Clinical Skills Laboratory Research Articles

Enhancing the effectiveness of the teaching and learning of core clinical skills

Over the last decade there has been great deal of debate about pre-registration nursing students' lack of confidence and ability, in performing core clinical skills in the UK [P. Elliott, Locality based teaching, Senior Nurse 13 (2) (1993) 35-39; S. Jowett, I. Walton, S. Payne, Challenges and Change in Nurse Education - A Study of the Implementation of Project 2000 Slough: NFER, 1994; P. Hilton, Clinical Skills Laboratories: teaching practical skills, Nursing Standard 10 (37) (1996) 44-47; , Integrating theory and practice: Professional Letter from the Chief Nursing Officer for England London; , Making a difference. Strengthening the nursing, midwifery and health visiting contribution to health and health care, London.]. A variety of solutions have been suggested in attempting to address these perceived deficits. One such initiative within the University of Sheffield was the introduction of the Clinical Demonstrator role, whereby clinicians were seconded to the School of Nursing for a fixed period of time to provide additional support to neophyte students in the classroom, laboratory and clinical settings. An action research approach was adopted where ongoing evaluation influenced further developments [W. Carr, S. Kemmis, Becoming Critical: Education Knowledge and Action Research, Falmer Press, London, 1986]. Formal and informal evaluation was therefore undertaken throughout and this influenced the evolution of the role. The methods used included; questionnaires; reflective diaries; focus group interviews; and ongoing dialogue with lecturers, students, demonstrators, clinicians and trust representatives. Since the start of this 5 year project there have been 25 Demonstrators in post who have in total supported 10 pre-registration nursing student cohorts undertaking the Common Foundation Programme (N=1496). As the study progressed they also provided support to more senior Adult Branch students undertaking the final year of the course (N=76). The outcomes have been exceptionally positive, though a number of lessons have been learnt along the way. This paper outlines this innovative project and shares a number of broad conclusions that can be drawn from the study.

Ohio State University College of Medicine and Public Health.

Ohio State University College of Medicine and Public Health.

Clinical skills acquisition in children's nursing: an international perspective.

Dave Clarke and Jane Davies describe how a study visit to Australia informed proposals for a child-specific, simulated clinical environment (clinical skills laboratory) for pre-registration child branch students in Wales.

Evaluating the practice outcomes of a venepuncture and intravenous cannulation

With the introduction of PREP (UKCC, 1997) and the Greenhalgh Report (DOH, 1994) more advanced clinical skills such as intravenous cannulation and venepuncture have been included in post-registration university based nursing programmes (Hilton, 1996). Academic institutes have a responsibility to focus on the theoretical basis of care, which may not always adequately prepare nurses for practicing skills such as intravenous cannulation in clinical practice. Students require opportunity to develop dexterity for new skills before they practise on patients for the first time, familiarising themselves with the equipment and steps for achieving the skill. Southbank University’s (SBU) intravenous cannulation course included a practical skills acquisition workshop using manikins and commonly used equipment to demonstrate the procedures. Whipps Cross University Hospital (WXUH), in partnership with SBU, recognized that one day continuing professional development courses, such as intravenous cannulation, would be better delivered from a hospital based environment rather than a university setting. It was anticipated that delivering such a course from a teaching facility, in closer proximity to clinical areas, would improve the translation of theory into practice. Plans were implemented to provide the course from the Clinical Skills Laboratory at WXUH. The programme had a larger practice based content and

Conference calls.

The A&E department at Birmingham and Heartlands NHS Trust is opening its doors to emergency care professionals on February 27 as part of a oneday clinical skills lab. Activities include practical skill stations, slide presentations and tours of the department. For details, call Penny Nevin on 0121 424 2257 or email Kerry.Daily@heartsol. wmids.nhs.uk.

Inter- and intra-operator reliability of the recording of occlusal contacts using 'occlusal sketch' acetate technique.

To develop a simple way of recording occlusal contacts with proven inter- and intra-operator reliability. Clinical skills laboratory in the University Dental Hospital of Manchester. The marked static occlusal contacts of 20 sets of models were recorded in a pseudo-clinical situation, by three dentists and in addition by one dentist on two occasions using a schematic representation of the dental arch - the 'occlusal sketch'. The median of Kappa agreement for inter- and intra-operator reliability was almost perfect. The occlusal sketch is a simple, inexpensive and easy way of recording the results of an occlusal examination using marking papers.

Reproducibility and reliability of the occlusal sketch

Objectives To develop a simple way of recording occlusal contacts with proven inter- and intra-operator reliability. Setting Clinical skills laboratory in the University Dental Hospital of Manchester. Materials and methods The marked static occlusal contacts of 20 sets of models were recorded in a pseudo-clinical situation, by three dentists and in addition by one dentist on two occasions using a schematic representation of the dental arch – the 'occlusal sketch'. Results The median of Kappa agreement for inter- and intra-operator reliability was almost perfect. Conclusions The occlusal sketch is a simple, inexpensive and easy way of recording the results of an occlusal examination using marking papers.

Clinical skills in final year medical students

Dr Tucker (February 2002 JRSM1) suggests that medical schools have lost enthusiasm for competency as an aim in itself, describing the value of his experience as a ‘shadow’ house officer when a final year student at St George's in the 1970s. Competency has not been forgotten by the present generation of clinical tutors at St George's. As a final year student I am currently partaking in my shadows as Dr Tucker once did—assisting an already qualified house officer in completion of forms, running errands, taking blood, learning other practical procedures and interacting with many members of the multidisciplinary team. During this time I have had ample opportunity to gain experience of the eight core clinical skills identified by Goodfellow and Claydon in their initial study2. The medical school has always made clear that, while it may facilitate my clinical learning, it cannot provide the same experiences and exposure for each student; I am ultimately responsible for my own learning, and have been well directed to this aim. St George's provides written learning objectives and offers access to a clinical skills laboratory, to supplement teaching by senior clinicians. We also record our experience in logbooks. Whilst I cannot claim total confidence in all clinical skills, the grounding has been good; and the ‘Introduction to the PRHO year’ lecture course held by St George's shortly after finals is said to be informative and useful. Although satisfied by my training so far, two developments are cause for concern. The first is the introduction of shift-systems for junior doctors, preventing continuity in education with patients throughout their training; and the second is the negative influence of medicolegal issues, limiting the activities of students. These factors might prevent my generation from gaining all the experience that our seniors enjoyed at the same level.

Teaching clinical skills to preregistration house officers

We agree with Goodfellow and Claydon (October 2001 JRSM1) that the training of final-year medical students and preregistration house officers (PRHOs) in clinical skills can be improved. Better use can be made of the induction programme for PRHOs to include training in clinical skills, particularly as there is a substantial gap between MB BS final examinations and the start of the first house job. This year, our induction programme at Barts and The London NHS Trust was extended to 2 days and the structure was changed. The purpose of this was threefold—foremost, to enable the new PRHOs to spend more time on the wards with the outgoing house officers; secondly, the number of talks was reduced to those deemed essential, to prevent information overload, and a less formal approach of ‘stands’ for other information was adopted; finally, the increased length of the induction allowed us to include small-group ‘hands-on’ training in cardiopulmonary resuscitation and also training in the patient database system. We would like to expand on clinical skills for the new PRHO induction in August 2002 to include urinary catheterization, venepuncture, intravenous cannulation, arterial blood sampling and electrocardiography interpretation, using the facilities of a clinical skills laboratory. Training in needle-stick injury should be included either in induction or early in the weekly teaching sessions for PRHOs. Post-induction, we have used our Simulation Centre to train PRHOs in management of acute emergencies in respiratory medicine and cardiology, and this year two more sessions have been added in head injury and diabetic emergencies. Extending induction to more than 2 days may pose logistical difficulties—e.g. payment for PRHOs, and accommodation. Since the starting day is always a Tuesday, greater than 2 days is not feasible.

Implementation of Problem-based Learning Curriculum in the Faculty of Medicine and Health Sciences, Universiti Malaysia Sarawak

Faculty of Medicine and Health Sciences (FMHS), Universiti Malaysia Sarawak (UNIMAS), chose to adopt Problem-based Learning curriculum since its inception in 1993 but retained a small proportion of formal lectures, especially in Phase I (so called pre-clinical phase), of its teaching programme. The faculty adopted a number of strategic plants to encourage a successful implementation of this curriculum, such as: programmes for staff development and students orientation; provision of dedicated PBL rooms; easy access to computer, Internet and published teaching/learning materials; careful formulation of triggers/problems and preparation of guide books for tutors; provision of museum and laboratories for practical demonstration, including clinical skill laboratory, etc. Also, the tools for student assessment were devised to concur with the teaching methods. On assessment after 5 years of its implementation, it appeared that in Phase I the teaching programme has somewhat deviated from the original PBL curriculum to a “hybrid” curriculum. With passage of time, the number of lectures increased and time for self-directed learning decreased. It was observed that some of the PBL sessions have been converted to mini lecture sessions. The possible reasons include in inadequate training of teaching staff who have been mainly trained in the traditional system and are either unfamiliar with the PBL curriculum or are not fully “converted” to PBL approach and lack of monitoring. These problems are likely to be resolved as further efforts are being made to train the staff (organizing workshops and preparation of guidebooks to familiarize the tutors with the concept of PBL curriculum). The plan to move the faculty to new premise in very near future would further help to overcome the problems of space and facilities.

The clinical skills laboratory: a cost-effective venue for teaching clinical skills to third-year medical students.

The authors taught clinical examination and procedural skills using manikins in a clinical skills laboratory as a part of an integrated curriculum in the third-year clerk-ship. This teaching modality was effective and well received by students and faculty.

Students sitting medical finals--ready to be house officers?

An initial survey of students approaching qualification and the preregistration house officer year revealed anxiety about competence in several important clinical skills. A questionnaire study was then undertaken to assess, first, the extent to which students had attained the skills required for the preregistration year and, second, the amount of training in these skills provided during the preregistration year. 122 medical students taking their final examinations were asked about training and practice in eight core clinical skills, and 84 graduates from the same school, approaching the end of their preregistration year, were asked about postgraduate training in these skills. The response rate of each group was 100%. Of the eight skills studied, most had been performed few times by the students at qualification. Less than half the current preregistration house officers could recall training being given in any of the skills studied. There were no significant differences in house-officer training between teaching hospitals and district general hospitals. Regarding needlestick injuries, nearly two-thirds of preregistration house officers were unable to recall any training at either undergraduate or postgraduate level. These results suggest that training in clinical skills can be improved. Training is already changing with use of clinical skills laboratories and logbooks. We also recommend mandatory needlestick training both in undergraduate programmes and in induction courses for preregistration house officers.

Evaluating the Effectiveness of a Clinical Skills Laboratory for First and Second Year Medical Students

Evaluating the Effectiveness of a Clinical Skills Laboratory for First and Second Year Medical Students

University of Michigan Medical School.

University of Michigan Medical School.

Helping medical students become good house officers: interprofessional learning in a skills centre

A report is presented on interprofessional study days for final-year medical students and junior staff nurses, providing valuable preparation for transition to the role of house officer. Guided by a view of shared learning as learning with and from members of another profession, a patient scenario pertinent to the nurses' ward experience was presented and developed. Participants planned and revised their responses to the patient's needs, practising pertinent clinical and communication skills at each stage. Students were challenged to integrate existing knowledge in the context of whole-patient care, and were able to clarify roles and responsibilities within the multidisciplinary team. They discussed ward management and patient management. The curriculum design and evaluation were guided by educational theories relating to readiness to learn and disjuncture. Nurse-medical student pairs, to teach each other practical skills and exchange information, were particularly highly valued. Siting the learning experience in a clinical skills laboratory was very successful.

Evaluation of the clinical skills lab in the pediatrics department of the university of Essen (Germany)

Background: In 1986 Prof. H. Olbing (University of Essen Pediatrics Department), supported by Prof. G. Stickler (Mayo Medical School, Minnesota), introduced a 4-weeks clinical skills lab for all students (annual class 250), based on self-instruction by means of computer-assisted, interactive, audiovisual learning materials, models, bedside teaching and seminars on special topics (partially peer-guided). Each year 14 chosen senior medical students get a two weeks intensive training in order to function as peer tutors for the bedside teaching. The peer tutors train the junior students in basic behaviour and clinical examination skills. Each tutor is active during 4–5 skills lab periods, and in each period he/she coaches two groups of two students each. During the bedside teaching phase each group examines and presents four patients.

An Undergraduate Clinical Skills Laboratory Developing Interprofessional Skills in Physical and Occupational Therapy

This article describes an interprofessional educational experience, a clinical skills laboratory which brings occupational therapy and physical therapy students together in a learning experience which will simulate professional interaction. Students in the School of Rehabilitation Sciences at McMaster University participate together in a clinical skills laboratory designed to promote physical handling skills and interprofessional skills. The experience is held at a clinical teaching unit (a geriatric chronic care facility) affiliated with the university. Students practice their skills in consideration of the patients' goals. Students' evaluation of this experience has been extremely positive which sustained the initiative. Ninetyeight percent of students believe that handling skills are an appropriate focus for an interprofessional educational experience. Future development of this experience is discussed.

Clinical skills laboratories: teaching practical nursing.

This article describes the development and subsequent use of a clinical skills laboratory in one school of nursing and midwifery. It aims to allow students more time to practise psychomotor skills which clinicians, managers, educationalists and students themselves have perceived to be lacking in students since the implementation of Project 2000. The author suggests that this teaching strategy facilitates skill acquisition, increases students' confidence, and may in the long term help to bridge the theory-practice gap.