Training paradigms to enhance clinical observational skills in clinical practice: A scoping review

Abstract

A number of training approaches to improve the clinical observation skills of undergraduate students have been identified in the literature. Immediate improvement from such approaches on students' clinical observational skills have been documented. However, this review identified that observational skill improvements did not occur in real and complex clinical conditions where the incidence of perception failure may increase. In six out of seven approaches examined, (i) the visual attention paid by students during observation is more focused than the actual visual attention clinicians usually pay in the real clinical area; (ii) the observations were made on images of clinical cases with visible signs which allowed findings to be noticed easily and with minimal searching efforts; (iii) the improvement in observation skills was based on what was noticed rather than what was missed, hence, perceptual failure was concealed; and (iv) in evaluations, students were asked to describe "what they see", the process of describing has the possibility to increase the tendency to conflate observations with inferences, and as a result, students may have stopped searching after being satisfied with their findings. To conclude, this review showed that perception paradigms have not been acknowledged in clinical observation training approaches with a need for further research relating to visual perception in clinical settings.