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TEACHING EFFECTIVE
CLINICAL & PRACTICAL
SKILLS TO HEALTH
SCIENCES STUDENTS
LEARNING OBJECTIVES
 At the end of session, the participants should be able to
 Describe methods to teach skills at work place effectively
 Describe the role of skill lab in skill teaching
 Describe the challenges of current skill teaching
 Describe the principles of skill teaching
SKILL
 Ability and capacity acquired through deliberate, systematic and sustained
effort to perform a task leading to predefined outcome
 Skill at HCO –
 Any action taken by HCW involved in direct patient care which has
measurable impact on clinical outcome
 Clinical skills – Greek word “klinikos” – Around sick bed, includes history
taking, clinical examination, diagnostic plan, procedure including post
procedure care, effective communication, team work and professionalism
ACTIVITY – 20 MINUTES – 10 MINUTES
SMALL GROUP, 10 MINUTES LARGE
GROUP
 THINK OF ONE SKILL YOU HAVE OTHER THAN YOUR HEALTH CARE
PROFESSION
 HOW DID YOU DEVELOP THAT SKILL
 WHAT WERE THE SUPPORTING FACTORS AND CHALLENGES YOU FACED
IN LEARNING THAT SKILL
 INDIVIDUAL ACTIVITY
 DISCUSS IN SMALL GROUP
 1 GROUP MEMBER EXPERIENCE TO BE DISCUSSED IN LARGE GROUP
WHY ARE SKILLS IMPORTANT
 TO REDUCE
 ADVERSE EFFECTS
 NEGLIGENCE
 MISCONDUCT
 UNETHICAL PRACTICES
 MISTRUST
 VOILENCE & LITIGATIONS
 PATIENT MORE AWARE ABOUT DISEASES (GOOGLE DOCTOR)
 MORE PATIENT RIGHTS AND RESPONSIBILITIES
LEVELS OF COMPETENCE
 Unconsciously Incompetent KN X, SK X
 Consciously Incompetent KN Y, SK X
 Consciously Competent KN Y, SK Y
 Unconsciously Competent KN (Not updated), SK Y
 Steps of Skill acquisition
 Novice -> Advanced beginner -> Competent -> Proficient -> Expert
TYPES OF SKILL
 Intellectual or Cognitive skill
 Knowledge, clinical reasoning
 Diagnosing and planning a treatment
 Reading a audiogram, ECG, PFT report
 Psychomotor or Procedural skill
 Perform a procedure
 RT insertion, taking blood sample, catheterization
 Communication skill
 Communicate with patient and relatives
 Consent, break bad news
 Team skill
 Work together interprofessionally (IPP)
 OT, Project, Health camps
 Leadership skill
 Attitude skill
Current Trend in teaching Skill
 SEE ONE – DO ONE
 MASTER – APPRENTICESHIP MODEL
 MASTER – directs, demonstrates, comments, inspires
 DISCIPLE – passive observer, listens, watches, imitates, does, seeks
approval
Problems in current Clinical skill
teaching
 Lack of clear objectives
 Lack of time
 Large number of students
 Lack of interest
 Not in curriculum
 No feedback and reflections
 Less/ uncooperactive patients
 No standardized patient/ simulation
 Lack of confidence in own skills/ competitive attitude
Ways of teaching skills
 WORK PLACE
 Bed side clinics, wards
 OT, OPD, Evening clinics
 Log book, portfolios
 Procedure room
 Mock drills
 Workshop/ CME
 Medical record writing
 Peer learning
Work place Methods
 DOAP
 D – demonstration by teacher, O – Observation, A – Assistance, P –
perform
 SNAPPS
 S – summarize history and findings, N – narrow d/d, A – Analyze d/d, P –
probe for uncertainities, P – plan management, S – Select this case for SDL
 OMP – One minute preceptor – get commitment, probe for supporting
evidence, give feedback – reinforce what is done well and give guidance
about errors, teach a concept, conclude
 Peyton’s 4 stage approach
 Step 1 – Teacher just demonstrates (DEMONSTRATION)
 Step 2 – Teacher demonstrates describing (DECONSTRUCTION)
 Step 3 – Student explains, teacher performs (COMPREHENSION)
 Step 4 – Student performs under supervision followed by feedback
(EXECUTION)
 GIVE AND TAKE FEEDBACK
SKILL LAB/ Simulation
 Approximation to reality that requires trainees to react to problems in
conditions similar to real life circumstances
 Simulated/ standardized patients – presents complaints in a constant
manner which can be reproduced
 Manequins
 Cadavers
 Models
 Animals
 Virtual dissection table
 Role play
 Role play – Type of simulation that focusses attention on interaction with
patient – communication/ attitude
 Advantages
 Safe protected environment, can make mistakes and learn
 Less risk to patients, no compromise of patient care, ethics, legal rights
 Good way of assessment
 All skills can be tested
 Rarely encountered clinical scenarios
 Feedback
 Disadvantages/ Limitations
 No real time feeling
 Not prepared for real life encounter
 Overprotection
 Expensive
 Cant assess all competencies
 Recruitment difficult/ time consuming
 Cannot simulate certain signs
 Faculty training
 Animal rights
LEARNING SKILLS EFFECTIVELY
 Learn – Knowledge
 See – observe teacher/ peers
 Practice – Skill lab
 Prove – Competency tested
 Do – under supervision
 Do – independently
 Teach
 Maintain/ update knowledge – Workshops/ CME
EARLY INTRODUCTION OF CLINICAL
SKILLS
 Integrate clinical and basic knowledge
 Integrate theory into practice
 Practical aspect of knowledge
 Measure Blood Pressure

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Teaching effective clinical & practical skills to health

  • 1. TEACHING EFFECTIVE CLINICAL & PRACTICAL SKILLS TO HEALTH SCIENCES STUDENTS
  • 2. LEARNING OBJECTIVES  At the end of session, the participants should be able to  Describe methods to teach skills at work place effectively  Describe the role of skill lab in skill teaching  Describe the challenges of current skill teaching  Describe the principles of skill teaching
  • 3. SKILL  Ability and capacity acquired through deliberate, systematic and sustained effort to perform a task leading to predefined outcome  Skill at HCO –  Any action taken by HCW involved in direct patient care which has measurable impact on clinical outcome  Clinical skills – Greek word “klinikos” – Around sick bed, includes history taking, clinical examination, diagnostic plan, procedure including post procedure care, effective communication, team work and professionalism
  • 4.
  • 5. ACTIVITY – 20 MINUTES – 10 MINUTES SMALL GROUP, 10 MINUTES LARGE GROUP  THINK OF ONE SKILL YOU HAVE OTHER THAN YOUR HEALTH CARE PROFESSION  HOW DID YOU DEVELOP THAT SKILL  WHAT WERE THE SUPPORTING FACTORS AND CHALLENGES YOU FACED IN LEARNING THAT SKILL  INDIVIDUAL ACTIVITY  DISCUSS IN SMALL GROUP  1 GROUP MEMBER EXPERIENCE TO BE DISCUSSED IN LARGE GROUP
  • 6. WHY ARE SKILLS IMPORTANT  TO REDUCE  ADVERSE EFFECTS  NEGLIGENCE  MISCONDUCT  UNETHICAL PRACTICES  MISTRUST  VOILENCE & LITIGATIONS  PATIENT MORE AWARE ABOUT DISEASES (GOOGLE DOCTOR)  MORE PATIENT RIGHTS AND RESPONSIBILITIES
  • 7. LEVELS OF COMPETENCE  Unconsciously Incompetent KN X, SK X  Consciously Incompetent KN Y, SK X  Consciously Competent KN Y, SK Y  Unconsciously Competent KN (Not updated), SK Y  Steps of Skill acquisition  Novice -> Advanced beginner -> Competent -> Proficient -> Expert
  • 8.
  • 9.
  • 10. TYPES OF SKILL  Intellectual or Cognitive skill  Knowledge, clinical reasoning  Diagnosing and planning a treatment  Reading a audiogram, ECG, PFT report  Psychomotor or Procedural skill  Perform a procedure  RT insertion, taking blood sample, catheterization
  • 11.
  • 12.
  • 13.  Communication skill  Communicate with patient and relatives  Consent, break bad news  Team skill  Work together interprofessionally (IPP)  OT, Project, Health camps  Leadership skill  Attitude skill
  • 14.
  • 15.
  • 16. Current Trend in teaching Skill  SEE ONE – DO ONE  MASTER – APPRENTICESHIP MODEL  MASTER – directs, demonstrates, comments, inspires  DISCIPLE – passive observer, listens, watches, imitates, does, seeks approval
  • 17. Problems in current Clinical skill teaching  Lack of clear objectives  Lack of time  Large number of students  Lack of interest  Not in curriculum  No feedback and reflections  Less/ uncooperactive patients  No standardized patient/ simulation  Lack of confidence in own skills/ competitive attitude
  • 18. Ways of teaching skills  WORK PLACE  Bed side clinics, wards  OT, OPD, Evening clinics  Log book, portfolios  Procedure room  Mock drills  Workshop/ CME  Medical record writing  Peer learning
  • 19. Work place Methods  DOAP  D – demonstration by teacher, O – Observation, A – Assistance, P – perform  SNAPPS  S – summarize history and findings, N – narrow d/d, A – Analyze d/d, P – probe for uncertainities, P – plan management, S – Select this case for SDL  OMP – One minute preceptor – get commitment, probe for supporting evidence, give feedback – reinforce what is done well and give guidance about errors, teach a concept, conclude
  • 20.  Peyton’s 4 stage approach  Step 1 – Teacher just demonstrates (DEMONSTRATION)  Step 2 – Teacher demonstrates describing (DECONSTRUCTION)  Step 3 – Student explains, teacher performs (COMPREHENSION)  Step 4 – Student performs under supervision followed by feedback (EXECUTION)  GIVE AND TAKE FEEDBACK
  • 21. SKILL LAB/ Simulation  Approximation to reality that requires trainees to react to problems in conditions similar to real life circumstances  Simulated/ standardized patients – presents complaints in a constant manner which can be reproduced  Manequins  Cadavers  Models  Animals  Virtual dissection table  Role play
  • 22.
  • 23.
  • 24.
  • 25.  Role play – Type of simulation that focusses attention on interaction with patient – communication/ attitude  Advantages  Safe protected environment, can make mistakes and learn  Less risk to patients, no compromise of patient care, ethics, legal rights  Good way of assessment  All skills can be tested  Rarely encountered clinical scenarios  Feedback
  • 26.  Disadvantages/ Limitations  No real time feeling  Not prepared for real life encounter  Overprotection  Expensive  Cant assess all competencies  Recruitment difficult/ time consuming  Cannot simulate certain signs  Faculty training  Animal rights
  • 27. LEARNING SKILLS EFFECTIVELY  Learn – Knowledge  See – observe teacher/ peers  Practice – Skill lab  Prove – Competency tested  Do – under supervision  Do – independently  Teach  Maintain/ update knowledge – Workshops/ CME
  • 28. EARLY INTRODUCTION OF CLINICAL SKILLS  Integrate clinical and basic knowledge  Integrate theory into practice  Practical aspect of knowledge  Measure Blood Pressure