89%), history-taking skills (N=101, 80%), physical exam skills (N=102, 81%), and note-writing skills (N=109, 89%). Pairwise comparison utilizing Wilcoxon signed-rank test indicated participants preferred the choice of a fourth-year student partnerover an MS1 partner (Z=1.436, p<0.001). Participants found working with a near-peer increased confidence in their clinical skills and near-peer feedback was more valuable. Although MS1s found that watching and evaluating their peers in a reciprocal-peer exercise was beneficial, students overwhelmingly preferred working with MS4s due to more valuable feedback.

Perceptions of Radiography Students Regarding the Qualities of an Effective Clinical Educator in Zambia

Background: Clinical education is the most influential and important component for the preparation of future radiographers. During clinical education, experiences of radiography students are formalised, managed, and assessed to ensure competence in radiography. Clinical educators are vital to this development and help students apply theory to practice. In Zambia, the qualities of effective clinical educators of radiography students are not well-defined. This study explored the perceptions of radiography students regarding the qualities of an effective clinical educator in Zambia.Methodology: The study was conducted at the Lusaka Apex Medical University (LAMU) of Zambia, using a qualitative exploratory research design. Data was collected using semi-structured interviews with a purposive sample of eight radiography students. Data was audio-recorded, transcribed, and analysed using framework analysis.Results: Three qualities of an effective clinical educator were identified: clinical competence skills, clinical education skills, and personal attributes. Exhibiting knowledge and experience in radiography and teaching, and displaying good communication skills were the most common qualities of an effective clinical educator that enhanced the learning experiences of radiography students. On the other hand, favourism was the main negative quality reported of clinical educators which hindered the radiography students’ learning process.Conclusion: The identified qualities of clinical educators will help radiographers who supervise students to self-assess, develop, and maintain the qualities necessary for effective clinical education. The study findings will also help schools of radiography to support their clinical educators and can be used for clinical education quality assurance.

Nurse educators clinical skill competence in Ethiopia: A phenomenological study

BackgroundThough literature focuses on how nurses become an educator and assume the educator’s role, little is known about their experience in relation to clinical skill competencies. Thus, the main aim of this study was to explore nurse educators’ experience of clinical skill competencies after assuming educator role. MethodsA descriptive phenomenological study was conducted on twelve purposely selected nurse educators in Ethiopian public universities from September to December 2021. Their prior clinical teaching experience (>=5years) and total teaching experience (>=5years) were taken as selection criteria. Colaizzi's seven-step analysis method was applied. ResultsThis study included four female and eight male nurse educators. Their clinical teaching experience ranged from 6 to 14 years, with an average of 11.2 years. Five of the participants had never worked in a clinical setting before becoming clinical educators. The experience of a nurse educator’s clinical skill competencies identified four themes and 24 sub-themes. The themes include; (1) Feelings of incompetence (2) Seeking Support (3) Self-development (4) Decline of clinical skills. ConclusionNurse educators in Ethiopia have been working through difficult conditions to obtain and maintain clinical skill competency. This is related to a poor role transition strategy, a lack of adequate clinical engagement and a lack of systems level support to sustain clinical competence. We recommend launching a full-time clinical educator training program; school-service integrations; the development of a mandatory continuing professional development activity; and regulating the educational activity.

Assessment Briefs

Assessment Briefs

The Florida Clinical Skills Collaborative: A New Regional Consortium for the Assessment of Clinical Skills.

Discontinuation of the United States Medical Licensing Examination (USMLE) Step 2 Clinical Skills (CS)exam and Comprehensive Osteopathic Medical Licensing Examination (COMLEX) Level 2 Performance Evaluation (2-PE) raised questions about the ability of medical schools to ensure the clinical skills competence of graduating students. In February 2021, representatives from all Florida, United States, allopathic and osteopathic schools initiated a collaboration to address this critically important issue in the evolving landscape of medical education.A 5-point Likert scale survey of all members (n=18/20 individuals representing 10/10 institutions) reveals that initial interest in joining the collaboration was high among both individuals (mean 4.78, SD 0.43) and institutions (mean 4.69, SD 0.48).Most individuals (mean 4.78, SD 0.55) and institutions (mean 4.53, SD 0.72) are highly satisfied with their decision to join. Members most commonly cited a "desire to establish a shared assessment in place of Step 2 CS/2-PE" as their most important reason for joining.Experienced benefits of membership were ranked as the following: 1) Networking, 2) Shared resources for curriculum implementation, 3) Scholarship, and 4) Work towards a shared assessment in place of Step 2 CS/2-PE.Challenges of membership were ranked as the following: 1) Logistics such as scheduling and technology, 2) Agreement on common goals, 3) Total time commitment, and 4) Large group size.Members cited the "administration of a joint assessment pilot" as the highest priority for the coming year. Florida has successfully launched a regional consortium for the assessment of clinical skills competency with high levels of member satisfaction which may serve as a model for future regional consortia.

A comparative analysis of the impact of online, blended, and face-to-face learning on medical students’ clinical competency in the affective, cognitive, and psychomotor domains

Background:The Coronavirus Disease-2019 (COVID-19) pandemic in South Africa compelled medical schools to switch to a purely online curriculum. The innovative changes transformed the standard clinical skills curriculum to increase learning transfer to bridge the theory-practice gap. The efficacy of this intervention remains unknown. This study aims to measure medical students’ clinical competency in the affective, cognitive, and psychomotor domains by assessing clinical skills knowledge retention and transfer from the online platform compared to face-to-face and blended learning.Methods:A non-random cross-sectional quasi-experimental study assessed third-year medical students’ knowledge retention and learning transfer in three domains of clinical skills competence. Data were obtained using a score sheet during a directly observed formative and a trial online summative assessment. One hundred and one third-year medical students volunteered for the formative onsite assessment that tested the psychomotor domain. Two hundred and thirty-nine students were evaluated on the affective and cognitive domains in the summative online trial mini-objective structured clinical examination (tm-OSCE). The OSCE scores were analysed using descriptive statistics. The significance of the findings was evaluated by comparing OSCE scores with the pre-pandemic 2019 third-year medical students.Results:Statistically significant differences were found between the two cohorts of medical students from both years (p < 0.05). The 2021 blended group’s (n = 101) medians were 90%, 95%CI [86, 92], 82%, 95%CI [80, 85], and 87%, 95% CI [84, 90] for the psychomotor, affective, and cognitive skills, respectively. The e-learning group’s affective and cognitive skills medians were 78%, 95%CI [73, 79] and 76%, 95%CI [71, 78], respectively. The 2019 face-to-face cohort (n = 249) achieved medians of 70%, 95% CI [69, 72] and 84%, 95%CI [82, 86] for the affective and psychomotor skills, respectively.Conclusion:Medical students demonstrated near and far transfer bridging the theory-practice gap in three clinical skills domains. The blended group performed significantly better than the e-learning and face-to-face groups. Medical schools and educators play a vital role in overcoming learning challenges and achieving higher transfer levels by adopting multiple student-centered teaching delivery approaches and arranging immediate application opportunities. This study offers medical educators suggestions that encourage the transfer of online learning to face-to-face practice, decentralising medical education with a revised blended learning strategy.

The effect of standardized patients for physical therapy students on behaving and communicating as a professional: a systematic review

Background Previous systematic review and meta-analysis examining standardized patients (SPs) in Physical Therapy (PT) education yielded 14 articles describing 16 studies; 10 addressed professional behaviors (PB), and six reported providing SP feedback to students. Of those six studies, four were randomized controlled trials (RCTs) emphasizing SP feedback on clinical competencies. Only two studies examined PB or communication in PT students after receiving SP feedback. There appears to be a gap within the current literature to understand better SPs’ ability to impact PT students’ communication and PB as they prepare for clinical education. This systematic review aimed to synthesize and critically appraise the findings of empirical studies (qualitative or quantitative) evaluating the contribution of SPs on the student’s affective learning domain (professional behavior and/or communication) in PT entry-level education. Methods A systematic review was completed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Guidelines for Reporting Systematic Reviews on December 1, 2021, using the following electronic databases PubMed, Cochrane Central Register of Control Trials, CINAHL, ERIC, SCOPUS, and Web of Science. Article inclusion criteria: peer-reviewed, assess PT students, assess the affective learning domain, intervention using live, standardized patient learning experiences, and be written in the English language. Studies were excluded if they involved peer-role play as the (SP) or if the authors did not describe the SP process. The risk of bias was evaluated through the Critical Appraisal Skills Programme tool (CASP), given the heterogeneity of study types anticipated for this systematic review, and PEDro if the study design was a RCT. Results There were ten included studies in this review. Two studies were RCT designs that explored Immersive Simulation-Based Learning Experience (SBE) in the clinic’s impact on PB, and all used the Assessment of Physiotherapy Practice (AAP) outcome measure. The other seven studies examined SPs or SBE on PB within the classroom and had significant heterogeneity based on study design and outcomes reported. Discussion Summative results suggest that SP or SBE has some unique attributes, if applied in the clinical environment, may improve students’ PB and core values development, consistent with a PT practice. This systematic review may inform academic leadership and clinical educators in physical therapy education delivery. Integrating experiential and simulated learning experiences into a program may increase efficiency by allowing students to demonstrate clinical competence skills sooner. Limitations Heterogeneity of study design and reported outcomes limited the results and pooling of data.

Comparing perceptions of nursing faculty and students to actual student performance in syringe measurement and use: An example of the Dunning-Kruger effect?

Introduction: A vital component of nursing education is the evaluation by faculty of student nurse’s skill competence. Erroneous estimations of skill competence, as in syringe measurements and dosages, can be critical to patient safety. The Dunning-Kruger effect describes the overestimation/underestimation of skill competence. It is the professional responsibility of faculty and students to be able to assess actual versus perceived competence levels accurately. Purpose: The purpose of this study was to compare the perceptions of nursing faculty and nursing students to student actual competence in syringe measurement and usage. Methods: A cross-sectional, descriptive, comparative study conducted in a School of Nursing Skills Laboratory. Participants included faculty and 3rd and 4th year nursing students. Results: The study sample included 96 students and 30 faculty members. Significant differences were found between faculty perception and student perception of competence (p=0.001). The actual successful performance of all students was lower than expected; 3rd year students had a higher perception of their skill competence than their actual performance, and 4th year students performing at a lower level than 3rd year students (p=0.001). Discussion: Nursing faculty educators and upper-class nursing students perceived a higher level of competence than actual performance. This supports the Dunning Kruger effect and behooves nursing faculty and students to be more precise in their assessments. Conclusions: In today's milieu of online teaching, keen awareness and objectivity regarding clinical skills competence is imperative for client safety. A longitudinal study measuring perception of competence as compared with actual skill performance is warranted.

THE IMPACT OF INDONESIAN MEDICAL DOCTORS NATIONAL COMPETENCY EXAMINATION (IMDNCE) TOWARDS LEARNING AND CLINICAL PRACTICES: A QUALITATIVE STUDY ON THE INTERNSHIP DOCTORS’ PERSPECTIVES

Background: The implementation of the national licensing examination for medical doctors is expected to have a broad impact on doctors and society. Indonesian Medical Doctor National Competency Examination (IMDNCE; Indonesian: Uji Kompetensi Mahasiswa Program Profesi Dokter or UKMPPD) as an ‘exit exam’ in the medical education process may significantly impact learning and clinical practices. The study’s objective was to explore the impact of IMDNCE on both the learning and clinical practices of doctors.Methods: The study subjects were internship doctors who had passed the IMDNCE. Participants were recruited by purposive sampling based on the ownership status of the institution (state/private) and the accreditation of respective medical schools and participants’ gender. The study participants consisted of 41 internship doctors working in 6 regions from 33 different medical schools out of 75 medical faculties in Indonesia.Results: IMDNCE has a positive influence on learning and clinical practice. The IMDNCE process emphasizes standard competencies that must be mastered and patient management process with current evidence that is not always achieved during clinical education, increasing clinical knowledge and skills, and increasing awareness of professional development. IMDNCE also has very well affected in the development of self-confidence and a sense of responsibility which are essential in clinical practice. In addition to psychological influences, IMDNCE improves competence in clinical skills and promotes good medical practice.