"Best practice" skills lab training vs. a "see one, do one" approach in undergraduate medical education: an RCT on students' long-term ability to perform procedural clinical skills

Abstract

Background: Benefits of skills lab training are widely accepted, but there is sparse research on its long-term effectiveness. We therefore conducted a prospective, randomised controlled-trial to investigate whether in a simulated setting students trained according to a "best practice" model (BPSL) perform two skills of different complexity (nasogastral tube insertion, NGT; intravenous cannulation, IVC) better than students trained with a traditional "see one, do one" teaching approach (TRAD), at follow-up of 3 or 6 months.

Methodology and principal findings: 94 first-year medical students were randomly assigned to one of four groups: BPSL training or TRAD teaching with follow-up at 3 (3M) or 6 (6M) months. BPSL included structured feedback, practice on manikins, and Peyton's "Four-Step-Approach", while TRAD was only based on the "see one - do one" principle. At follow-up, manikins were used to assess students' performance by two independent blinded video-assessors using binary checklists and a single-item global assessment scale. BPSL students scored significantly higher immediately after training (NGT: BPSL3M 94.8%±0.2 and BPSL6M 95.4%±0.3 percentage of maximal score ± SEM; TRAD3M 86.1%±0.5 and TRAD6M 84.7%±0.4. IVC: BPSL3M 86.4%±0.5 and BPSL6M 88.0%±0.5; TRAD3M 73.2%±0.7 and TRAD6M 72.5%±0.7) and lost significantly less of their performance ability at each follow-up (NGT: BPSL3M 86.3%±0.3 and TRAD3M 70.3%±0.6; BPSL6M 89.0%±0.3 and TRAD6M 65.4%±0.6; IVC: BPSL3M 79.5%±0.5 and TRAD3M 56.5%±0.5; BPSL6M 73.2%±0.4 and TRAD6M 51.5%±0.8). In addition, BPSL students were more often rated clinically competent at all assessment times. The superiority at assessment after training was higher for the more complex skill (IVC), whereas NGT with its lower complexity profited more with regard to long-term retention.

Conclusions: This study shows that within a simulated setting BPSL is significantly more effective than TRAD for skills of different complexity assessed immediately after training and at follow-up. The advantages of BPSL training are seen especially in long-term retention.

Figure 1. Study design and randomisation process.

BPSL = “best practice” skills lab, TRAD = “see one, do one”, OSCE = Objective Structured Clinical Examination, 3M = follow-up after 3 months, 6M = follow up after 6 months * = video material not useable.

Figure 2. Loss of skills level expressed as percentage of points on the corresponding binary checklist (NGT or IVC) at 3 (Figure 2A) and 6 months (Figure 2B) after initial training, respectively (error bars refer to SEM).

NGT = nasogastral tube insertion, IVC = intravenous cannulation, BSPL = Best Practice Skills Lab Training, TRAD = Traditional “see one, do one” teaching.

Figure 3. Single-item global rating of performance (mean + SEM) initially after training (t₀) and at 3 (t_3M) and 6 months (t_6M) later, respectively.

NGT = nasogastral tube insertion, IVC = intravenous cannulation, TRAD = traditional “see one, do one” training, BPSL = Best Practice Skills Lab Training. Significant differences (p<0.05) are marked with an asterisk.