A pre-clerkship simulation-based procedural skills curriculum: decreasing anxiety and improving confidence of procedural skill performance

Abstract

Introduction: Pre-clerkship procedural skills training is not yet a standard across Canadian medical school curricula, resulting in limited exposure to procedures upon entering clerkship. While simulated skills training has been documented in the literature to improve performance in technical ability, anxiety and confidence have yet to be investigated despite their documented impact on performance and learning. This study therefore aims to evaluate the effect of pre-clerkship procedural skills training on medical student anxiety and confidence.
 Methods: A procedural skills training program was designed based on an evidence-based near-peer, flipped classroom model of education. Ninety-two second-year medical students volunteered for the study. Fifty-six were randomized to the training group, and 36 were randomized to the control group. Students in the training group attended seven procedural skills tutorials over seven months. The control group represented the average medical school student without standardized procedural training. Student anxiety and confidence were assessed at the beginning and end of the program using the State Trait Anxiety Inventory and Confidence Questionnaires.
 Results: Students who participated in the procedural skills program demonstrated greater reductions in their state anxiety and greater improvements in confidence compared to the control group.
 Conclusion: Longitudinal procedural skills training in the simulation setting has demonstrated improvements in anxiety and confidence among pre-clerkship medical students. These added benefits to training have the potential to ease medical students’ transition into clerkship, while also contributing to a safer and more effective clinical experience. Therefore, future integration of standardized pre-clerkship procedural skills training within medical school curricula should be considered.

Videos of demonstration versus text and image-based material for pre-skill conceptualisation in flipped newborn resuscitation training for medical students: a pilot study

“…Fortunately, carefully designed content can optimize preparation by reducing cognitive load and positively influencing student engagement and motivation [22]. While manuals [23,24], PowerPoint presentations (PPs) [25,26] and video lectures [27,28] have been used to present various types of knowledge in flipped PS training, instructional theory suggests that PK is better learnt by the observation of a demonstration of the skill being performed [29]. Although demonstration videos (DVs) have been used as pre-skill conceptualisation in simulation-based flipped PS training in a handful of studies [7,8,[30][31][32][33], singly or in combination with other material, only 3 of these reported on objective measures of skills acquisition and presented conflicting results [7,8,31].…”

Clinical Simulation for Procedural Expertise: State of Education and Application

“…It has enhanced learner competence and expertise (Bamford et al, 2018;Greif et al, 2010;Hale et al, 2021;Hayden et al, 2014). Due to these findings, evidence supports the introduction of SBPT to students before clerkships (Battaglia et al, 2021;Omori et al, 2005) to better prepare them to learn in the clinical setting (Battaglia et al, 2021;Remmen et al, 2001).…”

“…Simulation-based research conducted over decades is ripe with evidence supporting improved educator and learner satisfaction (Bradley, 2006), learner knowledge and confidence (Battaglia et al, 2021;Laschinger et al, 2008), and competence when assessed on simulators (Hale et al, 2021;Morgan & Cleave-Hogg, 2000). Although most studies support the use of simulation for improved knowledge and skill, only a few studies have shown the effectiveness of transferring knowledge and skill gained in simulation training into clinical practice (Hill et al, 2011).…”

Pre-clerkship procedural training in venipuncture: a prospective cohort study on skills acquisition and durability

“…Thus, Remmen et al assumed that skills training better prepares students for clinical clerkships [ 41 ]. Students were found to be less anxious and more confident at the bedside with procedural training in the pre-clerkship period [ 42 ]. Therefore, SBPT is recommended to be integrated as a longitudinal training course into medical curricula [ 43 ], starting from the pre-clerkship period [ 44 ].…”