title: Tutor-led teaching of procedural skills in the skills lab: Complexity, relevance and teaching competence from the medical teacher, tutor and student perspective.
abstract: BACKGROUND
  In current medical curricula, the transfer of procedural skills has received increasing attention. Skills lab learning and tutor-led teaching have become an inherent part of all medical curricula at German medical faculties. In 2011, the initial basis for the classification of clinical skills in medical school was created by the German Association for Medical Education (GMA) Committee's consensus statement on procedural skills. As a recommendation for medical curricula, the National Competency-based Catalogue of Learning Objectives (NKLM, 2015) lists procedural skills according to their curriculum integration and competency level. However, classification in regard to the perceived complexity, relevance, or teaching competency is still lacking.
  
  
  OBJECTIVE
  The present study aimed to investigate procedural skills taught at the Medical Faculty of Heidelberg in regard to their complexity, relevance, and required teaching skills. To achieve this aim (1) the specific procedural skills in terms of complexity, that is, the degree of difficulty, and (2) the perceived relevance of taught procedural skills for studying and subsequent medical profession as well as (3) the personal preparation and required teaching skills were assessed in medical teachers, tutors and students.
  
  
  METHODS
  During the winter semester 2014/2015, the evaluations of all medical teachers, student tutors, and medical students in the skills lab teaching departments of internal medicine, surgery, pediatrics, gynecology, and otorhinolaryngology at the Medical Faculty of Heidelberg were assessed via a quantitative cross-sectional questionnaire survey using 7-point Likert scales. The questionnaire comprised four item sets concerning 1) demographic details, 2) procedural skill complexity, 3) practical relevance, and 4) required preparation and teaching skills. Descriptive, quantitative analysis was used for questionnaire data.
  
  
  RESULTS
  The survey included the data from 17 of 20 physicians (return rate: 85 %), 10 of 10 student tutors (return rate: 100 %) and a total of 406 of 691 students (return rate: 58.8 %). In terms of complexity and relevance, no major differences between medical teachers, tutors, and students were found. Procedural skills, assigned to the competence level of final year medical education in the NKLM, were also perceived as more complex than other skills. All skills were considered equally relevant, and student tutors were seen to have equally competent teaching skills as experienced medical teachers.
  
  
  CONCLUSIONS
  This study largely underpins the NKLM's classification of procedural skills. The complexity assessment allows for conclusions to be drawn as to which skills are perceived to require particularly intensive training. Finally, our study corroborates extant findings that student tutors are apt at teaching procedural skills if they have been properly trained.
authors.affiliation: Centre for Psychosocial Medicine, University Hospital Heidelberg, Department of General Internal Medicine and Psychosomatics, Heidelberg, Germany.
authors.forename: Jan
authors.initials: J
authors.lastname: Lauter
authors.affiliation: Centre for Psychosocial Medicine, University Hospital Heidelberg, Department of General Internal Medicine and Psychosomatics, Heidelberg, Germany.
authors.forename: Sylvie
authors.initials: S
authors.lastname: Branchereau
authors.affiliation: Centre for Psychosocial Medicine, University Hospital Heidelberg, Department of General Internal Medicine and Psychosomatics, Heidelberg, Germany.
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Herzog
authors.affiliation: Centre for Psychosocial Medicine, University Hospital Heidelberg, Department of General Internal Medicine and Psychosomatics, Heidelberg, Germany.
authors.forename: Till Johannes
authors.initials: TJ
authors.lastname: Bugaj
authors.affiliation: Centre for Psychosocial Medicine, University Hospital Heidelberg, Department of General Internal Medicine and Psychosomatics, Heidelberg, Germany. Electronic address: Christoph.Nikendei@med.uni-heidelberg.de.
authors.forename: Christoph
authors.initials: C
authors.lastname: Nikendei
mesh_terms: D003430:Cross-Sectional Studies; D003479:Curriculum; D004504:Education, Medical, Undergraduate; D005858:Germany; D006801:Humans; D013337:Students, Medical / Q000523:psychology*; D013663:Teaching
keywords: Klinisch-praktische Fertigkeiten; Skills-lab; medical education; medizinische Ausbildung; peer-teaching; procedural skills; skills lab; studentische Tutoren