|Year : 2007 | Volume
| Issue : 3 | Page : 130
In the News! An Opinion : Not in the News
J van Dalen
Associate Editor, Education for Health, The Netherlands
|Date of Web Publication||28-Jan-2013|
J van Dalen
POB 616, 6200 MD Maastricht
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
van Dalen J. In the News! An Opinion : Not in the News. Educ Health 2007;20:130
For some 30 years already I am proud to be employed at the Maastricht Skillslab, an educational institution within the Faculty of Health, Medicine and Life Sciences at Maastricht University, the Netherlands. The Skillslab was established in 1974, right at the onset of our school, and has developed into a department that houses some 35 staff members to date. Our students spend half a day per week on average at the Skillslab, primarily in the first half of their medical curriculum. Student evaluations are very positive, indicating that students learn a lot and enjoy the quality of teaching.
The present-day emphasis on best evidence (medical) education is the result of a growing awareness that the scientific basis for many of the things we teach in medical school is not as solid as we would like it to be, or as we always assumed it to be. We now know that the evidence for quite a number of things we teach is lacking. Fortunately many studies are currently undertaken to expand the scientific basis of what we teach.
Nowadays, the attempts to increase our knowledge base are mostly focused on the theoretical information we convey to students. When we look at the foundation of the skills that we teach we must conclude that many procedures seriously lack evidence. When we distinguish between different types of skills it is striking to see that there is quite some evidence available for communication skills, recently accumulated in two splendid handbooks (Silverman et al., 2005, Kurtz et al., 2005). The recognition of the value of communication skills is rather recent as it is no older than 30 years. In the 1960s and '70s those interested in communication skills first had to prove that what they did was needed and that teaching communication skills would lead to improved health care. To a large extent, this has now been realized, although this task is obviously never completely finished. The same can be witnessed in the area of laboratory skills.
However, when we look at the evidence for basic physical examinations the scientific proof seems to be largely absent or, if present, fairly meager. Apparently we teach many physical examination procedures like we always did, without exactly knowing why.
A JAMA series of articles on the evidence for some procedures does not reveal encouraging results. The series started in 1992 and continues intermittently. For Education for Health's Dutch-speaking readers I can refer to a similar series in the Nederlands Tijdschrift voor Geneeskunde, announced as: "A series of articles about usefulness and uselessness of physical diagnostics. - The sensitivity, specificity and reproducibility (especially the inter-assessor variation) of many physical diagnostic tests taught in the medical curricula appear not to have been established. Nevertheless, many of these tests are mentioned as end terms in the 1994 General Plan on Medical Education. A series of articles in this journal will be devoted to physical diagnostics tests and their usefulness and uselessness: sensitivity, specificity and reproducibility." (Oosterhuis, 1999).
Moreover, a series of books about Evidence Based Physical Examination has been published in the past decade, mostly drawing similar conclusions. By this time we can make a tentative map of what we don't know.
At the Maastricht Skillslab, as at all other clinical skills training facilities around the world, we are desperately in need of a more solid underpinning of what we teach. We conduct some studies ourselves, but we do need to join forces. No single institution can fill the evidence gaps for the clinical skills that are taught. However, if we take our teaching activities seriously we must fill this need. I would therefore like to encourage teachers and researchers to join forces. It is necessary for clinical skills teaching to develop beyond intuition!
More about the evidence on how we teach next time!
Jan van Dalen
Associate Editor Education for Health
KURTZ, S., SILVERMAN, J. & DRAPER, J. (2005).Teaching and learning communication skills in medicine. Oxon, Radcliffe Medical Press.
OOSTERHUIS, H. J.G.H. (1999). Artikelenreeks over nut en onnut van fysische diagnostiek. Nederlands Tijdschrift voor Geneeskunde, 143(3), 141-142.
SERIES 'The rational clinical examination', JAMA 1992-2007.
SILVERMAN, J., KURTZ, S. & DRAPER, J. (2005). Skills for communicating with patients. Oxon, Radcliffe Medical Press.