title: Conveying practical clinical skills with the help of teaching associates-a randomised trial with focus on the long term learning retention.
abstract: BACKGROUND
  Ensuring that all medical students achieve adequate clinical skills remains a challenge, yet the correct performance of clinical skills is critical for all fields of medicine. This study analyzes the influence of receiving feedback by teaching associates in the context of achieving and maintaining a level of expertise in complex head and skull examination.
  
  
  METHODS
  All third year students at a German university who completed the obligatory surgical skills lab training and surgical clerkship participated in this study. The students were randomized into two groups.
  
  
  METHODS
  lessons by an instructor and peer-based practical skills training. Intervention group: training by teaching associates who are examined as simulation patients and provided direct feedback on student performance. Their competency in short- and long-term competence (directly after intervention and at 4 months after the training) of head and skull examination was measured. Statistical analyses were performed using SPSS Statistics version 19 (IBM, Armonk, USA). Parametric and non-parametric test methods were applied. As a measurement of correlation, Pearson correlations and correlations via Kendall's-Tau-b were calculated and Cohen's d effect size was calculated.
  
  
  RESULTS
  A total of 181 students were included (90 intervention, 91 control). Out of those 181 students 81 agreed to be videotaped (32 in the control group and 49 in the TA group) and examined at time point 1. At both time points, the intervention group performed the examination significantly better (time point 1, p = <.001; time point 2 (rater 1 p = .009, rater 2 p = .015), than the control group. The effect size (Cohens d) was up to 1.422.
  
  
  CONCLUSIONS
  The use of teaching associates for teaching complex practical skills is effective for short- and long-term retention. We anticipate the method could be easily translated to nearly every patient-based clinical skill, particularly with regards to a competence-based education of future doctors.
authors.affiliation: Department of Oral, Cranio-Maxillofacial, and Facial Plastic Surgery, University Hospital Frankfurt, Goethe University, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany. shoefer@em.uni-frankfurt.de.
authors.forename: Sebastian H
authors.initials: SH
authors.lastname: Hoefer
authors.affiliation: Department of Trauma, Hand, and Reconstructive Surgery, University Hospital Frankfurt, Goethe University, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany.
authors.forename: Jasmina
authors.initials: J
authors.lastname: Sterz
authors.affiliation: Department of Trauma, Hand, and Reconstructive Surgery, University Hospital Frankfurt, Goethe University, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany.
authors.forename: Bernd
authors.initials: B
authors.lastname: Bender
authors.affiliation: Department of Trauma, Hand, and Reconstructive Surgery, University Hospital Frankfurt, Goethe University, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany.
authors.forename: Maria-Christina
authors.initials: MC
authors.lastname: Stefanescu
authors.affiliation: Department of Oral, Cranio-Maxillofacial, and Facial Plastic Surgery, University Hospital Frankfurt, Goethe University, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany.
authors.forename: Marius
authors.initials: M
authors.lastname: Theis
authors.affiliation: Department of Trauma Surgery, Medical Faculty University Hospital Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Germany.
authors.forename: Felix
authors.initials: F
authors.lastname: Walcher
authors.affiliation: Department of Oral, Cranio-Maxillofacial, and Facial Plastic Surgery, University Hospital Frankfurt, Goethe University, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany.
authors.forename: Robert
authors.initials: R
authors.lastname: Sader
authors.affiliation: Department of Trauma, Hand, and Reconstructive Surgery, University Hospital Frankfurt, Goethe University, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany.
authors.forename: Miriam
authors.initials: M
authors.lastname: Ruesseler
mesh_terms: D002983:Clinical Competence; D003162:Competency-Based Education / Q000379:methods* / Q000592:standards; D004504:Education, Medical, Undergraduate / Q000379:methods* / Q000592:standards; D004521:Educational Measurement; D005246:Feedback; D005260:Female; D005858:Germany; D006801:Humans; D007858:Learning; D008297:Male; D013337:Students, Medical / Q000523:psychology*; D013663:Teaching; D000078329:Workforce
keywords: Complex practical skills; Long term benefit; Long term evaluation; Medical education; Multimodal feedback; Teaching associates