PubMed · 9873294
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K Manley. Practice development: a growing and significant movement.. https://pubmed.ncbi.nlm.nih.gov/9873294/
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BACKGROUND: Technical competence is the bedrock of surgery, yet it has only recently been viewed as a valid area for either critical evaluation or formal teaching. METHODS: This review examines the teaching of surgical skills. The core is derived from a literature search of the Medline computer database. RESULTS AND CONCLUSION: The impetus for surgical change has generally related to the introduction of new technology. Advances initially allowed for open operation within the main body cavities; more recently minimal access surgery has appeared. The latter was introduced in an inappropriate manner, which has led to the evolution of teaching of technical skills away from an apprenticeship-based activity towards more formal skill-based training programmes. There is now a need for a solid theoretical base for the teaching of manual skills that accommodates concepts of surgical competence.
CONTEXT: The recommendations of the General Medical Council in Tomorrow's Doctors renewed efforts to define core knowledge in undergraduate medical education. They also encouraged better use of the medical knowledge base in nurturing clinical judgement, critical thinking, and reflective practice. What then does the medical world understand by 'science', 'critical thinking' and 'competence', given the need to address both growth and uncertainty in the knowledge base and to practise evidence-based healthcare? AIM AND OBJECTIVES: This review aims to outline the role of these key concepts in preparing undergraduate medical students for professional practice. Specifically, it explores: the fallibility of the 'scientific' foundations of medical practice; the role of understanding and thinking in undergraduate medical education; the need for a broad interpretation of competence and its relationship to transferability, and the nature of clinical judgement. COMMENT: Tensions are seen to lie in the varying interpretations of clinical decision making as art or science; the varying characterizations of the nature of skilled performance in the novice, the competent and the expert practitioner, and the varying reactions to the acceptability and usefulness of 'meta-' concepts in capturing the essence of professional practice. Habitual self-conscious monitoring of mental processes may be the key to the flexible transfer and application of knowledge and skills across the contexts, characterized by uncertainty and incomplete evidence, for which doctors must be prepared.