General Clinical Skills Research Articles

Direct Observation of Procedural Skills (DOPS) in Enhancing Clinical Competencies of Postgraduate Medical and Dental Education: A Scoping Review

Background: As postgraduate medical or dental education students, most of us will have come across Direct Observation of Procedural Skills or DOPS. DOPS promoted clinical effectiveness by evaluating practice-based skills in the authentic organizational context, and subsequently proactively feeding back the learning to learners. This scoping review sought to synthesize the work done in determining DOPS's effectiveness in enhancing clinical competencies in some fields of medicine and dentistry. Methods: The study was carried out by using the following search engines: PubMed, Medline, Google Scholar, Science Direct, SID, Medlib and Google searched unpublished sources (Gray literature) and selected references (reference of reference) by typing the following keywords: (DOPS), clinical competencies, postgraduate medical and dental education. Results: From 215 papers 40 were analyzed and together demonstrated the efficiency of the Direct Observation of Procedural Skills (DOPS) as an assessment tool for numerous medical and dental profiles. It was revealed that DOPS improved procedural confidence, procedural performance competence and general clinical skills, all over the world. In their views, learners and educators overestimated the usefulness of DOPS and acknowledged its function of enhancing clinical competencies and offering feedback. The participants encountered some difficulties such as time limitations, coordination problems, and curriculum mismatch Nevertheless, DOPS was much more effective than traditional approaches in increasing satisfaction and reliability of the assessments in various medical training settings. Conclusion: In the context of postgraduate medical and dental education and training, the DOPS assessment tool was found to be very effective in enhancing clinical competencies and procedural skills. However, the successful implementation has the points that need to be attended like the training of the assessors and standardization although there are benefits of the same. Further studies were encouraged to investigate ways of enhancing the use of DOPS and how best it could be incorporated into post-graduate training

Prevalence and Purpose of Medical App Usage In Pakistan: A Cross-Sectional Study

Objective: To determine the prevalence and purpose of medical app usage in Pakistan.Methodology: A cross-sectional study was conducted using a pretested form, distributed via Google Forms. Convenience sampling was used to select a sample of 357 MBBS, BDS, Allied Health, and Nursing students of CMH Lahore Medical College. Data was analyzed using “SPSS version 23.0”. Descriptive statistics were calculated as frequencies. A “p-value” of less than 0.05 was deemed statistically significant.Results: Out of all the participants (357), 40.3% were males, and 59.7% were females, with an average age of20.89 ± 1.61. 95.5% of the participants used intelligent devices, and 86.6% were aware of the medical apps available for use on mobiles. A majority (64.1%) of the students had various medical apps installed on their phones. Almost half of these students (45.1%) were advised by medical educators to use different medical apps for their studies. Most of the students made use of medical apps to search for medical information (49.7%), followed by exam preparations (37.6%), Revision (34.6%), and preparation of presentations (26.4.%). The use of general clinical textbooks and clinical skills guide apps were 22.2% and 23.9%, respectively. 20.5% of the participants did not use Medical Apps for any purpose. A Likert scale showed that students think that Medical Apps are easy to obtain, and many of them frequently use them too. They believe that these apps save time during clinical practice. Medscape was the most common app being used (29.3%), followed by Gray’s Anatomy (25%) and Pharmapedia (23.9%). Conclusion: The common usage of medical apps was recurrent amongst medical students

Integrated immediate postmortem and acute bereavement care: Competency-based entrustable professional activities for nursing

BackgroundIntegrated immediate postmortem and acute bereavement care alleviates emotional distress due to losing a loved one; however, the provision of effective nursing care remains insufficient. Therefore, preparing nursing students with such skills is essential in end-of-life care education, and entrustable professional activities (EPAs) offer potential to address this gap. ObjectivesTo establish EPAs concerning immediate postmortem and acute bereavement care with a seven-category description for EPAs, milestones, and assessment tools. DesignWe used a modified Delphi method and four-step consensus-building approach to i) identifying the list of possible EPA items related to immediate postmortem and acute bereavement care based on a literature review and clinical experiences, ii) select an expert panel, iii) pool, review, and revise the EPAs, and iv) validate EPA quality using the Queen's EPA Quality rubric. Data analysis was performed via modes and quartile deviations. ResultsThe following four major EPA components were identified: i) cultural and religious ritual assessment; ii) death preparation; iii) postmortem care; and iv) acute bereavement care. Three essential competencies were identified as highly correlated: general clinical skills, communication and teamwork capabilities, and caring. Consensus was achieved after three survey rounds. A 100 % questionnaire response rate was obtained. In the third round, all items received 4 or 5 points from >95 % of the panel members and were found to meet the quartile deviation cutoff score of <0.6, indicating that a high consensus level was established. The average Queen's EPA Quality rubric score was 62.5, with an average item score of 4.46, which was higher than the cut-off score of 4.07. Three major parts of EPAs were developed: task descriptions, milestones, and the assessment tool. ConclusionThe development of EPAs assessments concerning immediate postmortem and acute bereavement care may guide nursing curricula planning to bridge the gap between competencies and clinical practice.

NURSING STUDENTS’ SELF-ASSESSMENTS OF THEIR PROFESSIONAL COMPETENCIES

ABSTRACT&#x0D; Purpose: The study aims to determine the effect of clinical practice on nursing students’ professional competencies.&#x0D; Material and Methods: This is a quasi-experimental study with a one-group pretest-posttest design. Its population consisted of 375 second-, third- and fourth-year nursing students who had completed at least one year of nursing education at the nursing faculty where the study was conducted. No sampling was done, and the study was completed with 265 students who agreed to participate. The data were collected using an introductory information form and the Competency Inventory of Nursing Students (CINS). The pre-test data were collected in the second week when the students started their clinical practice, and the post-test data were collected in the twelfth week near the end of their clinical practice.&#x0D; Results: A statistically significant difference was found between the nursing students’ pre- and post-test mean scores on the CINS and its clinical biomedical science, general clinical skills, critical thinking and reasoning, caring, and lifelong learning subscales (p

Conducting an asylum evaluation focused on female genital mutilation/cutting status or risk.

Female genital mutilation or cutting (FGM/C) is considered a human rights violation and is practiced all over the world. It has been used as a basis for seeking asylum in various countries, including in the USA since 1996, and the precedent-setting matter of Kissindja. Clinicians in the USA and elsewhere who perform asylum evaluations may be called upon to evaluate women who seek asylum based on their FGM/C status or risk. In this manuscript, we provide expert-informed best practices to conduct asylum evaluations based specifically on FGM/C. We review evidence-based history taking, physical examination unique to the population of women and girls affected by FGM/C, and consider the evaluation in the context of trauma-informed care. Although general clinical skills often suffice to perform asylum evaluations, FGM/C represents a unique niche within the field of gynecological asylum evaluations and requires additional background knowledge and clinical competencies. As this is a clinical review and does not involve patients or research subjects no ethical approval was sought or was necessary.

Computerized Clinical Training Simulations with Virtual Clients Abusing Alcohol: Initial Feasibility, Acceptability, and Effectiveness.

Although masters-level social work students typically build clinical skills via role-playing with their peers or instructors, several innovative training simulations are emerging in the literature that may enhance existing skill-building methodologies. We evaluated the initial feasibility, acceptability, usability, and effectiveness of three computerized simulations (two cognitive behavioral therapy, one motivational interviewing) during an interpersonal practice course among 22 students in a Master of Social Work program accredited by the Council on Social Work Education. Trainees repetitively practiced their clinical skills with virtual clients while receiving feedback via real-time nonverbal cues, transcript review, and performance assessment across pre-specified theoretical learning objectives. Across the three simulations, at least 86.4% of students completed the required protocol and completed M = 468.95 (SD = 178.27) minutes of simulated sessions. Students improved their scores (range 0 to 100) across all the simulations from M = 63.41 (SD = 11.13) to M = 93.64 (SD = 3.24). Students found the simulations to be acceptable with strong usability. Paired sample t-tests revealed students reported greater self-efficacy in general clinical skills, exploration skills, insight skills, and action skills between pre-test and post-test after completing the simulations (all p < 0.001). Students reported that the clinical skills learned from the simulations translated into successful interactions with real-world clients during their field placements. We discuss the results of this initial feasibility study within the context of simulation-based learning and the potential for broader implementation within MSW programs.

Legacy of COVID‐19 – the opportunity to enhance surgical services for patients with colorectal disease

The COVID-19 crisis has undoubtedly taken a toll on the care of patients with colorectal disease. Elective services, be that face to face contact, endoscopy or operating all but ceased during the pandemic.

Evaluation of a new e-learning resource for calibrating OSCE examiners on the use of rating scales.

Rating scales have been described as better at assessing behaviours such as professionalism during Objective Structured Clinical Examinations (OSCEs). However, there is an increased need to train and calibrate staff on their use prior to student assessment. An online e-learning package was developed and made available to all examiners at the Institute of Dentistry at the University of Aberdeen. The package included videos of three OSCE stations (medical emergency, rubber dam placement and handling a complaint) which were recorded in two different scenarios; (excellent and unsatisfactory candidate). These videos were recorded to meet a pre-defined marking score. The examiners were required to mark the six videos using pre-set marking criteria (checklist and rating scales). The rating scales included professionalism, general clinical ability and/or communication skills. For each video, examiners were given four possible options (unsatisfactory, borderline, satisfactory or excellent), and they were provided with a description for each domain. They were also required to complete a questionnaire to gather their views on the use of this e-learning environment. Fifteen examiners completed the task. The total scores given were very similar to the expected scores for the medical emergency and complaint stations; however, this was not the case for the rubber dam station (P-value .017 and .036). This could be attributed to some aspects of the placement of the rubber dam being unclear as commented on in the examiners questionnaires. There was consistency in the selection of marks on the rating scales (inter-examiner correlation ranged between 0.916 and 0.979). Further studies are required on the field of e-learning training to calibrate examiners for practical assessment; however, this study provides preliminary evidence to support the use of videos as part of an online training package to calibrate OSCE examiners on the use of rating scales.

Peer-Assisted Learning of Procedural Skill in Basti Karma (Medicated Enema)- A Pilot Study

Background- Peer Assisted Learning (PAL) is learning style with informative, interactive, and interesting learning. In clinical setting, PAL has been modestly used for the purpose of training of physical examination and general clinical skills examination, gross anatomy, communication skills training and resuscitation training. PAL is instruction-based model which used for teaching and learning in few medical schools and it has a great importance in today’s scenario. So, one cannot ignore PAL implementation in undergraduate teaching for enhancement of skill. Objectives- To develop competency in Ayurveda graduate to offer standardized Basti treatment as a service to mankind. Materials &amp; methods- 20 potential undergraduate students were participated in the study and peer tutor role assigned to the rapid learner undergraduate students. Testing module (Erandamuladi Basti preparation and administration) was based on cognitive and psychomotor skill. Study was carried forward by introductory didactic lecture on Basti (medicated enema) preparation and its administration, introducing the concept of PAL, training session for peer tutors, PAL session with feedback and in last assessment of the participants through OSPE. Results- Near about95% students were in favor of PAL teaching method. And opined regarding good cooperative aspect, development of personal skills and keen study of subject by PAL method. Conclusion- PAL is one of way to develop competent Ayurveda graduate to provide standardized Basti treatment to mankind. Peer teaching is an easy effective way of equipping students with the procedural skill.&#x0D;

Application of clinical teaching model based on core competence in nursing interns

Objective To explore the application effects of clinical teaching model based on core competence in nursing interns. Methods From August 2015 to July 2017, we selected 80 nursing interns at a hospital as subjects by purposive sampling. Nursing interns from August 2015 to July 2016 were set in control group (n=38) ; another from August 2016 to July 2017 were set in observation group (n=42) . Nursing students of control group received routine practice teaching model. Nursing students of observation group were treated with the clinical teaching model based on core competence. All of the nursing students were evaluated with the competency inventory for nursing students (CINS) and clinical practice satisfaction scale of nursing intern before and at the end of internship. Results At the end of internship, the total score of CINS and dimension scores in clinical biomedical science, general clinical skills, critical thinking inferential capability, morality/responsibility and lifelong learning of nursing students in observation group were higher than those in control group with statistical differences (P<0.01) . At the end of internship, the scores of teaching content, practice effects, practice management, teaching diathesis and practice environment in clinical practice satisfaction scale of nursing intern of nursing students in observation group were higher than those in control group with statistical differences (P<0.01) . Conclusions The application of teaching model based on core competence in clinical nursing teaching can effectively improve nursing students' core competence and satisfaction. Key words: Students, nursing; Clinical clerkship; Core competence; Teaching model

Challenges in Creating a Mobile Digital Tutor for Clinical Communications Training.

Doctor-patient communication is a crucial element in effective medical care, and the striking health disparities evident in patients with Type II Diabetes may in part be caused by physicians' difficulties in establishing effective communication with patients who differ from them racially, culturally, and economically. REPEAT (Realizing Enhanced Patient Encounters through Aiding and Training) is a digital tutor developed to help solve this problem. REPEAT teaches and coaches learners to improve their general and disparities-focused clinical communication skills using simulated encounters with computer-generated Synthetic Standardized Patients (SSPs) and augments experiential learning in virtual encounters by applying customized, context-sensitive, learner-focused scaffolding. REPEAT authoring tools enable rapid development of learning content, allowing economical transferability to other domains. Key human factors challenges and their design solution in REPEAT are discussed.

Analysis of the level of general clinical skills of physician associate students using an objective structured clinical examination

Analysis of the level of general clinical skills of physician associate students using an objective structured clinical examination

Knowledge of managing avulsed tooth among general dental practitioners in Malaysia

BackgroundDental and maxillofacial injuries are one of the areas of concern highlighted in the Malaysian National Oral Health Plan 2011–2020. General dental practitioners (GDPs) have the responsibility of diagnosing and assessing dental trauma and determining the prognosis and outcomes of trauma along with its management. The purpose of this study was to evaluate the knowledge base and preferred methods of general dental practitioners regarding the management of avulsed tooth. MethodsA random convenient sampling methodology was employed for sample selection. A pre-tested 11-item questionnaire was validated on the dental officers. The survey was distributed to 182 GDPs attending the annual Malaysian Dental Association conference in January 2010. The data obtained was statistically analyzed using descriptive analysis and logistic regression was employed to predict the probability of achieving high scores. ResultsA total of 182 general dental practitioners participated in the study, with the majority being female (n=153, 75%). The place of practice significantly affected the knowledge score. In the group that scored more than 80 points (n=84, 46%), 76% of them worked with government hospitals. Age, work duration and number of traumatised teeth previously treated had no significant effect. The odds ratio for place of practice indicates that respondents who work in government hospitals are 3.6 times more likely to score more than 80 points compared to those who worked in private clinics (OR=3.615, P=0.001). ConclusionThe knowledge level on the management of avulsed tooth among general dental practitioners in Malaysia needs to be improved. Strategies in improvement of the Malaysian dental educational system, continuous dental educational activities and utilisation of guidelines on trauma management should be recommended to increase the knowledge level of avulsed tooth management to ensure good treatment outcomes. Clinical implicationTrauma prevention and further education regarding the management of avulsed tooth is an essential requirement to improve general dental practitioners knowledge and clinical skills.

Exploring the Perceptions of Core Values of Nursing in Taiwanese Nursing Students at the Baccalaureate Level.

The core values of nursing are a standard component of the nursing curriculum in Taiwan. Therefore, these values provide an essential guide for educating and evaluating the learning outcomes of nursing students. Student perceptions of those core values that relate to the process of curricula learning are key to measuring the core values of nursing. This study explores the views on the core values of nursing of baccalaureate-level nursing students at a Taiwanese university. This qualitative study collected data from the reflection reports of 109 students and analyzed these data using thematic content analysis. The results of this study identified that the learning of core values of nursing tends to utilize the latent curriculum rather than the open curriculum. Critical thinking was perceived and experienced by asking "why." General clinical skills and basic biomedical science were categorized collectively as care ability, which relates to the thinking, analysis, and mapping of client health problems. The value of communication and teamwork capability was defined as the sequential process of accepting, interacting, communicating, and collaborating. Caring was defined as contributing empathy with respect to one's self and to others. Ethics was defined as a moral perspective, as respecting others, and as prioritizing the needs of clients. Accountability was defined as a way of observing standards within the role given in a position. Finally, lifelong learning is a process of learning that encourages more aggressive learning. The progress of core values of nursing in this study reflects positive movement and achievement. The participants expressed the perception that the core values of nursing enhance understanding, which enables nursing educators to reframe the nursing curriculum to meet their learning needs. The perceptions of nursing students of core values of nursing may be used as a guide to increase clinical nursing competence in healthcare.

新疆地区实习护生自我效能感与护生护理专业临床沟通能力的关系研究

目的：调查新疆地区实习护生自我效能感及护生护理专业临床沟通能力的现状水平，分析探讨一般自我效能感与护生护理专业临床沟通能力的相关关系。方法：采用一般情况问卷、一般自我效能感量表和护生护理专业临床沟通能力量表，对194名实习护生进行问卷调查，采用回归分析，探讨一般自我效能感量表和护生护理专业临床沟通能力的关系。结果：实习护生一般自我效能感总分为2.71分 ± 0.57分，低于成人常模，其中少数民族护生自我效能感得分高于汉族护生P < 0.05；男生自我效能感高于女生，P < 0.05，护生专业沟通能力总分为84.62分 ± 14.15分，处于中等水平，采用Pearson相关分析护生一般自我效能感与护理专业临床沟通能力成正相关(r = 0.327, P < 0.01)。结论：实习护生自我效能感低于常模，处于中等偏上水平，护生护理专业临床沟通能力处于中等水平，均有待进一步提高，同时，提高护生一般自我效能有助于提高护生护理专业临床沟通能力，护理教育者应采取有效的干预措施以提高护生自我效感水平，进而提高护生的临床综合核心能力。 Objective: To investigate nursing students’ self-efficacy in Xinjiang area as well as the status level of clinical communication ability of nursing students, and to analyze the relationship between the general self-efficacy and clinical communication ability of nursing professional students. Methods: Using the general condition questionnaire, general self-efficacy scale and clinical communication ability of nursing professional students scale, 194 nursing students were surveyed. The relationship between general self-efficacy scale and clinical communication ability of nursing students was also explored by using regression analysis. Results: The interns’ general self-efficacy score was 2.71 + 0.57, lower than the adult norm, of which the minority nursing students’ self-efficacy scored higher than the nursing students of Han nationality (P < 0.05); boys’ self-efficacy was higher than girls’ (P < 0.05); nursing students’ professional communication ability score was 84.62 + 14.15, which is in the medium level; there is a positive correlation between nursing students’ general self-efficacy and clinical communication skills by using Pearson correlation analysis (r = 0.327, P < 0.01). Conclusion: The interns’ self-efficacy is lower than the norm, which is above the medium level, and the clinical communication ability of nursing students is in the medium level; all need to be further improved. At the same time, improving nursing students’ general self-effi- cacy helps to improve nursing students’ professional clinical communication ability; nursing educators should take effective intervention measures to improve the level of nursing students’ self- efficacy, so as to improve clinical comprehensive core competence of nursing students.

Analysis of the level of general clinical skills of physician assistant students using an objective structured clinical examination.

The physician assistant (PA) is trained to perform clinical tasks traditionally performed by medical doctors (MDs). Previous research showed no difference in the level of clinical skills of PAs compared with MDs in a specific niche, that is the specialty in which they are employed. However, MDs as well as PAs working within a specialty have to be able to recognize medical problems in the full scope of medicine. The objective is to examine PA students' level of general clinical skills across the breadth of clinical cases. A cross-sectional study was conducted. PA students and recently graduated MDs in the Netherlands were observed on their clinical skills by means of an objective structured clinical examination comprising five stations with common medical cases. The level of mastering history taking, physical examination, communication and clinical reasoning of PA students and MDs were described in means and standard deviation. Cohen's d was used to present effect sizes. PA students and MDs score about equal on history taking (PA 5.8 ± 0.8 vs. MD 5.7 ± 0.7), physical examination (PA 4.8 ± 1.3 vs. MD 5.4 ± 0.8) and communication (PA: 8.2 ± 0.8 vs. MD: 8.6 ± 0.5) in the full scope of medicine. In the quality of the report, including the patient management plan, PA students scored a mean of 6.0 ± 0.6 and MDs 6.8 ± 0.6. In this setting in the Netherlands, PA students and MDs score about equal in the appraisal of common cases in medical practice. The slightly lower scores of PA students' clinical reasoning in the full scope of clinical care may have raise attention to medical teams working with PAs and PA training programmes.

Anaesthesia priorities for Australian and New Zealand medical school curricula: a Delphi consensus of academic anaesthetists.

The role of anaesthetists has expanded and evolved to include critical care, perioperative and pain medicine and general clinical skills, as well as operating theatre-based clinical anaesthesia. Across Australia and New Zealand, these topics are taught to varying degrees, however no uniform curriculum or standardisation exists between universities. In this study, we used a Delphi technique to develop consensus-based priorities to guide medical educators when reviewing and implementing student anaesthesia curricula. A range of appropriate content has been defined, as well as details relating to duration, timing, teaching environment, faculty, feedback and assessment methods. Future enquiry to assess the efficacy of future and current teaching practices is needed to facilitate continued improvement.

Evaluation of the validity of medical students' self-assessments of proficiency in clinical simulations

BackgroundThe accuracy of self-assessments has not been well supported in the literature. This study was undertaken to examine the validity of medical students' ratings of their proficiency during encounters with simulated patients and simulation devices. MethodsConfidential self-assessments for 10 skills were collected from 195 students during a formal clinical skills assessment related to 3 cases at the end of a surgery clerkship. The cases required students to gather data from simulated patients and perform procedures such as rectal examinations, nasogastric tube insertions, and suturing on bench simulation models. The patients were trained to assess student performance. ResultsThere were significant differences between student self-assessments and simulated patient scores for general clinical skills as opposed to procedural skills. Students' mean self-assessments in the data gathering and interpersonal skills were 2–6 % points higher than ratings of their proficiency by simulated patients. However, self-assessments on procedures were 5–8 points lower than patient ratings. The median correlation between self-assessments and patient ratings for general clinical skills such as data gathering and interpersonal skills was 0.08 (not significant), whereas the median correlation between student and patient ratings in procedures was 0.22 (P < 0.01). ConclusionsThird-year medical students' self-assessments for specific procedures are more valid than self-assessments of general clinical skills. Students are less confident in their procedural skills compared with general clinical skills. Although self-assessments should not be used as the sole measure of performance in clinical simulations, self-assessments for specific procedures can provide supplemental information on proficiency.

Cultivation of the general clinical ability of professional degree graduate students in stomatology

How to cultivate oral medical graduate students with solid general medical foundation is still under exploration. There are some systematic, comprehensive and relatively weak limita- tions for different departments＇ rotations in training general clinical skills for professional degree post- graduates in stomatology. With the establishment of a comprehensive teacher group of oral medicine, prosthodontics and oral ＆ maxillofacial surgery in department of general dentistry, students can be trained for general clinical thinking and skills, and the students＇ ability of general clinical practice has been strengthened via these programs. On the basis of postgraduate students＇ analysis of structures and learning interests and under the premise of upholding the uniform requirements, the individualized and hierarchical teaching has been conducted to the students, paying attention to stimulating their interest in learning. Besides, by way of a comprehensive assessment, students＇ academic performance has been objectively evaluated. ern Key words: Master of stomatological medicine; Professional degree; General clinical think- ing; Practical ability; Teaching patt

The importance of clinical reasoning in the training of all medical practitioners.

Sam Leinster presents a very well-argued case for more generalists and describes clearly some of the barriers in the way of change. He states that ‘All doctors are taught general consultation and clinical reasoning skills’ but, while the first part is true, I wonder about the second. I am happy to be corrected, but my understanding is that only a minority of UKmedical schools have curricula that incorporate formal teaching of clinical reasoning as we now understand it. Its inclusion in postgraduate training may not be much better. Although there is still no consensus on a single best way to teach and learn the cognitive processes and errors that affect our decisions, there is growing recognition that effective clinical reasoning is vital for accurate and safe diagnosis and management. Strangely, the General Medical Council’s key publication ‘Tomorrow’s Doctors’ makes no mention of clinical reasoning in its recommendations for education and training. Acquiring clinical reasoning skills early can help doctors to make the most of the, often limited, clinical experience available in relatively short training programmes. Arguably, it is skill in clinical reasoning that underpins generalist expertise although wide experience is also essential. It may be that some will choose a generalist role before becoming specialists and others will choose the opposite path; ensuring that clinical reasoning is taught properly to all medical students and doctors might help both groups.