Browsing by Author "Kodikara, K. G."

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Procedural experience, confidence, and self-reported perceived competence among medical undergraduates: A study from a metropolitan university in Sri Lanka
(Faculty of Graduate Studies, University of Kelaniya Sri Lanka, 2022) Kodikara, K. G.; Seneviratne, H. M. T. W.; Premarathna, B. A. H. R.
Bedside procedures are a vital component of patient care. Evidence from medical schools across the world reveals a lack of exposure to bedside procedures among medical undergraduates. Our objective was to ascertain medical students’ experience, confidence, and competence in performing bedside procedures. An anonymous, electronic survey was conducted among medical undergraduates of the Faculty of Medicine, University of Kelaniya, Sri Lanka. The participants were from years three to five, who are engaged in clinical clerkships. Students were asked how often they were exposed to 20 common medical procedures, their anticipated level of self-confidence, and assumed self-competence in performing the procedure independently. Statistical analysis included student t-test, Chi-square test, and comparisons of means. In total, 178 students out of 250 replied to the questionnaire. Most respondents had not observed airway manoeuvres (48.8%), arterial puncture (44.3%), defibrillation (50%), paracentesis (55.6%), and trauma primary survey (56.1%) during their clinical attachments. Students were not confident to perform several bedside procedures either independently or under supervision: nasogastric tube insertion (91.5%), blood culture (69.6%), lumbar puncture (96.0%), cardiopulmonary resuscitation (59.5%), arterial puncture (85.9%), wound dressing (80.8%), and paracentesis (96.0%). Venipuncture, cannulation, and Foley catheter placement were the only procedures that greater than 50% of students had performed more than 5 times during their clinical attachments. Respondents assumed they were able to perform venipuncture (32.5%), cannulation (19.1%), and Foley catheter insertion (13.4%) independently. A significant correlation was observed (r ¼ 0.8) with higher experience, confidence and assumed competence. The present study demonstrates that medical students are underexposed to vital bedside procedures and feel uncomfortable performing such procedures. Level of experience appears to significantly improve the levels of confidence as well as self-reported perceived competence among medical students. Due diligence needs to be given to improve procedural competence in undergraduate medical education.
Value of multimodal instruction on improving procedural skill proficiency among medical undergraduates: A study from a Sri Lankan medical faculty
(Faculty of Graduate Studies, University of Kelaniya Sri Lanka, 2022) Kodikara, K. G.; Seneviratne, H. M. T. W.; Premarathna, B. A. H. R.
Acquisition of basic procedural skills is important for the medical students to practice as clinicians. Traditionally, such skills were taught or acquired by medical students at the bedside in the hospital setting during their clinical attachments. Skills laboratory training has been introduced to mitigate the ethical issues arising from practicing invasive procedures with inadequate training. The aim of the present study was to evaluate the effectiveness of simulation-based training and bed-side teaching for skill acquisition in the domain of procedural skills. Volunteer second-year medical students participated in this longitudinal cohort study. All participants rated their self-confidence and competence in performing venipuncture on a real patient (baseline). Afterwards, all the students underwent a simulation-based training (SBT) session followed by four-weeks of bed-side teaching/learning (BST) during clinical attachments in the hospital setting. The students rated their self-confidence and competence in performing venipuncture on real patients following simulation-based training and clinical training. Similarly, an independent assessor who was blinded to the study design scored the student’s performance following each method of training using the Integrated Procedural Protocol Instrument (IPPI). Simulated patients and real patients assessed the communication skills of the students using a Communication Assessment Tool (CAT) following the skills-lab training and clinical training respectively. A sample of 55 students included in the study. Majority were females (63.64%,35/55). The self-assessment ratings of both the confidence and competence of students were significantly higher following the simulation-based training (p < 0.01). A further increased in both self-competence and confidence (p < 0.01) was observed with the clinical training following simulation-based training. The independent assessment showed a significant increase of means across all categories of IPPI ratings (mean SBT: 2.35; mean BST: 2.78; p < 0.01). Student’s doctor-patient communication skills were rated significantly higher by real patients in the clinical setting when compared with the ratings given by simulated patients (mean SBT: 2.46; mean BST: 3.76; p < 0.01). This study confirmed the effectiveness of simulation-based training in procedural skill acquisition. A significant improvement in technical and communication skills as well as self-confidence and competence were observed following clinical training. This study demonstrated that simulation-based training compliments the bed-side learning and that a mix of these teaching/learning modalities substantially augments the clinical performance of medical students. A multimodal instruction for developing procedural skills can be recommended for undergraduate procedural skills training.
Who teaches basic procedural skills: perspectives of medical undergraduates in a university in Sri-Lanka
(Faculty of Graduate Studies, University of Kelaniya Sri Lanka, 2022) Kodikara, K. G.; Seneviratne, H. M. T. W.; Premarathna, B. A. H. R.
Learning procedural skills as a medical undergraduate has come a long way, as task trainers and simulators are now omnipresent. However, wide variations in procedural competence is observed among graduating doctors and medical students. Whether skills laboratory training has superseded bedside teaching or is adjunct to it, is an ongoing investigation. Furthermore, who is responsible for student education in the procedural skills domain, and how students learn in the current context are yet unclear. In this study, we sought to characterize the experience and opinions of medical students on procedural skills training. Six focus-group interviews were conducted among medical students who were undergoing clinical training, at the Faculty of Medicine, University of Kelaniya, Sri Lanka from July-October 2020. The interviews were recorded, transcribed, and analyzed for recurring themes. There were 18 third-year medical students, 17 fourth-year students, and 16 fifth-year students. Two focus group discussions were held per student from each academic year. Opinions on the learning environment, and learning methods for basic procedural skills, as well as who serves as the primary teacher, emerged prominently from the data. Third-year students reported simulation as the primary method of education. Bedside learning emerged prominently among fourth and final-year students. At the bedside, most students learn procedures through observation of health professionals. Nursing officers and intern medical officers were recognized as primary teachers by third and fourth-year medical students, whereas intern medical officers and registrars were identified as the primary teachers by the final-year medical students. The majority appreciated the skills laboratory training in developing procedural skills. Peer-assisted learning emerged prominently among discussions with all three academic years as a preferable mode of honing procedural competence among medical students. This study suggests that medical students recognize the utility of both simulation and bedside teaching in procedural skills training. They valued the contribution of nursing officers, interns, and registrars in their education. The student opinion varied in the degree to which they think simulation is or should be incorporated into learning procedural skills. Students visualize the capacity peer-assisted learning holds in improving procedural competence among medical undergraduates.