LISTENING AND ACTING ON PARTICIPANT VOICES; IMPLEMENTING THE RECOMMENDATIONS FROM A PRACTICAL SKILLS LOG

EVALUATION STUDY.

Williams S.E. (williamsse17@cardiff.ac.uk) Webb K. L. (marshkl1@cf.ac.uk) and Monrouxe L.V. (monrouxelv@cardiff.ac.uk)

Clinical Skills and Simulation Centre,

3rd Floor Cochrane Building, Heath Park Campus, School of Medicine, Cardiff University, CF14 4YU

Background and Purpose

The General Medical Council (GMC) stipulates undergraduate medical students

must be able to perform 32 practical skills or procedures to a satisfactory

standard1. These should be performed in clinical areas under close supervision

by a Healthcare Professional (HCP). One method of assessing practical skills

includes direct observation: a log book is used to record the students competency. This study was conducted to provide an insight into the thoughts,

experiences and conceptualisation of students and assessors involved in a

Practical Skills Log (PSL) process to shed light onto to the research question:

What are the personal experiences and opinions of students and HCPs who use a Practical Skills Log for assessment purposes within a clinical setting?

References 1.General Medical Council. (2009). Tomorrows Doctors. London: GMC

2. Bindal, T., Wall, D. & Goodyear, H.M. (2011). Trainee doctors views on workplace-based assessments: Are they just a tick box exercise? Medical Teacher. 33: 919 - 927

3. Cleland, J. A., Knight, L.V., Rees, C. E., Tracey, S., & Bond, C. M. (2008). Is it me or is it them? Factors that influence the passing of underperforming students. Medical

Education . 42: 800809

4. Monrouxe, L.V., & Rees, C.E (2012). "It's just a clash of cultures": emotional talk within medical students' narratives of professionalism dilemmas. Advances in Health

Science Education: Theory & Practice.17: 5. 671-70

5. Hauer, K.E, Holmboe, E.S & Kogan, J.R. (2011). Twelve tips for implementing tools for direct observation of medical trainees clinical skills during patient encounters.

Medical Teacher. 33: 27 - 33

Results Three main themes and 11 sub themes were identified within the data

(Highlights indicated in Table 1 & 2). Student participants talked of a tick box mentality, supporting the findings in other research2, lack of supervision, apathy towards work place assessment, embarrassment in requesting

assessment and examples of poor professionalism. In contrast, student

participants also found the PSL a tool that legitimised asking HCPs for assessment and an incentive to get skills signed off. HCP participants talked about students needing to get used to work place assessments, and the importance of good feedback. HCP narratives indicated some evidence of the

phenomenon failure to fail3.

Methods Using an interpretivist narrative enquiry methodology, 29 students and 5 HCP

assessors participated in group and one-to-one interviews in order to examine

their narratives of their PSL experience. An analytical coding framework was

developed from the transcribed data and audio recordings. Data were coded

within Atlas.ti using the developed framework.

Discussion The study highlights participants viewpoints of the PSL process that could be viewed as positive in nature, such as student empowerment and acting as an incentive (see Table 1). It also found numerous examples where students could

have been better supported by HCPs in the clinical area. Some professional dilemmas highlighted in the student narratives mirrors earlier work4.

Students(s)and assessors

(a) positive perceptions of

the PSL process

Students (s) and assessors

(a) negative perceptions of

the PSL process

Legitimises interaction with

HCPs (s) PSL is a Tick box exercise. (s)

Provides an incentive to

ask for assessment (s)

Embarrassment in asking

assessors to participate (s)

Receiving useful feedback

(s)

Receiving no feedback (s)

Receiving useful feedback

(a)

Communication issues with

School/Placement site (s)

Getting used to similar assessments later in career

(a)

Reluctance to use the PSL

formatively (s)

Other themes and Sub themes

Preference for simulation in assessment

Assessment similar to that used by postgraduates

Professionalism lapses

Recommendations We have a number of recommendations arising from the study (Figure 3). The

concept of Skills Champions is discussed in the literature5. These individuals are selected to work in health care environments where students are placed,

actively encouraging and supporting students, and essentially creating and

promoting a vision of good observation, feedback skills, and assessment

standardisation. In addition, the analysis of a larger survey questionnaire

should be undertaken in order to add to the findings and discussion of this

study.

Table 1

Skills Champion

Further research

using linguistic word

tool

Improved links with

assessors in placement

sites

Faculty and assessor

development

Improved process

information from School to students

Table 2

We are completely at the mercy of the people who sign these things. (Year 5, Male Student)

it is good for me I think because I tend to shy away from practical stuff cos Im a bit...under confident so I think it's good that there's something that sort of...makes me do it. (Year 5, Female Student)

Take Home Message

A Practical Skills Log enables students to legitimately ask placement

site HCPs for assessment and feedback in practical skills. Students need to be well informed about the purpose of the PSL and assessors

have a professional responsibility to ensure they engage with students

to enable them to learn and be assessed in practical procedures in the

health care environment.

Figure 3