The document discusses the effective teaching of clinical skills, emphasizing the importance of active participation and a master-apprentice model over passive observation. It outlines various skill types required for medical professionals and highlights current teaching challenges, such as unclear objectives and inadequate supervision. The document also weighs the advantages and disadvantages of skill labs and workplace-based training in developing these essential competencies.

1. Effective teaching of Clinical skills
Dr. Hironmoy Roy
MD, MBA, DHM, FAIMER (2015)
MHPE, MIPHA, MNAMS

2. “ The end of education,
especially
professional education is
Not knowledge
but appropriate action”

3. "Having studied the Science
Having grasped the meaning
Having acquired the skills
Having operated on dummies
And with ability to teach the science,
a Physician should enter the profession”.

5. Skill
" An ability and capacity acquired through
deliberate, systematic and sustained effort
to smoothly and adaptively carry out
complex activities or job functions involving
ideas (cognitive skills), things (technical
skills) and /or people (interpersonal skills).

6. Skill- types
Intellectual skill
To think in a desirable way- underlining
component is knowledge
e.g. - Ability to interpret liver function test
results of a patient with jaundice

7. Skill- types
Psycho-motor Skill
Manual abilities needed towards diagnosing
and treating patients
e.g. - Ability to obtain a blood sample by
venepuncture

8. Skill- types
Communication skill
Ability to communicate with others in a given
situation. Strong underlying component is attitude
e.g. - Ability to motivate relatives for blood donation.

9. Skill- types
Team Skill
Ability to work together in a team
e.g. - Ability to work towards implementing a
project/ operating on a patient with the team.

10. Current trends of teaching “skill”
Master- apprenticeship model
• ‘ See one, do one’- heralds problems
• Knowing and watching a procedure does not mean
one can perform it
• Passive observation rather than active
• participation of learners

11. Master- apprenticeship model

12. Master- apprenticeship model

13. The “master is the model”, who
directs, demonstrates, comments, inspires
&
The “apprentice is the disciple”, who,
listens, watches, imitates, does and seeks approval

14. Problems in teaching
clinical skill
Lack of clear objectives
Large number of students
Teacher has “no time” (load of patient/practice)
Students are not interested (more to MCQ)
Not explicit in the curriculum/syallabus
Not standardized across schools
Over-burdening with content information
Inadequate supervision and feedback
Little opportunities for reflection and discussion
Clinical teaching not given high priority

15. Then, why to emphasise on learning of skill?
• Growing mistrust among public for medical profession
(cases of negligence, misconduct, and unethical practices)
• Performance emphasis is increasing at all levels of our
professional activity
• Greater public understanding and enhanced patient’s
rights
• Medical school skills education has been slipping down

16. Teaching “Skill”
Where? How?

17. How u learnt?

18. Instructor does & describes
Instructor does, while the
student describes
The student does & describes
(under supervision) ; receives
feedback
The student practice his own
The student does his own

19. Unaware
Incompetence
Aware
Incompetence
Conscious
Competence
Reflex
(Unconscious)
Competence
Awareness
Training
Practice

23. Teaching
“Skill”
Where?
Work
place
Skill lab
How?

24. Work place based training

25. Work place based training

26. Work place based training

27. Work place based training

28. Work place based training

29. Skill lab

30. Skill lab

31. Skill Lab

32. Skill Lab

33. Skill lab

34. Simulation……advantage or disadvantage?
Advantage
• Practice in a safe, protected
• environment
• Decreases risk to patients
• Enables deliberate practice
• Is safe to learn from errors
• Scenarios can be reproduced
• Rarely encountered important
clinical accidents e.g. Anaphylaxis
• Technical as well as non-technical
skills can be practiced
• Skills assessed in objective and
reproducible manner
Disadvantage
• No real life feeling
• Students may not feel
comfortable in real-life settings
• Over-protection makes
handicapped
• Students not get aware of the
real life ‘side-effects’

35. Finally, while to plan the teaching on clinical skills…..
Objective
• What to teach?
Settings
• Whom to teach?
• Where to teach?
• How to teach?
Execute
• Implement
• Feedback

36. "Education is
Not
Teaching students what they do not know
but
Making them behave as they do not behave”
-----Ruskin Bond