A comparison of approaches to teaching clinical skills

Background: The most appropriate timing and mode for teaching clinical skills as preparation for medical students' clinical rotations or clerkships is not widely agreed upon. Increasing pressure on placement opportunities has led to a shift towards simulation-based teaching in the early years of medical training. Approach: A major curriculum renewal provided an opportunity for comparison of the effectiveness of a largely ward-based (early patient exposure) curriculum with a largely simulation-based one in preparing students for clinical rotations. Evaluation: We surveyed students from two different programs and invited them to take part in voluntary objective structured clinical examinations (OSCEs) to compare their skills and self-reported preparedness. Qualitative data was also collected from focus groups with a small number of students. Implications: The findings suggest that the more structured, simulation-based curriculum is at least equivalent to the ward-based approach in teaching clinical skills and preparing students for clinical rotations. Students' clinical reasoning skills could be enhanced in a simulation-based curriculum through more explicit training to prepare them for being asked questions on clinical placement.