Target-Oriented Clinical Skill Enhancement (TOCSE) Is an Effective Tool to Bridge Didactic to Clinical Learning: A Randomized, Controlled Trial

Leilani B. Mercado-Asis, Maria Victoria D. Garcia, Ma. Charlene Ann V. Balili, Erick S. Mendoza, Melvin R. Marcial, Estrellita J. Ruiz

Dec 2021 DOI 10.35460/2546-1621.2021-0160     Access   

Abstract

Purpose: To connect didactic learning to clinical application is a challenging task both for the teachers and students. Target-Oriented Clinical Skill Enhancement (TOCSE) is a teaching and learning tool that integrates basic medical sciences at the clinical level. The authors sought to determine if TOCSE is effective in bridging didactic knowledge to clinical skill and enhancing the clinical performance of fourth year medical students.
 

Method: Between March 2021 and June 2021, in an online platform, the authors randomly allocated 141 fourth year medical students into the experimental (n=12 groups; n=63) and control groups (n=12 groups; n=78). Participants in the experimental group underwent the TOCSE module workshop while the control group utilized the standard method of teaching. The actively teaching faculty staff blinded of group allocation were invited to assess case presentations using a standardized rubric. A survey was done by the students (experimental and control) to evaluate how they perceived TOCSE to their performance and learning. Independent parametric t-test was performed to compare the clinical skill scores between the two groups.
 

Results: The experimental group had a mean clinical skill score of 35.29 (SD=2.64, excellent) while the control group had a mean clinical skill score of 31.96 (SD=4.04, satisfactory). The between-group comparisons using independent t-test indicated that the mean difference of -3.33 clinical skills scores between the experimental and control groups was statistically significant (t=–2.39, p=0.026, 95% CI=–6.22 to –0.45). Moreover, the perceived usefulness score (scale 10 as highest) among the TOCSE presenters (experimental groups) was 8.43 (SD=0.84) and scores among the TOCSE audience (control groups) was comparable at 8.36 (SD=0.71), both of which were interpreted as very helpful.
 

Conclusion: TOCSE is effective in bridging didactic knowledge to clinical skill and enhancing clinical performance of fourth year medical students.


Key words: TOCSE

 

  1. O’Brien B, Cooke M, Irby DM. Perceptions and attributions of third year student struggles in clerkships: do students and clerkship directors agree? Acad Med. 2007;82:970–8.
  2. Frellsen SL, Baker EA, Papp KK, Durning SJ. Medical school policies regarding struggling medical students during the internal medicine clerkships: results of a national survey. Acad Med. 2008;83:876–81.
  3. Lyss-Lerman P, Teherani A, Aagaard E, Loeeser H, Cooke M, Harpeer GM. What training is needed in the fourth year of medical school? Views of residency program directors. Acad Med. 2009;84:823–9.
  4. Weinrich M, Jackson MB, Scherpbier AJ, Wolfhagen IH, Ramsey PG, Goldstein EA. Ready or not? Expectations of faculty and medical students for clinical skills preparation for clerkships. Med Educ Online. 2010; 15:5295.
  5. Dehghani M, Athar O, Ashourioun V, Akhlaghi M, Avizhgan M, Esmaeili A, et al. A transitional curriculum for preparing medical students for internship, does it work? J Res Med Sci. 2013;18:506–9.
  6. Surmon L, Bialoceerkowski A, Hu W. Perceptions of preparedness for the first medical clerkship: a systematic review and synthesis. BMC Med Educ. 2016;16:89.
  7. Sahu PK, Chattu VK, Rewatkar A, Sakhamuri S. Best practices to impart clinical skills during preclinical years of medical curriculum. Journal of Education and Health Promotion. 2019;8:57.
  8. Mercado-Asis LB. Introducing TOCSE: A tool to bridge didactic learning to clinical application (Part 1). Journal of Medicine UST. 2018;1:133–5. Available from: http://dx.doi.org/10.35460/2546-1621.2017-0098
  9. Mercado-Asis LB. Introducing TOCSE: A tool to bridge didactic learning to clinical application (Part 2). Journal of Medicine UST. 2019;3:313–7. Available from: http://dx.doi.org/10.35460/2546-1621.2019-0023
  10. Boyko EJ, Alderman BW. The use of risk factors in medical diagnosis: Opportunities and cautions. Journal of Clinical Epidemiology. 1990;43:851–8.
  11. Kalan ME, Sis HY, Kelkar V, Harrison SH, Goins GD, Jafarabadi M, et al. The identification of risk factors associated with patient and healthcare system delays in the treatment of tuberculosis in Tabriz, Iran. BMC Public Health. 2018;18:174–84.
  12. Grady A, Carey M, Oldmeadow C, Bryant J, Mazza D, Sanson-Fisher R. GP detection of health risk factors among general practice patients at risk of primary and secondary stroke. Family Practice. 2015;32:336–42.
  13. WHO 2009. Risk factors assessment and screening procedure. Available from: http://origin.wpro.who.int/philippines/publications/module2.pdf
  14. Lobig N, Wezel F, Martini T, Schroppel B, Bolenz C. (Article in German). Microscopic hematuria: Reasonable and risk-adapted diagnostic. Urologe A. 2017;56:1139–46.
  15. Giffrey RT, Pines JM, Farley HL, Phelan, MP, Beach CB, Schuur JD, et al. Chief complaint-based performance measures: A new focus for acute care quality measurement. Annals of Emergency Medicine. 2015;65:387–95.
  16. Mowafi H, Dworks D, Bisanzo M, Hansoti B, Seidenberg P, Obermeyer Z, et al. Making recording and analysis of chief complaint a priority for global emergency care research in low-income countries. Academic Emergency Medicine. 2013;20:1241–5.
  17. Faustinella F. Jacobs JR. The decline of clinical skills: A challenge for medical schools. Int J Med Educ. 2018;9:195–7.
  18. Elstein AS, Shulman LS, Sprafka SA, Medical problem solving: an analysis of clinical reasoning. Cambridge, MA: Harvard Press; 1978.
  19. Kassirer JP, Gorry GA,. Clinical problem solving: a behavioral analysis. Ann Intern Med. 1978;89:245–55.
  20. Akers A, Blough C, Iyer MS (April 23, 2020) COVID-19 implications on clinical clerkships and the residency application process for medical students. Cureus 12(4):e7800. DOI: 10.7759/cureus.7800
  21. Geha R, Dhaliwal G. Pilot virtual clerkship curriculum during the COVID-19 pandemic: Podcasts, peers and problem solving. Med Educ. 2020;54(9):855–6.
  22. Kim SM, Park SG, Jee YK, Song IH. Perception and attitudes of medical students on clinical clerkship in the era of the Coronavirus Disease 2019 pandemic. Med Educ Online. 2020;25:1809–929. Available from: https://doi.org/10.1080/10872981.2020.1809929
  23. Mian A, Khan S. Medical education during pandemics: A UK perspective. BMC Medicine. 2020;18:100. Available from: https://doi.org/10.1186/s12916-020-01577-y
  24. Hashemiparast M, Negarandeh R, Theofanidis D. Exploring the barriers of utilizing theoretical knowledge in clinical settings: A qualitative study. Int J Nurs Sci. 2019;399–405.

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