Strategies for Developing Clinical Competence

• In Event: 31.040 - Learning Strategies for Diverse Learners in the Health Sciences

Abstract

Objective/Purpose:
Developing clinical competence is a challenge for learners in the health sciences, requiring knowledge, clinical reasoning, patient examination, and interpersonal skills. The purpose of this review is to explore the efficacy of commonly used educational practices for developing clinical competence across healthcare disciplines.

Perspective:
Deliberate practice is a critical component for the development of expertise and requires “effortful activities designed to optimize improvement” (Ericsson, Krampe & Tesch-Römer, 1993). Although deliberate practice is very relevant in health sciences education, understanding what activities are most beneficial for expertise development is still unclear (Duvivier et al, 2011; Ericsson, 2004).

Modes of inquiry:
An examination of existing literature will be conducted to determine best practices for use in learning and teaching clinical skills. Through analysis of the current commonly used practices, we will weigh the evidence of the efficacy of educational activities to better elucidate best practices in clinical education (Rycroft-Malone et al, 2004).

Data Sources
The most common activities to encourage deliberate practice are simulation, standardized patients, interactive sessions such as faculty mentoring, tutoring and role play, the use of written materials in the form of clinical vignettes, and written practice questions. The authors will discuss the strengths and limitations of these practices in healthcare education, and examine the skills for which these strategies are best suited. For example, direct teaching by faculty has long been the standard for development of clinical skills; however, studies suggest student learning may be very limited and lacking integration and application of knowledge (Cooke, Irby & O’Brien, 2010; Lingard, Schryer, Garwood & Spafford, 2003), and feedback may be ineffective (Cooke et al, 2010;Donaldson & Gray, 2012).

Results and Recommendations
Through the analysis of commonly used practices, themes emerged as best practices. Scaffolded, guided learning with quality feedback that the student can use for incorporating feedback, is a key component of the deliberate feedback model and is necessary for the effectiveness of these practices (Ericsson, 2004). To be effective, this feedback must be targeted to the learner (i.e. skill that is being developed) and contain substantive feedback that goes beyond basic checklists into constructive areas of improvement. Research has shown that this type of practice-feedback routine may improve the learner’s self-regulation and self-assessment skills over time (Duvivier et al, 2011) and increase decision-making abilities (Cook, Irby & O’Brien, 2010).
Authenticity and “real world” learning and practice are also vital for experiential learning and expertise development (Ericsson, 2004). Drawbacks to simulation and standardized patients are the resources required to develop authentic cases and the expense. However, guiding student learning through alternatives (e.g. working through potential differential diagnoses or treatments) and extension through “what-if” scenarios can help develop stronger clinical skills.
Scholarly Significance
In order to implement quality, evidence-based educational practices, it is crucial to evaluate the evidence related to the strategy and target the learners’ needs (Rycroft-Malone et al, 2004). This review presents evidence-based best practices so that educators and students can select appropriate strategies for developing clinical competence.

Authors

• Jane Rosenthal, Keck Graduate Institute

• Denise Souder, University of Southern California