Design and effectiveness of a required pre-clinical simulation-based curriculum for fundamental clinical skills and procedures

Abstract

Background: For more than 20 years, medical literature has increasingly documented the need for students to learn, practice and demonstrate competence in basic clinical knowledge and skills. In 2001, the Louisiana State University Health Science Centers (LSUHSC) School of Medicine - New Orleans replaced its traditional Introduction in to Clinical Medicine (ICM) course with the Science and Practice of Medicine (SPM) course. The main component within the SPM course is the Clinical Skills Lab (CSL). The CSL teaches 30 plus skills to all pre-clinical medical students (Years 1 and 2).

Methods: Since 2002, an annual longitudinal evaluation questionnaire was distributed to all medical students targeting the skills taught in the CSL. Students were asked to rate their self- confidence (Dreyfus and Likert-type) and estimate the number of times each clinical skill was performed (clinically/non-clinically). Of the 30 plus skills taught, 8 were selected for further evaluation.

Results: An analysis was performed on the eight skills selected to determine the effectiveness of the CSL. All students that participated in the CSL reported a significant improvement in self-confidence and in number performed in the clinically/non-clinically setting when compared to students that did not experience the CSL. For example, without CSL training, the percentage of students reported at the end of their second year self-perceived expertise as "novice" ranged from 21.4% (CPR) to 84.7% (GU catheterization). Students who completed the two-years CSL, only 7.8% rated their self-perceived expertise at the end of the second year as "novice" and 18.8% for GU catheterization.

Conclusion: The CSL design is not to replace real clinical patient experiences. It's to provide early exposure, medial knowledge, professionalism and opportunity to practice skills in a patient free environment.

Keywords: Application; Environment; Experience; Exposure; Knowledge; Opportunity; Practice; Safety; Simulation; Students.

Fig. 1

Mean scores for medical students’ self-efficacy/confidence ratings (5-point Likert scale) for performing eight clinical skills at four points during medical school: 1) Beginning, immediately prior to starting curriculum (L1), 2) End of second year, immediately after CSL training (L2), 3) End of third year, completion of core clerkships (L3), and 4) At the end of medical school, just prior to graduation (L4).