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Teaching and assessing clinical skills (TACS)

Dr Reg Dennick, Dr Ed Fitzgerald, Dr David Matheson, Medical Education Unit, Medical School, University of Nottingham

The development of practical skill based competence is an important feature of both undergraduate and postgraduate medical education; the days of see one, do one, teach one are over. In the past few years the need has grown markedly to demonstrate robust mechanisms to ensure that all undergraduate medical students and F1/F2 doctors are effectively taught and assessed on specific practical psychomotor skills. However, not all doctors are experienced in teaching skills effectively and many have limited knowledge of the variety of competence based assessment schemes currently in use.
In our Medical School at the University of Nottingham we have been running the Teaching Improvement Project (TIPs) course for over fifteen years, and have taught basic teaching skills and an introduction to some assessment concepts to well over a thousand doctors and others during that time. However, the demand for an easily available course directed at doctors who are teaching and assessing clinical skills has now led to the development of the one-day Teaching and Assessing Clinical Skills (TACS) course. The TACS course has been developed by the authors from examples of best practice in the teaching and assessing of clinical skills and consists of a morning devoted to the theory and practice of clinical skills teaching followed by an afternoon concerned with assessment techniques. The course, aimed at groups of about twelve people, uses a variety of active learning methods including brief interactive presentations, small group discussions and activities, skill demonstrations and practice, video observations and evaluations. The table overleaf shows the overall programme for the day. Participants are encouraged to activate their prior knowledge of teaching and learning clinical skills and are asked to bring a simple practical skill to teach in a triad. Participants can bring along any skill they choose, as long as it

can be taught in about five minutes and is neither messy nor dangerous either in its execution or product. Within each triad, one person teaches the skill they have brought along to another person, while the third observes and then feeds back to both. No rules are given or suggested for this task and the debriefing reveals the range of teaching and feedback styles. Just in case a participant is in want of inspiration, a sheet of possible skills and instructions on how to do them is available. After debriefing this experience, teaching next focuses on describing and explaining recognised techniques or protocols for teaching clinical skills, leading to the method advocated by the Royal College of Surgeons. This consists of five stages: conceptualisation, visualisation, verbalisation, practice and mastery. Many participants are familiar with this protocol, having been exposed to it during their training, including ILS, ALS and ATLS courses but they

Aims and objectives of TACS course

Aim:To enhance participants competencies in teaching and assessing clinical skills. Learning objectives: Identify the features common to all forms of skills teaching Use a protocol for skills teaching Use feedback in teaching and assessing clinical skills Choose an appropriate form of clinical skills assessment Create and use assessment criteria in the assessment of clinical skills



Teaching and assessing clinical skills

1. 2. 3. 4. Introduction Activation of prior learning Teaching a skill: in threes Identifying common features of skills teaching The afternoon concentrates on assessment of clinical skills and again begins by activating participants own knowledge of the principles of skill assessment including core concepts such as validity, reliability, reproducibility and feasibility. Videos of non-clinical and clinical skills are used to encourage the group to explore the criteria that can be used to assess practical competence. Several assessment methods are discussed and evaluated: OSCEs, OSLERs, DOPS and MinCEX. Finally, pairs of participants develop a set of criteria that could be used to assess a trainee performing an abdominal examination. These are swapped with other pairs who then have to use them to assess a video of this skill. A discussion of the problems of developing and using these criteria is the final phase of the course. It is difficult to construct a simple one-day course that will cover clinical skill teaching and assessment in an active and interesting way but we feel that the TACS course fits the bill. Evaluations, so far, have been very positive with participants glad of the opportunity to explore skill teaching and assessment concepts and methods more deeply. We hope that we are creating a growing number of teachers who can go back into clinical practice and spread the word about skill teaching methods and who can more effectively and thoughtfully apply the assessment tools that are currently being used. For more about the TACS and TIPS courses and how to enrol see:
www.nottingham.ac.uk/ medical-school/tips/home.html

BREAK 5. 6. 7. Theory: RCS skills teaching method Feedback: what does it mean to give feedback in the context of skills teaching? Show video of skill being taught: discuss

LUNCH BREAK 8. 9. Assessing practical skills Activation of Prior Learning

10. Shows DOPS video and discuss 11. Outline variety of methods for assessing skills BREAK 12. In threes construct assessment criteria for abdominal examination 13. Swap assessment criteria and use while watching abdominal examination video 14. Discuss reliability of assessment criteria 15. Closure

have not often had an opportunity to reflect on the rationale for its specific sequencing. The TACS course allows participants to analyse this protocol and to explore particular variants that might be more relevant to their own clinical teaching areas. This is followed by the highlight of the course: Learning how to make an origami shirt! This task was chosen as it neatly illustrates the steps in the RCS protocol with a degree of humour - especially with regard to the health and safety and ethical aspects of making an origami shirt.
Origami shirt (Photo: D Matheson).

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Print: ISSN 1740-8768 Online: ISSN 1479-523X