Trialling a new way to learn clinical skills: systematic clinical appraisal and learning.
OBJECTIVE
To describe and evaluate the effectiveness of a new method of teaching clinical skills designed to increase students' active and self-directed learning as well as tutor feedback.


METHODS
A total of 22 consenting Year 4 medical students undertaking general practice and general surgery clinical experience were involved in a pre- and post-test research design. In the initial period of the study, students were taught clinical skills in a traditional manner. In the second phase a clinical teaching strategy called systematic clinical appraisal and learning (SCAL) was utilised. This learning strategy involved active and self-directed learning, holistic care and immediate feedback. Students independently saw a patient and were asked to make judgements about the patient's potential diagnosis, tests required, management, psychosocial needs, preventive health requirements, and any ethical problems. These judgements were then compared with those of the clinical supervisor, who saw the same patient independently. Students recorded details for each consultation. Comparisons were made of the two study periods to examine whether the use of SCAL increased the number of students' independent judgements, perceived student learning, tutor feedback and self-directed learning.


RESULTS
During the SCAL learning period, students reported making a greater number of statistically significant independent judgements, and receiving significantly increased tutor feedback in both general practice and general surgery. The number of learning goals set by students was not found to differ between the two periods in surgery but significantly increased in general practice in the SCAL period. Students' perceptions of their learning significantly increased in the SCAL period in surgery but not in general practice. During the traditional learning period in both settings, there was limited student decision-making about most aspects of care, but particularly those relating to prevention, psychosocial issues and ethics.


CONCLUSIONS
The SCAL approach appears to offer some advantages over traditional clinical skills teaching. It appears to encourage active and independent decision-making, and to increase tutor feedback. Further exploration of the approach appears warranted.
Sanson-Fisher
R W
RW
Faculty of Medicine and Health Sciences, University of Newcastle, Callaghan, NSW, Australia. robsf@mail.newcastle.edu.au
Rolfe
I E
IE
Jones
P
P
Ringland
C
C
Agrez
M
M
D002983:Clinical Competence / Q000592:standards*; D003657:Decision Making; D004504:Education, Medical, Undergraduate / Q000379:methods*; D005194:Family Practice / Q000193:education; D006801:Humans; D007858:Learning; D009517:New South Wales; D013663:Teaching / Q000379:methods*