The acquisition of practical skills by U.S. medical students

Increasing interest in skills training has been prompted by concerns over risks posed by new, complex clinical environments and the need for medical students to function effectively in such settings. To gain a better idea of the type of instruction currently provided to U.S. medical students, a national survey was conducted in 1991. A survey instrument was prepared after a literature review on practical skills training. Eleven skill and knowledge areas were selected for analysis; six were considered "basic" and five "advanced." Mailings were directed to the deans of 126 U.S. medical schools. Based on a 94% response rate (118/126), the skill and knowledge areas taught most commonly included universal precautions, phlebotomy, intravenous line placement, advanced cardiac life support, and suturing lacerations. Fifty-one (43%) of 118 respondents reported that they conducted "transition courses" for practical skills training. At most such institutions, basic skills were taught more frequently than advanced skills. Where there was no transition course, formal instruction was provided in standing courses and clerkships. The survey indicates that five skills areas are formally taught in the majority of U.S. medical schools. These include universal precautions, phlebotomy, starting intravenous lines, suturing lacerations, and advanced cardiac life support. In most cases, evaluation and certification procedures are infrequent. Further studies are necessary to gain a better idea of what practical training should be undergone by all U.S. medical students.