Evaluation of medical student retention of clinical skills following simulation training

Abstract

Background: Adequate clinical skills training is a challenge for present day medical education. Simulation Based Education (SBE) is playing an increasingly important role in healthcare education worldwide to teach invasive procedures. The impact of this teaching on students along with retention of what is taught is not fully understood. The purpose of this study was to evaluate the retention levels of practical skills taught and assessed by SBE and to explore the degree of re-training required to restore decayed performance. In exploring this aim, the study further investigates how skilled performance decays over time and which dimensions of clinical skills were more likely to decay.

Methods: Study participants were 51 final year medical students. They were provided with online pre-course videos and procedural guides asynchronously with repeatedly access. 7 of the skills taught over 2 years using task trainers were selected. Following demonstration from faculty, students practiced in small groups with faculty facilitated supervision and peer support prior to formal testing. Score sheets with itemised procedure checklists detailing the minimum passing standard (MPS) for each skill were designed. To test retention of skills, 18 months later, there was an unannounced test to demonstrate proficiency in the skills. Students were asked to complete a questionnaire indicating how many times and where they had practiced or performed the skills.

Results: 55% of the students were deficient in 3 or more skills and 4% were not competent in 5 or more skills. A significant number of students had never practiced some skills following the initial teaching session. A relationship was noted with the number of times students self-declared that they had practiced and their performance. Decay is evident in both psychomotor and cognitive domains of the skills.

Conclusion: A curriculum with deliberate practice significantly increases the competence of students in defined clinical skills. Deliberate practice of clinical skills, under supervision of an engaged instructor, is a key component of the mastery model. Experiences and assessments in the clinical setting need to be augmented with focus on direct observation and focused feedback to reinforce the skills acquired in the simulated setting.

Keywords: Clinical skills; Deliberate practice; Medical school curriculum; Psychomotor and cognitive domains; Retention; Simulation.

Fig. 1

Percentage of poorly performed tasks. The individual tasks required to perform skills completely were identified under Blooms Taxonomy as psychomotor, behaviour, or knowledge. At the retest of venepuncture, students performed less poorly the behavioural aspects of this task as compared to the psychomotor elements (a). For catheterisation student performed equally poorly on both the psychomotor and behavioural aspects of the tasks (b)

Fig. 2

Students’ confidence in own clinical skills pre and post retesting and retraining. Students filled in a questionnaire pre and post-retesting to detail how confident they were at the individual skills. Students were not confident with their own skill levels prior to retesting (a) and they expressed that they were much happier to attend clinical duties post retesting (b). (n = 51 students)