Skills & its Assessment

“Knowing is not enough, we must apply

Willing is not enough, we must do”
(Goethe)

Devender
MAMC
Delhi
 What is a skill?
• Conventionally = Psychomotor domain

• Any action by a health care practitioner,

involved in direct patient care which has a
measurable impact on clinical outcome

• Technical and Non-technical

 Technical v/s Non-technical
• Different approaches needed
• Non-technical skills enhance the learning of
technical skills
 Examples of Skills
• History taking • Situational awareness
• Physical examination • Task management
• Communication • Decision making
• Procedural skills • Prioritizing skills
 Stages of Competence
Actively working at a skill, Skilled and does it effortlessly
require lot of thoughts
Competent

Aware, lack of skill Not aware, lack of a skill

In-competent

Conscious Sub-Conscious
Stages of Skill Learning
 Why Teach Skills?
• Rehearsing skills in preparation for practices
• Reduces adverse events

• Attitude change
• Newer curriculum need (CBME)

• Changing healthcare scenario (Need of

society)
 Issues with Skill Teaching
• Students Numbers (Large…?)
• Time constraint

• Different levels of learners

• Mismatched learners priorities

• Awkwardness in pointing errors

 Group task
• How do you teach clinical skills?

• What changes can be made in the way clinical

skills are taught?
Clinical Skills Learning Formats
 See One, Do One, Teach One
(SODOTO)
• One of the oldest apprenticeship model
• Poorly structured & supervised

• Wrong practices transmitted over generations

• Assessment difficult
• Patient may be exposed to iatrogenic harm
 Teaching Technical Skills

SISFR Model
S Set context, identify roles & outcome
I Immerse in roles & practice for agreed
time
S Summarize progress
F Feedback from tutor
R Refine practice
 Teaching Technical Skills

STEPS Model
S Set foundation, importance of skill,
context
T Tutor demonstration without
commentary
E Explanation with repeat demonstration
P Practices under supervision and
feedback
S Subsequent deliberate practice
 Other Techniques for Skills Teaching
• Peer assisted learning
• Clinical Skills Laboratories
• Simulations
• Simulated Patients
 Teaching Clinical Reasoning
• Key concept is to activate prior knowledge and
link it to the current problem
• One minute preceptor (OMP)
• SNAPPS
• Mini CEx
 Assessment of Clinical Skills
• Competency difficult to assess using only
objective tools
• Narratives carry more weight than numbers

• Skills assessment should be criterion based

• Don’t ignore assessment of knowledge related

to that skills
 Assessment of Clinical Skills …..contd.
• No single method useful
• Multiple methods – compliment and
compensate
• Basic principle is direct standardized
observation (checklist / rating)

• Focused feedback
 Assessing Clinical Reasoning
• Application oriented MCQ
• Extended matching questions (EMQ)
• Viva voce (oral examination)
• Mini CEx
• Portfolios
 Group Task
• Reflect on challenges in teaching & assessing
clinical skills

• Think of developing teachers’ capabilities in

this area