Proficiency In Clinical Skills Research Articles

The application of blended teaching in medical practical course of clinical skills training

BackgroundBlended teaching is an effective approach that combines online and offline teaching methods, leading to improved outcomes in medical education compared to traditional offline teaching. In this study, we examined the impact of blended teaching in clinical skills training, a medical practice course.MethodsThis study involved forty-eight undergraduate students studying clinical medicine in the fifth semester at Wuhan University of Science and Technology. The students were divided into two groups: the control group, which received traditional offline teaching, and the experimental group, which received hybrid teaching. Following the completion of the 4-month course, both groups underwent the Objective Structured Clinical Examination (OSCE) to evaluate their proficiency in clinical skills. Furthermore, the experimental group was given a separate questionnaire to gauge their feedback on the Blended Teaching approach.ResultsBased on the OSCE scores, the experimental group outperformed the control group significantly (P<0.05). The questionnaire results indicated that a majority of students (54.2%, 3.71 ± 1.06) believed that blended teaching is superior to traditional offline teaching, and a significant number of students (58.3%, 3.79 ± 1.15) expressed their willingness to adopt blended teaching in other courses. Furthermore, students in the experimental group displayed varying levels of interest in different teaching contents, with emergency medicine (79.2%), internal medicine (70.8%), and surgery (66.7%) being the most popular among them.ConclusionsThis research demonstrates for the first time that blended teaching can achieve a good pedagogical effectiveness in the medical practice course, clinical skills training and practice. Moreover, in different teaching contents, the teaching effects are different. In the content of Emergency Medicine and Surgery, which is more attractive to students, the application of blended teaching could result in a better pedagogical outcome than other contents.

Perceived Disruption of COVID-19 on Medical Education in Incoming Psychiatric Residents.

In 2020, the global COVID-19 pandemic caused educational disruptions to many medical students nationally. Societal and hospital guidelines, including social distancing protocols, resulted in the cancellation or postponement of many elective procedures. A shortage in personal protective equipment also contributed to restrictions in clinical experiences for trainees. The purpose of this study was to determine resident-perceived preparedness in core clinical competencies and evaluate the disruptions to core clerkships. A survey was developed to assess self-perceptions of clinical competencies and disruptions to core clerkship experiences. It was distributed to 63 incoming psychiatric residents who matched to training programs in the United States. The survey response rate was 97%. The majority of respondents achieved self-expected levels of proficiency in clinical skills. Deficits were greatest for pelvic/rectal exams and transitions of care. Most students did not experience disruptions to clerkships. Internal medicine, obstetrics, and gynecology clerkships reported the highest rates of virtual completion. Procedures with the lowest reported perceived preparation were arterial puncture, airway management, and IV placement, respectively. Our survey results indicated that most learners did not perceive disruptions to their medical education and incoming psychiatry residents felt well-prepared to start residency. Some specific procedural skills appear to have been affected. Attempts to mitigate these specific inadequacies may help mitigate disruptions due to future events.

Do clinical and communication skills scores on credentialing exams predict potentially inappropriate antibiotic prescribing?

There is considerable variation among physicians in inappropriate antibiotic prescribing, which is hypothesized to be attributable to diagnostic uncertainty and ineffective communication. The objective of this study was to evaluate whether clinical and communication skills are associated with antibiotic prescribing for upper respiratory infections and sinusitis. A cohort study of 2,526 international medical graduates and 48,394 U.S. Medicare patients diagnosed by study physicians with an upper respiratory infection or sinusitis between July 2014 and November 2015 was conducted. Clinical and communication skills were measured by scores achieved on the Clinical Skills Assessment examination administered by the Educational Commission for Foreign Medical Graduates (ECFMG) as a requirement for entry into U.S residency programs. Medicare Part D data were used to determine whether patients were dispensed an antibiotic following an outpatient evaluation and management visit with the study physician. Physician age, sex, specialty and practice region were retrieved from the ECFMG databased and American Medical Association (AMA) Masterfile. Multivariate GEE logistic regression was used to evaluate the association between clinical and communication skills and antibiotic prescribing, adjusting for other physician and patient characteristics. Physicians prescribed an antibiotic in 71.1% of encounters in which a patient was diagnosed with sinusitis, and 50.5% of encounters for upper respiratory infections. Better interpersonal skills scores were associated with a significant reduction in the odds of antibiotic prescribing (OR per score decile 0.93, 95% CI 0.87-0.99), while greater proficiency in clinical skills and English proficiency were not. Female physicians, those practicing internal medicine compared to family medicine, those with citizenship from the US compared to all other countries, and those practicing in southern of the US were also more likely to prescribe potentially unnecessary antibiotics. Based on this study, physicians with better interpersonal skills are less likely to prescribe antibiotics for acute sinusitis and upper respiratory infections. Future research should examine whether tailored interpersonal skills training to help physicians manage patient expectations for antibiotics could reduce unnecessary antibiotic prescribing.

Simulation-Based Medical Learning: The Future of Sri Lankan Health Care

Novel medical curricula stress the need for proficiency in clinical skills by medical and nursing undergraduates over the mere possession of knowledge. Simulation-based Medical Learning has gained the attention of modern clinical training by enhancing clinical performance and patient safety more than traditional clinical training at hospitals. The present modern medical context uses various types of simulators. However, Simulation-Based Medical Learning in Sri Lanka remains at a preliminary stage compared to the international context due to multiple challenges.This paper aims to identify the challenges faced in Simulation-Based Medical Learning in Sri Lanka and recommend the mechanisms to overcome those challenges. Lack of resources and infrastructure, lack of funding, poor literacy on handling simulators, lack of trained personnel, and cultural and mindset barriers were the identified potential challenges in Sri Lanka towards Simulation-Based Medical Learning. Nevertheless, these challenges can be mediated by finding international partnerships and funding sources, establishing foreign training with new collaborations, increasing awareness through faculty development programmes, combining Simulated Patients with low-fidelity simulators, and integrating Simulation-Based Medical Learning into the medical curriculum.

The Need for Purposeful Teaching, Learning and Assessment of Crisis Resource Management Principles and Practices in the Undergraduate Pre-Hospital Emergency Care Curriculum: A Narrative Literature Review

Introduction Traditionally, undergraduate emergency medical care (EMC) training programs have, over the years, typically focussed on developing individuals with proficiency in clinical skills who can perform complex procedures in the act of administering safe and effective emergency care in the pre-hospital setting. A shortcoming of this training relates to the attention given to the soft skills needed to work efficiently in a team-based environment. Crisis resource management (CRM) is a structured, evidence-based approach to training that is designed to enhance teamwork performance in critical circumstances where the absence of coordinated teamwork could lead to undesired outcomes. Methods A narrative review of GOOGLE SCHOLAR, MEDLINE, PUBMED, CINAHL as well as paramedic-specific journals was conducted. Articles were included if they examined the importance of CRM in pre-hospital emergency care; training undergraduate pre-hospital emergency care students on the principles and practices of CRM; and non-technical skills in pre-hospital emergency care. Discussion Researchers found limited articles related to CRM and the pre-hospital emergency care setting. Our findings reveal that CRM focusses on addressing non-technical skills necessary for effective teamwork and that those identified to be relevant for effective teamwork in pre-hospital emergency care setting include situation awareness, decision-making, verbal communication, teamwork as well as leadership and followership skills. Conclusion Effective team management is a core element of expert practice in emergency medicine. When practised in conjunction with medical and technical expertise, CRM can reduce the incidence of clinical error and contribute to effective teamwork and the smooth running of a pre-hospital emergency care plan.

Evolution of an obstetrics and gynecology interprofessional simulation-based education session for medical and nursing students.

Simulation and Objective Structured Clinical Examination assessment of learners can teach clinical skills proficiency in a safe environment without risk to patients. Interprofessional simulation-based education (IPSE) contributes to a transformation in students’ understanding of teamwork and professional roles. Long term outcomes for stimulation and IPSE sessions, are less well studied. We hypothesized that a progressive interprofessional education simulation program incorporating both faculty and interprofessional student collaboration would improve medical students’ knowledge retention, comfort with procedural skills, positive teamwork and respectful interaction between students.An Obstetrics and Gynecology IPSE for medical and nursing students (NS) was developed in collaboration between a school of medicine and a school of nursing from 2014 to 2017. By 2017, content included(1)fetal heart rate case-based workshop;(2)simulated vaginal delivery;(3)cervical examination and assessment;(4)contraception station including intrauterine device insertion practice;(5)obstetric procedures including hands-on B-Lynch Suture practice.From 2014 to 2016, medical students completed attitude, knowledge, and perception surveys both pre and immediately post simulation, at 4 months, and 8 months. In 2017; all students completed self-assessments and received faculty-assessments.The program trained 443 medical and 136 NS. Medical students’ knowledge, comfort, and interest increased significantly post simulation. Outcome scores decreased but were still significantly improved at 4 months but nearly dissipated by 8 months. There were no significant differences between medical and NS self-assessment or faculty-assessment scores regarding IUD insertion, cervical examination, or contraception quiz scores. Medical students’ birth simulation self-assessment versus faculty-assessment scores were 8.6 vs 8.9, P < .001.Simulation improved students’ short-term medical knowledge, comfort, and perception with some long-term persistence at 4–8 months. Medical and NS learned obstetrics and gynecology skills in a collaborative environment and in role-specific situations. Medical students had the opportunity to learn from NS. Positive teamwork and respectful interaction occurred between the students.

The Effect of Hands-on Practice on the Skills Proficiency of Nursing Home Nurses

Background: The most recent nursing home regulations indicate that nurses must possess the skills sets needed to properly provide residents’ care (“Reform of Requirements,” 2016). Nursing home directors of nursing (DONs) frequently meet the requirement to train their nurses using online continuing education programs. However, the hands-on practice of fundamental clinical nursing skills necessary to maintain proficiency cannot be accomplished with this method. Purpose: This study aimed to determine whether an educational intervention including hands-on practice of two clinical skills would improve the skills proficiency of nursing home nurses. Method: The study used a pretest-posttest design with skills fair-style educational intervention for nursing home nurses recruited from two nursing homes. The pretest and posttest each included a multiple-choice quiz and hands-on demonstrations of two different clinical skills. Statistical analysis using paired t-tests showed significantly improved skills proficiency for the participating nurses following the educational intervention with hands-on practice of the two clinical skills. Findings: The findings suggest that nursing home DONs should consider educational interventions that include hands-on practice to maintain clinical skills proficiency.

HOW MANY REPETITIONS OF CHILD CARE SKILLS ARE REQUIRED FOR HEALTH WORKER STUDENTS TO ACHIEVE PROFICIENCY? LEARNING CURVE PATTERNS IN CHILD CARE SKILLS ACQUISITION.

Introduction:The vulnerability of children under 5 years old requires paying more attention to the health of this group. In the Iranian health care system, health workers are the first line of human resources for health care in rural areas. Because most health workers begin working in conditions with minimal facilities, their clinical qualifications are crucial. The aim of this study was to determine the number of repetitions of child care skills, required for health worker students to achieve proficiency based on the learning curve.Methods:A time series research design was used. Participants in this study were first year health worker students enrolled in three health schools in 2011. Data were collected using a questionnaire consisting of demographic information and a checklist evaluating the health worker students’ clinical skills proficiency for child care. Data were analyzed using SPSS version 16.0 software (SPSS Inc., Chicago, IL) using descriptive and inferential statistics including Kruskal-Wallis and Pearson correlation coefficient tests.Results:Learning curve patterns in child care skills acquisition showed that for less than 20 and between 20 to 29 times, the level of skill acquisition had an upward slope. Between 30- 39 the learning curve was descending, however the slope became ascending once more and then it leveled off (with change of less than 5%).Conclusion:It seems that 40 repetitions of child care skills are sufficient for health worker students to achieve proficiency. This suggests that time, resources and additional costs for training health worker students’ trainees can be saved by this level of repetition.

IPadagogy 101: Using Clinical ORthopedic Exam (C.O.R.E.) to Facilitate Evidence-Based Practice in the Orthopaedic Evaluation Classroom

Evidence-based practice (EBP) and educational technology have become fundamental skills within athletic training programs. The objective of this article is to share experiences implementing clinical orthopaedic evaluation applications (“apps”) that can be integrated into classroom and clinical education to enhance students' proficiency and efficiency utilizing and interpreting special test findings. Today's entry-level allied health professional is expected to have a deeper understanding of special tests than ever before. In addition to developing proficiency in clinical skills, these future clinicians must understand validity statistics in order to select appropriate special tests and interpret the results. The Clinical ORthopedic Exam (C.O.R.E.) application is a database of nearly 250 special tests with descriptions of the test, a video of the special test being performed, and statistical support for the use of the test in reported sensitivity/specificity and likelihood ratios. The series of anatomy applications developed by 3D4Medical.com allows the user to view, zoom, and rotate the joint in 3 dimensions, providing cross-sectional views and virtual layer removal (revealing muscles, connective tissue, bones, vessels, and nerves). Textbooks that overview clinical special tests are not updated often enough to reflect the growing body of research surrounding these techniques. Students and clinicians require the most up-to-date information in order to make sound clinical decisions. The C.O.R.E. application provides access to the most recent peer-reviewed validity statistics. Patient education is also highly valued; the series of applications by 3D4Medical provides vivid anatomical images that can aid in explanation of injury to patients. With EBP a required educational content area within athletic training education and with medical technology becoming commonplace in allied health settings, it is essential that athletic training programs engage students in the use of technology during their classroom and clinical experiences.

The weak relationship between anatomy competence and clinical skills in junior medical students

In modern curricula, the early integration of anatomy and clinical skills education at undergraduate level is seen as important. However, the direct relationship between medical students' competence in anatomy, and their clinical proficiency during early undergraduate years, has scarcely been studied. In this study, the marks for anatomy and clinical skills of three consecutive cohorts of medical students (n = 538 in total) during their first two years were correlated. The anatomy competence was measured using a new marker, the Anatomy Competence Score (ACS) which was calculated with equal contributions from theory knowledge and its practical and clinical application. Proficiency in clinical skills was determined by OSCE performance marks for stations which examined physical examination and practical procedural skills. The possible compounding effect of students' general academic ability was investigated by using the overall performance mark for each student based on their performance in all subjects over the first two years of the medical curriculum. We found that the correlation between anatomy and clinical skills marks was weak to moderate. However, this correlation was virtually nullified once the effect of academic ability was accounted for. Although these findings suggest that anatomy education does not compliment early clinical education, the lack of complexity of clinical problems used in clinical skills assessments (OSCEs) during the early stages may well be the primary contributing factor to this finding.

Conceito global: um método de avaliação de competência clínica

Muito se tem feito para desenvolver métodos que avaliem de forma confiável a proficiência em habilidade clínica dos alunos de graduação médica. Há fortes evidências de que a avaliação global pode ser uma alternativa viável e confiável na avaliação de estudantes de graduação no ambiente clínico. Rotineiramente, a competência clínica tem sido avaliada pelos docentes por meio de um conceito subjetivo. Essa nota, dada por um especialista, não é objetiva e está sujeita a vieses. O uso de um instrumento bem delineado, com diversos itens pontuados numa escala, oferece a vantagem de especificar o que deve ser avaliado, auxiliando os avaliadores a distinguir os diferentes níveis do desempenho. Usando este método, os docentes podem expressar sua percepção global dos alunos, de forma mais objetiva, em relação a duas esferas distintas da competência: técnica (contendo itens como história clínica, exame físico, conhecimento médico, julgamento clínico, solução de problemas e hábitos no trabalho) e humanista (incluindo comunicação com pacientes e familiares, respeito, habilidades reflexivas, sensibilidade ao contexto e trabalho em equipe).

An Exploratory Examination of Student Dismissals and Prompted Resignations From Clinical Psychology PhD Training Programs: Does Clinical Competency Matter?

How do clinical psychology PhD training programs decide whether a student should be dismissed? Are these decisions related to the student's clinical competency or suitability? Accredited, scientist-practitioner clinical psychology PhD training programs were surveyed about their experiences with dismissal decisions and clinical competency evaluations. Average rates of student dismissal and prompted resignations were low (less than 3% and 6%, respectively) but highly variable across programs. The most common basis for dismissals and resignations pertained to clinical competency concerns and academic standards. However, for 29% of programs, documented dismissal criteria did not include expectations for achievement of a prescribed level of clinical skills proficiency. Implications and suggested courses of action are discussed.

A web-based presentation of an undergraduate clinical skills curriculum.

The aim of this study was to use information and communications technology to present a curriculum of clinical skills in a user-friendly format. A UK undergraduate medical school with a problem-based curriculum and a strong emphasis on proficiency in clinical skills. Case study describing the qualitative analysis of users' requirements and development of a web-based learning portfolio. The study involved direct observation of users during a 'think-aloud' protocol, a validated software users' measurement inventory and a 17-item questionnaire designed to test whether 'SkillsBase' met its users' requirements. Students wanted a clear and flexible presentation of their skills curriculum that was easy to navigate, offered instructional material and standards for self- and peer assessment, offered useful Internet links, allowed them to compare their progress with school standards and peer norms, and could be used as a learning portfolio. During the think-aloud protocol, students made very few errors in data interpretation or navigation, and found SkillsBase easy to learn and aesthetically pleasing to use. They rated it higher on all measures of usability than standard commercial software. The questionnaire showed that it met most aspects of its design specification, although many students were doubtful that they would use its reflective function. It is available for inspection at http://www.skillsbase.man.ac.uk/. SkillsBase meets the design specification for a training and reflective aid to learning clinical skills and is very usable.

A problem-based learning curriculum for occupational therapy education.

To prepare practitioners and researchers who are well equipped to deal with the inevitable myriad changes in health care and in society coming in the 21st century, a new focus is needed in occupational therapy education. In addition to proficiency in clinical skills and technical knowledge, occupational therapy graduates will need outcome competencies underlying the skills of critical reflection. In this article, the author presents (a) the rationale for the need for change in occupational therapy education, (b) key concepts of clinical reasoning and critical reflection pertaining to the outcome such change in occupational therapy education should address, (c) problem-based learning as a process and educational method to prepare occupational therapists in these competencies, and (d) the experience of the Program in Occupational Therapy at Shenandoah University in Winchester, Virginia, in implementing a problem-based learning curriculum.

Graduate Nurse Transition Program

school and begins work in a hospital. Not only does the new graduate face a conflict between values and behaviors she knew as a nursing student in an educational setting and those of a new graduate in her first work situation, but she also finds that her theoretical knowledge is of little use to her until she no longer is anxious about her clinical skills. The Graduate Nurse Transition Program (GNTP) was designed to assist such nurses to become comfortable as members of the health care team in the realistic work setting of a small to moderate-sized acute care hospital in Northern Virginia. It is a practical guided experience for beginning level staff nurses, structured to enable them, at its end, to function as beginning staff in the critical care area. The nursing administrators' concerns that new graduates come to the hospital setting with limited clinical skills were corroborated by a 1978 Nursing Survey Questionnaire of the Virginia Hospital Association Committee on Nursing, in which a majority of the respondents indicated that associate degree and baccalaureate nurses lack adequate entry-level clinical skills(l). Carozza cites a Colorado Nurses Association statement pointing out serious inadequacies in the clinical performance skills of new graduate nurses(2). In our interviews with several nursing administrators the point was made that generalized orientation programs usually are not long enough or intensive enough to develop adequately the new graduate's proficiency in clinical skills and independent functioning. Arm-