Knowing is not enough; we must apply. Willing is not enough; we must do. Goethe

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Knowing is not enough; we must apply. Willing is not enough; we must do. Goethe. Clinical Skills Education Considerations on Why, What & How?. Eugene C. Corbett, Jr., M.D., FACP Brodie Professor of Medicine Professor of Nursing University of Virginia - PowerPoint PPT Presentation


  • Knowing is not enough; we must apply. Willing is not enough; we must do. Goethe

  • Clinical Skills EducationConsiderations onWhy, What & How?Eugene C. Corbett, Jr., M.D., FACPBrodie Professor of MedicineProfessor of NursingUniversity of VirginiaChair, AAMC Task Force on Clinical Skills Education

  • AgendaWhat is skill learning?Knowledge versus skills educationWhy the emphasis on skills education now?Does curricular emphasis make a difference?How?AAMC Task Force recommendationsSome examples of clinical skills teachingSome closing tips for skills teaching

  • In skills education..the accent is upon learner doing!

    .upon the application of knowledge and understanding to an intellectual, psychomotor or affective activity

  • What is skill learning?

    Reflect on your own skill development

    Think of anyone (teacher, friend, family member) who has been most helpful to you in developing a skill that you are good at. What is the skill? What did they do to help you learn to do that skill?

  • General Principles of Skills Teaching & LearningIt has a clear and specific purposeIt reinforces knowledge and understandingIt must be demonstrated wellAn opportunity to try it outAn opportunity to practice itCoaching (observation) andUseful evaluation and helpful feedbackEmphasis upon self-directed initiativeGuided by an explicit performance standardGuided by a high performance standardConfidence-building opportunity in direct patient care

  • Knowledge Acquisition vs Skill Development

    DOMAINKNOWLEDGESKILLTeacher RolelecturementorActivity CenterteacherlearnerLearning OpportunityanytimelimitedLearningIncrementvariable sizediscrete & well definedAssessment &Feedback:anytimeas soon as possible

    Settingalmost anywhereclinical/simulatedNeed for repetition:variablemandatory

  • Why the emphasis on skills education?

    Patient care is an applied activityPerformance emphasis is increasing at all levels of our professional activityMedical school skills education has been slippingWe want better UME clinical performance outcomes

  • Competency-based Clinical Performance Outcomes in Medical Education & PracticeLCME: Medical Education Objectives andDocumentation of Students ClinicalExperienceUSMLE Clinical Skills ExaminationAAMC: Students Clinical Skills EducationACGME Postgraduate competenciesIOM: Medical Error in the caring processJCAHO: Hospital Performance Measures3rd Party Payers: Physician Pay-for-Performance

  • Abraham Flexner On the pedagogic side, modern medicine, like all scientific teaching, is characterized by activity. The student no longer merely watches, listens, memorizes: he does. His own activities in the laboratory and in the clinic are the main factors in his instruction and discipline. An education in medicine nowadays involves both learning and learning how; the student cannot effectively know, unless he knows how. (1910)

  • The Purpose of Undergraduate Medical Educationto provide for the development of the knowledge, skills and values necessary to undertake the life-long responsibilities of a physician.

  • UME Clinical Skills Education:(It looks weak!)It is not explicit in the curriculumIt is variable within a schoolIt is not standardized across schoolsIt is not explicitly developmental over the 4 year curriculumIt is only loosely connected to GME expectations

  • Some AAMC Medical School Data:Competency-based skill learning objectives26%Any formal skills curricula52%Skills curricula in clinical years13%Explicit list of skills to be learned21%Clinical skills education facility59%Standardized patients/assessment65%

  • UVA CLINICAL SKILLS SURVEYStudent Self-estimate of Skill Performance(2003)Hepatic size & consistency77%Basic CPR73%Suture a Laceration72%Observe & interpret a Gallop65%Interpret spirometry62%Do a peak pulmonary flow52%Work with a reluctant nurse52%Phone: a swallowed penny45%Jugular venous pulsation38%Simple forearm cast 8%

  • UVA Post-clerkship OSCE data(2006)

  • A 4th Year Medical Student(2006)While in medical school we are continually encouraged to master a common body of knowledge, we are not as expected to master clinical skills. After reviewing my performance on videotape, I realize that I also have to master the skills of the patient encounter.

  • Clinical Skills Education, Curricular EmphasisDoes it make any difference in clinical learner performance outcomes??

  • New CurriculumOld CurriculumOverall Score on 4th Year Clinical Skills Assessment# Students# Students


  • AAMC Task Force onClinical Skills Education,a key consensus issue:How do we define basic clinical method?

    What are the essential clinical competencies for UME?? 2005, 2008

  • Medical Education:begin with the end in mindClinical Competency Domains=Medical Education Objectives

  • 12 Clinical Competency Domains of Basic Clinical MethodAAMC 2005#1-3. Three competencies that students bring to medical school in varying degrees of development #4-8. The five elementary competencies#9-11. The 3 clinical management competencies#12. The most practical clinical competency

  • Basic Clinical MethodThe 3 competencies that students bring in varying degrees of development to medical school:

    1. Professionalism2. Patient engagement & communication3. Scientific knowledge & method

  • Basic Clinical MethodThe 5 elementary competencies:

    4. Clinical history-taking5. Mental & physical examination6. Clinical tests & imaging7. Basic clinical procedures8. Clinical information management

  • Basic Clinical MethodThe 3 case management competencies:9. Diagnosis & differential diagnosis{defining the clinical problem}10. Clinical Intervention{caring for the clinical problem}11. Clinical prognosis{anticipating and planning for future healthcare outcomes}

  • AAMC 2005The final universal clinical competency:12. The ability to provide the patients care within the context ofthe patient and their preferences,family preferences,economic, cultural,ethical, legal, healthsystem,and societal preferences and constraints.

  • ACGME 1999ProfessionalismInterpersonal & communication skillsMedical knowledgePatient careSystem-based practicePractice-based learning & improvement

  • ACGME for UME??Patient CareProfessionalismInterpersonal & communication skillsMedical knowledgeSystem-based practicePractice-based learning & improvement

  • How?

    What are some examples of skills teaching?

  • Some practical tips for clinical skills teachingKeep in mind the 12 domains of basic clinical methodSpecifically speaking, there are many basic clinical skills to teach and learnChoose to your strengths but add on some othersMake it case-based if at all possiblePlease dont worry about being too basicKnow your learners and what they can doIn the clinical setting, delegate clinical task doing whenever you canEncourage others (including your residents) to do the same

  • Some practical tips for clinical skills teachingObserve your learners more and give them performance feedback whenever you canSet up your expectations explicitly ahead of time!Encourage your patients to help out!Encourage yourself and your colleagues to lecture less and mentor more in the clinical settingPractice makes perfect at all levelsHelp set higher standards for clinical skills teaching and learningMake it fun!

  • Organizing Clinical Skills EducationBy the spectrum of clinical care:

    Emergency careAcute careCritical careChronic carePalliative & terminal careWellness & preventive carePopulation Care