Clinical skills training of U.S. medical students

Although there is general agreement that the teaching of clinical procedures needs vast improvement, little appears to have been done to achieve this goal, particularly with regard to medical students.

In the summer and fall of 1992, 60 U.S. medical schools participated in a telephone survey about how they taught clinical procedures to medical students. The schools were in 30 states and the District of Columbia; 36 were public and 24 were private. The schools were asked to describe what procedures were taught, how, and over what duration of time, with a focus on whether students were taught procedures prior to their clinical rotations.

More than three-fourths of the schools (47 of 60) offered nothing other than an introduction to phlebotomy. Only four schools offered more extensive courses (40-50 hours) that covered a variety of topics.

Few schools had adopted any formal method for training students to perform clinical procedures. In light of this problem, the authors describe a solution that has proven popular at the Stanford University School of Medicine--an elective course in surgical skills developed in 1988-89 and continuing to the present. Although the content of this particular course focuses on surgical procedures, important topics from other disciplines could easily be added or substituted. The course incorporates techniques that have previously been shown to be successful, such as the use of plastic models and cadavers. It also enables students to learn by performing procedures on each other, and to benefit from continuity of supervision by being taught by one faculty member.