Learning physical examination skills outside timetabled training sessions: what happens and why?

Abstract

Lack of published studies on students’ practice behaviour of physical examination skills outside timetabled training sessions inspired this study into what activities medical students undertake to improve their skills and factors influencing this. Six focus groups of a total of 52 students from Years 1–3 using a pre-established interview guide. Interviews were recorded, transcribed and analyzed using qualitative methods. The interview guide was based on questionnaire results; overall response rate for Years 1–3 was 90% (n = 875). Students report a variety of activities to improve their physical examination skills. On average, students devote 20% of self-study time to skill training with Year 1 students practising significantly more than Year 3 students. Practice patterns shift from just-in-time learning to a longitudinal selfdirected approach. Factors influencing this change are assessment methods and simulated/real patients. Learning resources used include textbooks, examination guidelines, scientific articles, the Internet, videos/DVDs and scoring forms from previous OSCEs. Practising skills on fellow students happens at university rooms or at home. Also family and friends were mentioned to help. Simulated/real patients stimulated students to practise of physical examination skills, initially causing confusion and anxiety about skill performance but leading to increased feelings of competence. Difficult or enjoyable skills stimulate students to practise. The strategies students adopt to master physical examination skills outside timetabled training sessions are self-directed. OSCE assessment does have influence, but learning takes place also when there is no upcoming assessment. Simulated and real patients provide strong incentives to work on skills. Early patient contacts make students feel more prepared for clinical practice.

The impact of students and curriculum on self-study during clinical training in medical school: a multilevel approach

“…It is encouraging to compare our figures with those of Snelling et al because together they suggest that effective self-study is not just a matter of time available, but depends on students taking responsibility for their own learning [2]. Beyond timetabled training sessions, students undertake self-study with textbooks, examination guidelines, scientific articles, the Internet, videos, previous OSCEs and practice skill training [20]. Based on our results it would be important to look for students’ characteristics that may predict study time investment in the clinical years.…”

“…Although extensive research has recognized the importance of curriculum and individual differences in time devoted to self-study, it is still unclear to what extent these variables affect time to study [20]. Given the responsibility of schools to develop adequate curricula for achieving learning objectives, it is important to discriminate the relative contributions from students and curriculum to the time devoted to self-study.…”

How well do final year undergraduate medical students master practical clinical skills?

“…In reality, this is hardly controllable and students develop a large part of their “clinical practice” outside class [39]. Effectively this means that an important part of medical training is beyond the grasp of university structures and therefore escapes institutional quality standards.…”

OSCE para Competências de Comunicação Clínica e Profissionalismo: Relato de Experiência e Meta-Avaliação

“…A partir desse momento, ele se tornou uma ferramenta importante para avaliar as habilidades clínicas, conhecimento, atitudes, comunicação e profissionalismo 6,8 . Desde então, é aplicado na avaliação de estudantes de Medicina e residentes, em avaliações somativas ou formativas em todo o mundo 6,[14][15][16] .…”