Muhammad Imran Suliman, Faiqa Imran, Ikram -ur-Rahim, Anser Shafiq, Iftikhar Qayum


Background: Combining cognitive skills teaching related to the techniques leads to better understanding in a skill training course; but still there a substantial disagreement in curriculum on such combinations. This study aims to help guide the designers in making the outline of instructional plan for a Clinical Skills Module (CSM) for the undergraduates. Objectives were to assess performance of students on a clinical skill after training by two different models of (hands-on only or with cognitive skills) instructions and explore their perception on the employment of educational strategies through Focus Group Discussions (FGD) through a Sequential mixed method study design: (1) Quantitative (Pre- and post-assessments and comparing their results (2) Qualitative (Exploration of perspectives through constructivist approach using qualitative phenomenological design) The study was conducted during the month of September, 2015 at Rabigh Medical College, King Abdul Aziz University, Jeddah. Methods: Students entering fourth year were randomized to two groups to participate in pre-post OSCE using global rating scale and their scores were compared. The examiners were kept blinded to the randomization of students undergoing two separate training methods. The test group (group A) was trained for both procedural as well as cognitive skills whereas the control group (Group-B) was trained only with hands-on practice. Later their perception about the addition of cognitive skills to improve of procedural skills was explored through focus group discussions. The recorded audio tapes of FGDs were transcribed and analysed thematically. Triangulation of themes and trends was achieved by relating the content analysis to the relevant frequency of quotes. Auditing of the data verification was done by all the authors separately. Results: A total of 42 students completed both pre- and post-tests. As a result, student performance in OSCE significantly  increased from pre- to post-test (p<0.001) in both the groups; on the other hand no statistically significant difference was found in the pre- and post- test scores between groups A and B (p=0.108). Five themes (1) advantages, (2) disadvantages of combining theory with practice, (3) time balance in teaching a skill, (4) training on skills, (5) skills-assessment, were found prevalent on thematic analysis of the FGDs. Conclusion:  Students’ ability to grasp the procedural skills was not significantly different when they acquire the cognitive skills in addition to the practical sessions. Students were more convinced to adopt combination of the two in the learning of procedural skills.

Keywords: Objective structured clinical examination, assessment, student learning, cognitive skills, skill centre

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Ziv A, Wolpe PR, Small SD, Glick S. Simulation-based medical education: an ethical imperative. Acad Med 2003;78(8):783–8.

Kneebone R. Evaluating clinical simulations for learning procedural skills: a theory-based approach. Acad Med 2005;80(6):549–53.

Maran NJ, Glavin RJ. Low‐to high‐fidelity simulation–a continuum of medical education? Med educ 2003;(37):22–8.

Jolly B, Rees L. Medical education into the next century. In: Rees L, Jolly B. editors. Medical Education in the Millennium. Oxford, UK: Oxford University Press; 1998.p.246–56.

Engum SA. Do you know your students' basic clinical skills exposure? Am J Surg 2003;186(2):175–81.

Malik GM. How we teach practical skills in an undergraduate medical curriculum: 5 years of experience at Gezira Medical School (Sudan). Med Teach 1991;13(1):67–71.

Kohls-Gatzoulis JA, Regehr G, Hutchison C. Teaching cognitive skills improves learning in surgical skills courses: a blinded, prospective, randomized study. Can J Surg 2004;47(4):277–83.

Ericsson KA. The road to excellence: The acquisition of expert performance in the arts and sciences, sports, and games. Psychology Press; 2014.

Ericsson KA, Krampe RT, Tesch-Römer C. The role of deliberate practice in the acquisition of expert performance. Psychol Rev 1993;100(3):363–406.

Regehr G, MacRae H, Reznick RK, Szalay D. Comparing the psychometric properties of checklists and global rating scales for assessing performance on an OSCE-format examination. Acad Med 1998;73(9):993–7.

Allmendinger J. Educational systems and labor market outcomes. Eur Sociol Rev 1989;5(3):231–50.

Bjork C. Local responses to decentralization policy in Indonesia. Comp Educ Rev 2003;47(2):184–216.

Schifferdecker KE, Reed VA. Using mixed methods research in medical education: basic guidelines for researchers. Med Educ 2009:43(7):637–44.

Creswell JW, Plano Clark V. Choosing a mixed methods design. Des Conduct Mix Methods Res. 2007;58–88.

Fred AR. Teaching for better learning. A Guide for Teachers of Primary Health Care Staff 2nd Ed. Geneva: World Health Organization. 1992. p.74–88.

Peitzman SJ, Mefeinley D, Curtis M, Burdick W, Whelan G. Performance of international medical graduates in techniques of physical examination, with a comparison of U.S Citizens and non-U.S citizen. Acad Med 2000;75(10 Suppl):S115–7.

Murray E, Jolly B, Modell M. Can students learn clinical methods in general practice. A randomised crossover trial based on objective structured clinical examinations. BMJ 1997;315(7113):920–3.

Ahmed AM. Deficiences of physical examination among medical students. Saudi Med J 2003;24(1):108–11.

Ahmed AM. Role of clinical skills centres in maintaining and promoting clinical teaching. Sudan J Public Health 2008;3(2):94–103.

Cauraugh JH, Martin M, Martin KK. Modeling surgical expertise for motor skill acquisition. Am J Surg 1999;177(4):331–6.


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