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At least 19 recordsLinked to original sources

PubMed2005

Comparison of clinical skills of 3rd-year students who completed structured clinical skills program with 6th-year students who acquired clinical skills in unsystematic way.

BACKGROUND: The timing and methods of teaching clinical skills are some of the main concerns of medical education. PURPOSE: The aim of this study was to compare clinical skills of the 3rd and 6th-year students who acquired clinical skills training within different years and methods. METHODS: Randomly chosen students were observed and evaluated in the form of "did it-didn't do it" over the checklists composed of parameters of communication, history taking, and physical examination. The results were evaluated on the SPSS 10.0 for Windows program and Pearson chi-square test was used in the statistical analyses. RESULTS: Third-year students who had clinical skills training in early years and structured methods had better results for most of the parameters (p < .05). CONCLUSIONS: The clinical skills training given through a structured program that is widespread in the early years of medical school makes a great contribution to the development of students' clinical skills.

Clinical Competence↗

PubMed2003

Skills or skilled? Children's nursing in the context of the current debate around nursing skills.

This article seeks to demonstrate how the current debate around nursing skills is derived from an economic model of care and competency that has been based on the needs of the adult population. The professional perspective of children's nursing has been unheard in policy and decision-making circles concerning the skills agenda debate within educational and clinical practice. As a consequence, the need of children's nurses has been assumed to be the same as those of general/adult nursing. This article argues that children's nursing has followed a different historical and professional pathway on its progression to maturity. These differences call for alternative educational and clinical solutions for children's nurses in the issue of skills acquisition. In the children's nursing context, this is the difference between having a skill and being skilled. Recognition of this could ensure that children's nursing has a valuable contribution to make to the debate from its unique perspective.

Clinical Competence↗

PubMed2006

Comparison of communication skills in medical residents with and without undergraduate communication skills training as provided by the Faculty of Medicine of Gadjah Mada University.

OBJECTIVE: To promote better doctor-patient relationships in clinical practice, many medical faculties have introduced practical communication skills training programs for their students. This study is aimed at comparing the communication skills of graduates of the Faculty of Medicine of Gadjah Mada University, Indonesia, educated with and without communication skills training as perceived by their patients and by the graduates themselves. METHODS: Over 300 patients were seen by 18 medical residents trained in communication skills before graduation and 30 residents who had not attended this training. After consultation patients and residents completed a 39-item questionnaire addressing the doctor's communication behavior skills. In the questionnaires completed by patients the desired communication behavior of doctors was also rated. RESULTS: Patients did not observe any differences in communication behavior skills among residents who received training and those who did not. These two groups of trained and non-trained residents assessed their own communication behavior skills. On 4/39 questionnaire items patients rated the communication behavior skills of trained residents lower than the residents themselves and the ratio was 13/39 for non-trained residents. A significant gap was noted between doctors' communication behavior skills as observed and desired by their patients (p < 0.001). CONCLUSIONS: Undergraduate communication skills training in the institution under study could not be demonstrated to illustrate a difference in the communication behavior skills of its graduates from graduates from the same institution who did not attend communication skills training. Trained graduates, however, were more aware of communication behavior skills as being preferred by their patients than their peers who were not trained in communication behavior skills training during their undergraduate studies.

Communication↗

PubMed2003

Teaching clinical skills in developing countries: are clinical skills centres the answer?

CONTEXT: There is growing international interest in teaching clinical skills in a variety of contexts, one of which is Clinical Skills Centres. The drivers for change making Skills Centres an important adjunct to ward and ambulatory teaching come both from within and outside medical education. Educationally, self-directed learning is becoming the accepted norm, encouraging students to seek and maximize learning opportunities. There are global changes in health care practice, increased consumerism and increasing student numbers. In some countries, professional recommendations influence what is taught. Increasingly, core skills curricula and outcome objectives are being defined. This explicit definition encourages assessment of the core skills. In turn, all students require equal opportunities to learn how to practise the skills safely and competently. The moves towards interprofessional education make joint learning in a"neutral" setting, like a Clinical Skills Centre, appear particularly attractive. OBJECTIVE: To discuss the potential role of Clinical Skills Centres in skills training in developing countries and to consider alternative options. DISCUSSION: Many developing countries seek to establish Clinical Skills Centres to ensure effective and reliable skills teaching. However, the model may not be appropriate,because fully equipped Clinical Skills Centres are expensive to set up, staff; and run. They are not the only way to achieve high quality clinical teaching. Suggested options are based on the philosophy and teaching methods successfully developed in Clinical Skills Centres that may fulfil the local needs to achieve low cost and high quality clinical teaching which is reflective of the local health needs and cultural expectations.

Clinical Competence↗

PubMed2004

Teaching cognitive skills improves learning in surgical skills courses: a blinded, prospective, randomized study.

OBJECTIVE: To investigate the teaching of cognitive skills within a technical skills course, we carried out a blinded, randomized prospective study. METHODS: Twenty-one junior residents (postgraduate years 1-3) from a single program at a surgical-skills training centre were randomized to 2 surgical skills courses teaching total knee arthroplasty. One course taught only technical skill and had more repetitions of the task (5 or 6). The other focused more on developing cognitive skills and had fewer task repetitions (3 or 4). All were tested with the Objective Structured Assessment of Technical Skill (OSATS) both before and after the course, as well as a pre- and postcourse error-detection exam and a postcourse exam with multiple-choice questions (MCQs) to test their cognitive skills. RESULTS: Both groups' technical skills as assessed by OSATS were equivalent, both pre- and postcourse. Taking their courses improved the technical skills of both groups (OSATS, p < 0.01) over their pre-course scores. Both groups demonstrated equivalent levels of knowledge on the MCQ exam, but the cognitive group scored better on the error-detection test (p = 0.02). CONCLUSIONS: Cognitive skills training enhances the ability to correctly execute a surgical skill. Furthermore, specific training and practice are required to develop procedural knowledge into appropriate cognitive skills. Surgeons need to be trained to judge the correctness of their actions.

Arthroplasty, Replacement, Knee↗

PubMed2002

A focused breast skills workshop improves the clinical skills of medical students.

PURPOSE: The aim of this study was to determine the effectiveness of a focused breast skills workshop for teaching clinical skills to third-year medical students. METHODOLOGY: One hundred twenty-four third-year medical students involved in the surgical core clerkship were randomly assigned to two groups. Group 1 (n = 67) participated in a 2-h focused breast skills workshop. Group 2 (n = 57) received "traditional" ambulatory teaching for a period of 4 h in the breast clinic. The focused workshop consisted of a series of encounters concentrating on mammogram and ultrasound interpretation, physical examination skills, lump detection, and workup of a breast mass. Both groups received a didactic core curriculum lecture from surgical faculty. All students completed a satisfaction rating scale and a subset of students completed a pre- and postencounter self-efficacy rating scale on several aspects of breast skills. Student's t test was used to compare the groups in the areas of clinical skills as evidenced by performance on the breast-specific items on the end of the clerkship Objective Structure Clinical Examination and student satisfaction as evidenced by their response on a satisfaction rating scale. ANCOVA (controlling for preencounter self-efficacy rating) was used to compare the change scores between pre- and postencounter self-efficacy ratings. RESULTS: Students in Group 1 performed significantly higher than the students in Group 2 in the areas of clinical examination skills (t = -2.99, P < 0.05); in sensitivity (t = -5.82, P < 0.05) and specificity (t = -7.27, P < 0.05) in the examination of breast models; and with their satisfaction with the encounter (t = 10.72, P < 0.05). Students in Group 1 also demonstrated a higher level of confidence in their breast skills at the end of the clerkship than students in Group 2 (F = 6.22, P < 0.05). CONCLUSIONS: The focused breast skills workshop is more effective than the traditional ambulatory setting for teaching clinical breast examination skills. This setting also demonstrated the development of higher confidence in breast skills than the traditional ambulatory setting.

Ambulatory Care↗

PubMed1996

Young drivers' overestimation of their own skill--an experiment on the relation between training strategy and skill.

Young drivers' accident involvement may be explained by a number of different factors, one of which is that they tend to overestimate their skill in driving a car. This study is based upon the assumption that the degree of overestimation is related to the type of training the driver has received. In an experiment, two different strategies for training have been compared with regard to their influence on estimated and actual driving skill, as well as the drivers' degree of overestimation of their own skill. One of the strategies, used in the "skill" group was to make the learner as skilled as possible in handling a braking and avoidance manoeuvre in a critical situation. The other strategy, used in the "insight" group was to make the driver aware of the fact that his own skill in braking and avoidance in critical situations may be limited and unpredictable. The experiment was carried out at the Bromma driving practice area in Stockholm. Low friction has been simulated by using "Skid Car" equipment. Fifty-three learner drivers were randomly divided into two groups. Each of the groups was taught on the basis of one of the strategies. The training session was 30 minutes long. One week later, the drivers returned to take part in a test of their estimated and actual skill. The "skill" group estimated their skill higher than the "insight" group. No difference was found between the groups regarding their actual skill. The results confirm the main hypothesis that the skill training strategy produces more false overestimation than the insight training strategy.

Accidents, Traffic↗

PubMed1989

Lectures and skills workshops as teaching formats in a history-taking skills course for medical students.

The consulting skills acquired by medical students during their training are an important determinant of their ability to conduct adequate and efficient clinical interviews. These skills comprise: the acquisition of medical knowledge and the ability to apply this; and communication skills required to obtain full, accurate clinical histories from patients and to be able to give to patients the information they need to comply with prescribed regimens. Until recently, consulting skills training has certainly not had a high profile in medical curricula, despite evidence that students do not gain sufficient expertise during their medical training. A history-taking skills course within the Austin Hospital Clinical School, utilizing mass lecture and small-group skills workshops is described. Independent evaluation of students' videotaped interviews with patients, completed before training, after mass lectures and following small-group workshops, showed that students trained in consulting skills demonstrated significant improvements in interview skills and techniques, compared with a similar group of students for whom training followed the more traditional model. Whilst there were some improvements after mass lectures, most significant gains in history-taking skills were obtained following skills workshops. Ongoing evaluation of these students will determine if these short-term improvements in consultation skills persist over their clinical training and internship.

Clinical Clerkship↗

PubMed1994

Teaching and learning clinical skills, Part 1--Development of a multidisciplinary skills centre.

A critical review of current nursing, midwifery and medical education programmes in the context of a changing health service, had led staff at the nursing and medical colleges at St Bartholomew's Hospital in London to conclude that radical approaches to teaching and learning are needed. This is particularly the case for the teaching and assessment of competence in clinical skills. Increased emphasis on community care, day care and outpatient teaching with the concomitant increase in dependency and throughput of inpatients, makes it increasingly difficult for students to observe and practice communication and clinical skills. To meet this major challenge, a joint initiative between the College of Nursing & Midwifery, the Medical College and the St Bartholomew's NHS Group to develop a clinical skills learning facility has been established. The Skills Centre will provide a focus for the learning and assessment of clinical and communication skills in a multidisciplinary environment. In a series of two papers the aims and development of the joint initiative will be explored together with four key outcomes, a Clinical Skills Matrix, a staged approach to skills teaching, a schedule for teaching and assessing clinical skills and the Integrated Skills Teaching Model.

Clinical Competence↗

PubMed2004

Cognitive task analysis for teaching technical skills in an inanimate surgical skills laboratory.

BACKGROUND: The teaching of surgical skills is based mostly on the traditional "see one, do one, teach one" resident-to-resident method. Surgical skills laboratories provide a new environment for teaching skills but their effectiveness has not been adequately tested. Cognitive task analysis is an innovative method to teach skills, used successfully in nonmedical fields. The objective of this study is to evaluate the effectiveness of a 3-hour surgical skills laboratory course on central venous catheterization (CVC), taught by the principles of cognitive task analysis to surgical interns. METHODS: Upon arrival to the Department of Surgery, 26 new interns were randomized to either receive a surgical skills laboratory course on CVC ("course" group, n = 12) or not ("traditional" group, n = 14). The course consisted mostly of hands-on training on inanimate CVC models. All interns took a 15-item multiple-choice question test on CVC at the beginning of the study. Within two and a half months all interns performed CVC on critically ill patients. The outcome measures were cognitive knowledge and technical-skill competence on CVC. These outcomes were assessed by a 14-item checklist evaluating the interns while performing CVC on a patient and by the 15-item multiple-choice-question test, which was repeated at that time. RESULTS: There were no differences between the two groups in the background characteristics of the interns or the patients having CVC. The scores at the initial multiple-choice test were similar (course: 7.33 +/- 1.07, traditional: 8 +/- 2.15, P = 0.944). However, the course interns scored significantly higher in the repeat test compared with the traditional interns (11 +/- 1.86 versus 8.64 +/- 1.82, P = 0.03). Also, the course interns achieved a higher score on the 14-item checklist (12.6 +/- 1.1 versus 7.5 +/- 2.2, P <0.001). They required fewer attempts to find the vein (3.3 +/- 2.2 versus 6.4 +/- 4.2, P = 0.046) and showed a trend toward less time to complete the procedure (15.4 +/- 9.5 versus 20.6 +/- 9.1 minutes, P = 0.149). CONCLUSIONS: A surgical skills laboratory course on CVC, taught by the principles of cognitive task analysis and using inanimate models, improves the knowledge and technical skills of new surgical interns on this task.

Catheterization, Central Venous↗

PubMed2006

An electrophysiological investigation of semantic and phonological processing in skilled and less-skilled comprehenders.

The most prominent theories of reading consider reading comprehension ability to be a direct consequence of lower-level reading skills. Recently however, research has shown that some children with poor comprehension ability perform normally on tests of lower-level skills (e.g., decoding). One promising line of behavioral research has found semantic processing differences between good and poor comprehenders and suggests that impoverished semantic ability may be linked to poor comprehenders' difficulties. In the current study, we used event related potentials (ERP) to compare adult skilled and less-skilled comprehenders on a set of semantic and phonological processing tasks. The results revealed that the N400 component of the ERP and the P200 component were sensitive to differences between skilled and less-skilled comprehenders during a semantic processing task. Importantly, skilled and less-skilled comprehenders showed no differences in their ERP response during a phonological processing task. These findings provide neurophysiological support for the hypothesis that less-skilled comprehenders have a weakness in semantic processing that may contribute to their comprehension difficulties.

Articulation Disorders↗

PubMed1994

Teaching and learning clinical skills, Part 2--Development of a teaching model and schedule of skills development.

In Part 1 of this paper the development of a multidisciplinary Skills Centre in a London teaching hospital, and the Clinical Skills Matrix, a composite list of skills required by nurses and doctors was described. Part 2 describes how a model for skills teaching, the Integrated Skills Teaching Model, was developed in order to provide a framework for teaching within the centre. This work and that of Alavi et al (1991) led to the development of a Schedule of Skills Development. This identifies the skills to be acquired and indicates the level of performance at specific stages throughout the Project 2000 programme. The schedule provides a comprehensive overview of skill development for teachers, students and clinical staff.

Clinical Competence↗

PubMed2004

The skilled attendance index: proposal for a new measure of skilled attendance at delivery.

Increasing the proportion of deliveries with skilled attendance is widely regarded as key to reducing maternal mortality and morbidity in developing countries. The percentage of deliveries with a health professional is commonly used to assess skilled attendance, but measures only the presence of an attendant, not the skills used or the enabling environment To supplement currently available information on the presence of an attendant at delivery, a method to measure the extent of skilled attendance at delivery through use of clinical records was devised. Data were collected from 416 delivery records in hospitals, government health centres and private non-hospital maternity facilities servicing Kintampo District, Ghana, using a case extraction form. Based on the defined criteria, summary measures of skilled attendance were calculated. Between 32.6% and 93.0% of the criteria for skilled attendance were met in the sample, with a mean of 65.5%. No delivery met all the criteria. A Skilled Attendance Index (SAI) was developed as a composite measure of delivery care. The SAI revealed that 26.9% of delivery records met at least three-quarters of the criteria for skilled attendance. Documentation of haemoglobin, current pregnancy complications, post-partum vital signs and completed partographs were amongst the criteria most poorly recorded. The purpose of applying these measures should be seen not as an end in itself but to advance improvements in delivery care.

Delivery, Obstetric↗

PubMed2003

Correlates of fundamental skills versus complex skills for medical technologists.

This 4-year study examined 165 medical technologists generally in the achievement phase of their careers. After distinguishing between two types of skills, fundamental and complex, different antecedents for each type of skill were found. Prior professional commitment was related positively to fundamental skills, whereas professional withdrawal intent was related negatively. Prior scholarly professional development and job involvement were related positively to complex skills, whereas job insecurity was related negatively. Complex skills time acquisition had a stronger positive relationship to complex skills than the relationship of fundamental skills time acquisition to fundamental skills.

Career Mobility↗

PubMed2004

Characterization of motor skill and instrumental learning time scales in a skilled reaching task in rat.

Successful motor skill learning requires repetitive training interrupted by rest periods. In humans, improvement occurs within and between training sessions reflecting fast and slow components of motor learning [Karni A, Meyer G, Rey-Hipolito C, Jezzard P, Adams MM, Turner R, et al. The acquisition of skilled motor performance: fast and slow experience-driven changes in primary motor cortex. Proc Natl Acad Sci USA 1998;95:861-8]. Here, these components are characterized in male and female rats using a model of skilled forelimb reaching and are compared to time scales of instrumental learning. Twenty female and 14 male adult Long-Evans rats were pre-trained to operate a motorized door (via a sensor in the opposite cage wall) to access a food pellet by tongue. Latencies between pellet removal and door opening were recorded as measures of instrumental learning. After criterion performance was achieved, skilled forelimb reaching was requested by increasing the pellet-window distance to 1.5cm. Reaching success was recorded per trial. Mean latencies decreased exponentially over sessions and no improvement within-session was found. Skill learning over eight training sessions followed an exponential course in females and a sigmoid course in males. Females acquired the skill significantly faster than males starting at higher baseline levels (P < 0.001) but reaching similar plateaus. Within-session improvement was found during the sessions 1-3 in females and 1-4 in males. Performance at the end of session 1 was not carried over to session 2. Learning curves of individual animals were highly variable. These findings confirm in rat that motor skill learning has fast and slow components. No within-session improvement is seen in instrumental learning.

Animals↗

PubMed1989

Working memory in skilled and less skilled readers.

This study assessed skilled and less skilled readers' working memory performance. Fifty skilled and less skilled readers at two age levels were presented with sentence span and concurrent memory tasks. The span task results indicated that working memory differences exist between reading groups. The concurrent task revealed performance deficits for less skilled readers across verbal and nonverbal conditions, suggesting a central processing deficiency. Age differences were isolated to skilled readers. It was concluded that less skilled readers' working memory deficiencies were pervasive in the sense that they involve deficiencies in memory components related to central executive processing.

Attention↗

PubMed2005

Skilled birth attendance: what does it mean and how can it be measured? A clinical skills assessment of maternal and child health workers in Nepal.

The presence of a skilled birth attendant at delivery is important in averting maternal and neonatal mortality and morbidity. It has now shown that even trained traditional birth attendants (TBAs) cannot, in most cases, save women's lives effectively because they are unable to treat complications, and are often unable to refer. Qualified midwives and doctors are often not available in the rural areas and community settings where most women in developing countries deliver. Defining the minimum competency level necessary to meet the definition of skilled birth attendant is important, particularly in countries such as Nepal with limited availability of facility-based emergency obstetric care. Maternal and child health workers are local women aged 18-35 who completed a 15-week course in maternal and child health. As the role of MCHWs has expanded to meet the country's needs for skilled attendance, a 6-week "refresher" course in midwifery skills is offered. The results of this clinical skills assessment of 104 randomly selected MCHWs from 15 districts across Nepal supports the premise that MCHWs with appropriate training have an acceptable level of knowledge and skill, demonstrated in a practice situation, to meet the definition of community level skilled birth attendants. Yet, competency alone will not necessarily improve the situation. To affect maternal mortality in Nepal, MCHWs must be widely available, they must be allowed to do what they are trained to do, and they must have logistical and policy support.

Adult↗

PubMed2004

Communication behaviours of skilled and less skilled oncologists: a validation study of the Medical Interaction Process System (MIPS).

The Medical Interaction Process System (MIPS) was originally developed in order to create a reliable observation tool for analysing doctor-patient encounters in the oncology setting. This paper reports a series of analyses carried out to establish whether the behaviour categories of the MIPS can discriminate between skilled and less skilled communicators. This involved the use of MIPS coded cancer consultations to compare the MIPS indices of 10 clinicians evaluated by an independent professional as skilled communicators with 10 who were considered less skilled. Eleven out of the 15 MIPS variables tested were able to distinguish the skilled from the less skilled group. Although limitations to the study are discussed, the results indicate that the MIPS has satisfactory discriminatory power and the results provide validity data that meet key objectives for developing the system. There is an ever-increasing need for reliable methods of assessing doctors' communication skills and evaluating medical interview teaching programmes.

Communication↗