Medical students' deliberate practice of patient assessments

Dear Sir

Conducting patient assessments in a clinical context provides medical students with opportunities to practice and develop examination and communication skills. Such practice is expected to increase their confidence in interacting with patients, and enhance their development from trainee to practicing clinician.

There is good evidence that expertise develops through a protracted process of incremental improvement in skills. Opportunities to repeatedly practice performing patient assessments (defined as a full history, complete physical examination and patient problem formulation), both independently and when observed by more experienced practitioners who provide feedback on skills are components of deliberate practice and are critical in skill acquisition (Ericsson et al. 1993).

In health systems where resources are increasingly scarce, there are fewer opportunities for students in the initial stages of clinical training to engage in deliberate practice through conducting patient assessments. This may occur for a number of reasons, including fewer accessible, suitable patients and prioritising the learning needs of later year medical students and interns. Such difficulties accessing opportunities for deliberate practice could have a significant impact on the learning of medical students, yet there are little data to describe the number of patient assessments undertaken by medical students. Admittedly, such data are difficult to obtain. Unless students are required to maintain detailed logs of patient assessments, we tend to be reliant on student estimates of approximate numbers of assessments collected retrospectively. Nonetheless, the significance of deliberate practice for skill acquisition among medical trainees implies that understanding student opportunities for patient contact is extremely important (Reid et al. in press).

The process by which accumulation of practice promotes clinical skills needs to be better understood. Should students be encouraged to complete an optimal number of patient assessments for the development of clinical skills? How many patient assessments are too few, leading to insufficient development of skills? Understanding the range of factors (individual, organisational) that contribute to opportunities for deliberate practice are essential to developing an educational experience where all students have the chance to maximise their skills. These issues have received scant research attention and we would argue that efforts to understand the quantity, quality and consequences of deliberate practice of patient assessments are warranted.