Comparison of three clinical environments for pre-clinical clinical skills training

Objectives: Primary health care (PHC), secondary health care (SHC), and tertiary health care (THC) were compared in search of the most suitable setting for clinical skills training of pre-clinical students. Methods: The Dundee Ready Educational Environment Measure questionnaire was presented to 300 clerkship students of the Faculty of Medicine at Gadjah Mada University, Indonesia who were attached to PHC, SHC, and THC settings. Students were asked to assess their current attachment for suitability for training of pre-clinical students. Semi-structured interviews were held with 46 clinical supervisors based on the three types of settings. Results: Clerkship students preferred PHC centers over SHC and THC hospitals for clinical skills training of pre-clinical students (p<0.05). PHC staff felt their centers to be well-equipped to train pre-clinical students, including availability of supervisors' time for teaching, adequate physical facilities and equipment, and suitable patient cases. Conclusion: In the developing country context, PHC centers seemed more appropriate for clinical skills training of pre-clinical students than SHC and THC hospitals. However, the skills laboratory must guard that clinical skills are trained and performed in the same way in that facility, in PHC centers and in teaching hospitals.