What is a clinical skill? Searching for order in chaos through a modified Delphi process

Figures & data

Table

Practice points

Faculty should define what they mean when they speak about CSs. Which domain are they referring to? Physical examination, treatment skills, etc. Physicians involved in teaching do agree that the three components, procedural steps, underlying knowledge, and clinical reasoning, are part of CS learning and teaching. Skill analysis must be used to ensure that appropriate teaching methods are applied.

Table 1  Initial trigger questions for the Delphi process

• What is a CS, which are the sub-skills?

• Which are the different components or elements involved in learning a CS?

• Which are the different components or elements involved in teaching a CS?

Table 2  Statements generated by round 1 of the Delphi, with scores expressed as percentage of the panel voting strongly agree or agree out of a four point Likert scale

Question: what is a CS, which are the sub-skills?	%SA + A
4) CS includes -practical procedures:	100%
5) CS includes-examination skills:	100%
6) CS includes -the use of instruments required to examine	100%
16) CS can be diagnostic:	100%
46) CS can be acquired:	100%
3) CS includes -communication skills (verbal-non verbal):	95%
17) CS can be treating:	95%
42) CS is an acquired/learned/taught ability to perform them:	95%
43) CS is gained through experience:	95%
44) -CS is gained through training:	95%
7) CS includes -observation:	90%
10) CS includes -specialist skills:	90%
13) CS includes-implementation of appropriate management:	90%
18) CS is an ability which can be technical or cognitive:	90%
29) CS is a competency:	90%
38) I use a CS when I do something – When I employ an ability in which I apply my knowledge	90%
8) CS includes-core CS:	85%
40) each clinical group has its own specific CSs:	85%
9) CS includes -generic CS:	80%
14)CS includes -thinking skills (but those are not confined to the health professionals:	80%
20) CS is a task performed by a practitioner in relationship with their patients:	80%
25) CS is a tool of the work as doctors:	80%
30) CS define the clinical competence/the clinical ability:	80%
45) CS can be natural:	80%
12) CS includes-attitudinal skills:	75%
15) in most but not all cases CS requires interaction of observational/verbal/diagnostic and treatment skills:	75%
22) CS is a technique required to perform a clinical activity:	75%
37) CS is the foundation of the professional life:	75%
19) CS is the ability to carry out a task required form clinical professionals:	70%
23) there is a distinction between a CS and a technique:	70%
31) CS is an action between the health care professional and patient:	70%
33) CS is an action/ability not only done by a health professional:	70%
36) CS is working out what is going on with a patient:	70%
39) each profession develops its own vocabulary and way of arguing (belief system) →different med professionals give different advices to the same problem:	70%
48) contributes to the well being of the patient:	70%
49) a CS includes a degree of interpretation:	70%
21) a skill is a practical activity with motor component and supported by cognitive and attitudinal components	65%
26) CS is a craft:	60%
35) CS is a behavior that allows diagnosis:	60%
41) clinical: to do with medicine:	60%
1) CS is any defined component of an interaction between a patient and a clinician:	55%
11)CS includes review success:	55%
34) CS is a procedure:	55%
27) CS is an accomplishment:	50%
2) CS is performed around the bedside:	45%
28) CS is an aptitude:	35%
32) CS is an action/ability only when done by a health professional:	35%
47) the clinical context and the clinical knowledge make the ability specific to the medical profession (e.g.: a stitch):	35%
24) CS is an art required to perform a clinical activity:	30%
Which are the different components or elements involved in learning a CS?	%SA + A
L1) relevant to the context so the student knows why to learn it:	100%
L2) relevant to the context so the student knows when they should need to use it:	100%
L2) relevant to the context so the student knows when they should need to use it	100%
L5) understanding of what is required:	100%
L6) understanding the skill to be learned:	100%
L7) understand why you are doing it:	100%
L8) to see the usefulness/need of the CS in practice:	100%
L10) the opportunity to ask questions:	100%
L18) demonstration (modeling):	100%
L22) opportunity to use the skills taught:	100%
L23) repeated practice:	100%
L24) repeated practice under supervision:	100%
L25) reflection on one's own skill:	100%
L27) understanding of the limitation of the skill and when not to use it:	100%
L29) feed back:	100%
L39) opportunities to reinforce learning:	100%
L47) good teaching technique:	100%
L48) an open mind: which is a mind receptive to examination of new ideas and facts	100%
L9) to see the importance of learning the CS:	95%
L11) working from where the student is:	95%
L16) clear objectives and outcomes so the student knows what is required:	95%
L26) critical evaluation:	95%
L33) physical ability to perform:	95%
L34) the ability to adjust to individual variations between patients:	95%
L37) having sufficient time:	95%
L12) related to knowledge and understanding of the student:	90%
L13) relevance to current stage of training:	90%
L28) assessment in the clinical environment as to whether CSs can be appropriately be employed and carried out:	90%
L38) being allowed to get it wrong at first:	90%
L46) competence of teacher:	90%
L4) theoretical foundation:	85%
L21) move only to the next level if judged competent to do so:	85%
L32) skill labs but not that important if sufficient real life opportunities exist:	85%
L36) offer the deconstructed elements to the learner:	85%
L3) the learning should be based on medical knowledge:	80%
L14) prior knowledge:	80%
L17) observation of an expert:	80%
L31) a non threatening encouraging surrounding:	80%
L35) the ability to deconstruct and reconstruct:	80%
L44) ability:	80%
L40) follow excepted methods:	75%
L15) previous skills:	70%
L20) helpful text:	65%
L45) depends on learning styles:	65%
L42) objectivity:	60%
L19) description of the skill (book):	55%
L30) understanding of the framework of the medical model:	55%
L43) humility:	55%
L41) learn how to use the CS only if put in context:	50%
Which are the different components or elements involved in teaching a CS?	%SA + A
T1) being competent in the skill being taught:	100%
T6) to understand the theory behind the practice:	100%
T10) as safe environment to demonstrate and observe practice:	100%
T11) clinical environment to observe the use of CS on real patients:	100%
T12) feed back of students abilities in the clinical environment:	100%
T15) anticipation of the learner's potential difficulties:	100%
T23) understand the learner:	100%
T25) enthusiasm of the teacher:	100%
T3) being familiar with the theoretical basis:	95%
T5) how to convey the knowledge:	95%
T8) teach why you are doing it:	95%
T9) a structured easy to follow method which can be modified with experience:	95%
T14) adapt to students needs:	95%
T16) reflection on the context of the task:	95%
T20) setting appropriate expectations:	95%
T4) knowledge:	90%
T13) a small number of students:	90%
T21) allow the learner to suggest ways to improve the skills:	90%
T24) interested and enthusiastic students:	90%
T26) ability to make it interesting:	90%
T19) various methods of teaching the skill:	85%
T22) teach each other:	85%
T7) teaching based on anatomy and physiology:	80%
T29) the ability to direct learning:	75%
T2) the person who is teaching should be actively involved in clinical practice:	70%
T27) teach GSOH (good sense of humour)	50%
T28) students initiated teaching:	50%
T17) teaching script:	35%
T18) different teachers should teach the skill in the same way:	10%