Journal Club

Elms SA, Chumley H: Nursing faculty teaching basic skills to medical students. Medical Teacher 2006: 28 (4): 341-344.

Reviewed by Randy Rockney, Brown University

One of the first principles of medical practice that a medical student learns--at least they had better learn it--is that when a nurse says "jump" the proper response is to ask "how high?" This study from the University of Texas Health Science Center in the city of our next COMSEP meeting, San Antonio, is inspired by the fact that many nursing school faculty become experts in teaching basic clinical skills such as inserting intravenous catheters. The authors contrast the traditional "see one, do one, teach one" approach to teaching clinical skills that is commonly used in medical education with the more intense competency based approach used in nursing education. The authors also note that while preclinical students are expected to learn history and physical examination skills, they have little exposure to physical skills like nasogastric tube insertion and few opportunities to work with the equipment used on a day-to-day basis in clinical settings. This study was done to evaluate medical student skills training by nursing faculty.

The Class of 2006, 176 students, participated in a four hour skills laboratory taught by nursing school faculty who routinely teach those skills to nursing school students. The four hour session included one hour sessions devoted to 1) intravenous catheter insertion, 2) placement of a nasogastric tube, 3) management of respiratory equipment, and 4) an introduction to the equipment commonly encountered in clinical settings. The evaluation strategy consisted of student satisfaction ratings and self-assessments of how prepared they felt pre and post-laboratory and in comparison to the Class of 2005 which had not experienced the laboratory.

Not surprisingly, the student satisfaction with the skills laboratory was very high. They also felt significantly more prepared to perform the skills after the laboratory than before, The Class of 2006 students felt more prepared to perform the skills than the Class of 2005. Although students were satisfied with the laboratory and felt more prepared to perform the skills, there was no measure of their actual ability to perform them. Also, there was no assessment of long-term outcomes. One important finding was that more time for nursing faculty instruction and less time for actual practice was needed than anticipated. Students would have liked more opportunity for hands-on practice than the sessions afforded.

This study makes the point that real skills training akin to that used by nursing faculty in nursing schools would be useful for the preparation of medical students' entry into the real world of clinical medicine. An additional benefit of the skills laboratory, mentioned but not measured, was that it provided an opportunity for real collaboration between nursing and medicine and gave the medical students exposure to nurses as experts.

(Editorial comment: So much to learn, so little time. Clearly, students need to be familiar with certain technical skills, and perhaps even have attempted them. What skills should they absolutely master prior to graduation? Attempts to limit these lists of skills have been quite difficult to generate, and often lack consensus. As an aside, this paper is an interesting jumping off point for discussions about the differences between training and education. Bruce Morgenstern)