The apprenticeship model has been the mainstay of training for hundreds of years. Supervised on-the-job practice can be highly effective if sufficient in numbers and if done deliberately. However, in our current reality, it has become challenging. Patient safety, cost control and efficiency have pushed learners away from the bedside. Lack of practice makes learners less able to learn from the limited caseload that remains.
Most medical residency training programs have shifted to simulation training to prepare students for clinics; even so, those programs can struggle to provide enough supervised training opportunities to meet the needs of all learners. Several researchers have proposed a more targeted skills training program, focusing on the skills needed by the individual as determined by their career path. Better research studies are also needed to identify the most effective clinical training programs.
Options
Low cost clinics – Some programs have expanded primary care opportunities to include low cost clinics in which clients expect students to manage cases more directly in exchange for lower cost. This model can result in more hands on training but is ethically more challenging.
Skills training rotations –Other programs have expanded clinical year opportunities to include laboratory or simulation “just in time” training to ready students to meet clinical needs. This model is more consistent with clinician preparation for unusual or challenging cases. These rotations can also ensure all learners obtain practice at a range of skills, regardless of caseload.
Internship and residency prep courses – Bootcamp courses either at the end of the year or the beginning of the new experience can help the trainees be more confident and competent, particularly when focused on the particular needs of their new program. Such courses can also ensure more consistent skills in the new cohort.
All programs have been popular with students and successful at improving skill sets.
Resources
Tolsgaard MJ. Assessment and learning of ultrasound skills in Obstetrics & Gynecology. Dan Med J 2018;65(2):B5445
Brydges R et al. Core Competencies or a Competent Core? A Scoping Review and Realist Synthesis of Invasive Bedside Procedural Skills Training in Internal Medicine. Acad Med. 2017;92:1632–1643
McDonald H et al. Transition to Residency: The Successful Development and Implementation of a NonclinicalElective in Perioperative Management. J Surg Ed, 2017:75(3):628-638.
Christensen BW and Danielson JA. Utility of an Equine Clinical Skills Course:A Pilot Study. JVME 2016, Vol.43(4), pp.406-419.
Huang GC et al. Procedural instruction in invasive bedside procedures: a systematic review and meta-analysis of effective teaching approaches. BMJ Qual Saf 2016;25:281–294
Minter RM et al. Transition to Surgical Residency: A Multi-Institutional Study of Perceived Intern Preparedness and the Effect of a
Formal Residency Preparatory Course in the Fourth Year of Medical School . Acad Med. 2015;90:1116–1124
Roberts L et al. Effect of Bedside Physical Diagnosis Training on Third-Year Medical Students’ Physical Exam Skills. Teaching and Learning in Medicine, 26(1), 81–85, 2014
Rego P et al. Using a structured clinical coaching program to improve clinical skills training and assessment, as well as teachers’ and students’ satisfaction. Med Teach 2009; 31: e586–e595
