Challenges in Learning Procedural Skills: Student Perspectives and Lessons Learned for Curricular Design

Abstract

Phenomenon: Developing foundational clinical procedural skills is essential to becoming a competent physician. Prior work has shown that medical students and interns lack confidence and competence in these skills. Thus, understanding the student’s perspective on why these skills are more difficult to acquire is vital for developing and reforming medical curricula. Approach: This study explored procedural skills learning experiences of medical students with qualitative methods. Through purposive sampling, 52 medical students from the third, fourth, and final years were selected for inclusion. Data were collected using six audio-recorded, semi-structured focus group discussions. Transcripts were manually coded and analyzed using inductive content analysis. Findings: Students provided rich and insightful perspectives regarding their experiences in learning procedural skills that fell into three broad categories: 1) barriers to procedural learning, 2) reasons for learning, and 3) suggestions for better learning outcomes. Students described a range of barriers that stemmed from both patient and clinician interactions. Students were reluctant to make demands for their own benefit during clerkships. The most commonly expressed reason for wanting to learn procedural skills was the desire to be a competent and independent intern. The motivators suggested that students felt empathetic toward interns and visualized a successful internship as a learning goal. Participants suggested peer learning, improved teaching of procedural skills, assessments, and feedback to improve their learning. Insights: This study generated valuable information to promote critical reflection on the existing curriculum and pedagogical approaches to procedural skills development. Medical educators need to sensitize the clinical teachers to student perspectives and what students are really learning to make impactful changes to teaching and learning procedural skills. Students’ self-advocacy skills and self-directed learning skills need to be developed for them to seek out learning opportunities and to promote life-long learning. Lessons from this study may also apply to curriculum design in general, especially in teaching clinical skills. Empowering the learner and embracing a learner-centered approach to teaching and learning procedural skills will benefit future clinicians and their patients.

Keywords:

• Medical education
• procedural skills
• medical students
• instructional design
• learner perspective

Acknowledgements

We would like to thank all the study participants for participating in the focus group discussions.

Disclosure statement

The authors declare they have no competing interests.

Data availability statement

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

Additional information

Funding

The author(s) reported there is no funding associated with the work featured in this article.

Notes on contributors

Kaumudee Kodikara

Kaumudee Kodikara (first author and principal investigator) is a lecturer in Medical Education at Faculty of Medicine, University of Kelaniya, Sri Lanka. This study was part of her Ph.D. thesis. She reviewed the literature, designed the study, conducted the focus group discussions, analyzed the transcripts and wrote the manuscript.

Thilanka Seneviratne

Thilanka Seneviratne is a senior lecturer and a Consultant Pediatrician at Faculty of Medicine, University of Peradeniya, Sri Lanka. She was the first author’s second Ph.D. thesis supervisor. She co-analyzed a subset of transcripts, checked the analysis of all transcripts and critically reviewed the manuscript.

Pavithra Godamunne

Pavithra Godamunne is a clinical psychologist and senior lecturer at Faculty of Medicine, University of Kelaniya, Sri Lanka. Currently she is the Director of Staff Development Center of the University. She is an experienced qualitative researcher and guided in selecting a theoretical framework for the study. She co-analyzed a subset of transcripts, checked the analysis of all transcripts and critically reviewed the manuscript.

Ranjan Premaratna

Ranjan Premaratne is a senior professor in Medicine at Faculty of Medicine, University of Kelaniya, Sri Lanka. He is the first author’s local Ph.D. supervisor. He supervised the study from the beginning to the final stage of manuscript writing with its revisions.