Review of the Critical Role of a Clinical Skills Unit in a PBL Curriculum

臨床技能學習單位在PBL學程中所扮演之重要角色

10.6145/jme.200703_11(1).0001

F.I. Achike

clinical skills unit ； integrated curriculum ； PBL

Journal of Medical Education

11卷1期（2007 / 03 / 01）

1 - 12

英文

Problem-based learning has grown to perhaps the most popular medical education paradigm of the day. With its emphasis on integration, community orientation and self-directed life-long learning, it is distinct from the traditional medical curriculum. The learning of clinical skills from the early days of the PBL curriculum is essential to PBL goals and so is the establishment of administrative units (clinical skills unit-CSU) for this purpose. Data from recent conferences particularly in the Asia-Pacific region, however, reveal that the importance of the CSU has not been commensurately highlighted. This paper, therefore, defines clinical skills, establishes its essence in a PBL curriculum, and compares the traditional opportunistic approach with the innovative structured approach to the teaching of clinical skills. The three major administrative structures for teaching skills are highlighted, and from the students' perspective, the need for standardisation is emphasised. The threats to modern teaching of skills posed by traditional attitudes and practices, and the need, therefore, for formal teacher-training and professionalism in clinical skills teaching are discussed. Themodern approach to skills assessment by way of the objective structured clinical examination (OSCE) is discussed with reference to the traditional method. We express the view that the teaching of skills in the undergraduate medical curriculum of the future will be more the responsibility of the generalist (with holistic attitude) than of the specialist (with narrow organbased focus) doctor who may be more suited to postgraduate training.

1. Achike FI(2003).Sustaining the effectiveness of PBL in a medical curriculum.J Med Educ (Taiwan),7,298-302.
2. Achike FI,Kwan CY(1997).Problem-based learning (PBL) in medical education: why, what and how.Journal of the University of Malaya Medical Centre,2,89-93.
3. Albanese M(2000).Problem-based learning: whycurricula are likely to show little effect on knowledge and clinical skills.Med Educ,34,729-738.
4. ASSOCIATION OF AMERICAN MEDICAL COLLEGES(1984).Physicians for the twenty first century: the GPEP Report.Report of the Panel on the General Professional Education of the Physician and College Preparation for Medicine.
5. Dent JA(2001).Current trends and future implications in the developing role of clinical skills centers.Med Teach,23,483-489.
6. du Boulay C,Medway C(1999).The clinical skills resource: a review of current practice.Med Educ,33,185-191.
7. GENERAL MEDICAL COUNCIL(1993).Tomorrow`s Doctors: Recommendations on Undergraduate Medical Education.London:General Medical Council.
8. Godden DR,Baddeley AD(1975).Context-dependent memory in two natural environments: on land and under water.Br J Psychol,66,325-332.
9. Lam TP,Irwin M,Chow LW(2002).Early introduction of clinical skills teaching in a medical curriculum-factors affecting students` learning.Med Educ,36,233-240.
10. Ledingham I McA,Dent JA,Dent JA,Harden RM (eds.)(2001).A practical Guide for Medical Teachers.London:Churchill Livingstone.
11. Ledingham I McA,Harden RM(1998).Twelve tips for setting up a clinical skills teaching facility.Med Teach,20,503-507.
12. Markle SM(1964).Good Frames and Bad: A Grammar of Frame Writing.New York:John Wiley & Sons.
13. Spaulding WB(1996).The undergraduate medical curriculum (1969 model):McMaster University.Can Med Assoc J,100,659-664.