Survey of proficiency and factors mitigating clinical skills acquisition during medical school training

Abstract

Background: Traditionally, the art and science of medical skills acquisition occur through an apprenticeship model where trainers supervise trainees who are learning on the patients exposed to variety of risk. The concern for patient safety and other limitations in provision of adequate training has necessitated the introduction of skills simulation for trainees to acquire certain proficiency before encounter with live patients. Objectives: The study is aimed to determine the level of skills acquired and constraints experienced by newly graduated medical doctors during their training in various medical schools in Nigeria. Method: Structured questionnaire s were administered to interns undergoing orientation training programme at the University of Ilorin Teaching Hospital, Nigeria. Items were set to determine the frequency of practice and proficiency attained in basic clinical procedures during medical school training; and the factors that influenced their attempts of the procedures. The data was entered in SPSS for Windows version 17.0 and p value d" 0.05 was taken as statistically significant. Results: There were 163 new interns who graduated from 11 medical schools (three outside Nigeria). The participants were aged between 22 and 35 years with no significant statistical difference between the mean ages of interns trained at home or abroad. Mean attempt of basic procedures ranged between 1.73 and 3.93 overall among 9.8 to 81.5% of the trainees. Most of them performed poorly on the pre-training self-assessed proficiency level. Urethral catheterization and intravenous cannulation were the commonest procedures done while the least performed procedures were nasogastric intubation, chest tube insertion; and fracture reduction and splinting (1.53- 2.10 mean attempt) among less than 25% of trainees. Inadequate training facilities and competition between undergraduate and postgraduate trainees for procedures on the available but reluctant patients were considered as limiting factors in the acquisition of skills. However, inadequate number of trainers was considered least of a preventive factor.