Clinical skills temporal degradation assessment in undergraduate medical education

Introduction: Medical students’ ability to learn clinicalprocedures and competently apply these skills is an essentialcomponent of medical education. Complex skills with limitedopportunity for practice have been shown to degrade withoutcontinued refresher training. To our knowledge there is noevidence that objectively evaluates temporal degradation ofclinical skills in undergraduate medical education. The purposeof this study was to evaluate temporal retention of clinical skillsamong third year medical students.Methods: This was a cross-sectional study conducted at fourseparate time intervals in the cadaver laboratory at a publicmedical school. Forty-five novice third year medical studentswere evaluated for retention of skills in the following threeprocedures: pigtail thoracostomy, femoral line placement, andendotracheal intubation. Prior to the start of third-year medicalclerkships, medical students participated in a two-hour didacticsession designed to teach clinically relevant materials includingthe procedures. Prior to the start of their respective surgeryclerkships, students were asked to perform the same threeprocedures and were evaluated by trained emergency medicineand surgery faculty for retention rates, using three validatedchecklists. Students were then reassessed at six week intervalsin four separate groups based on the start date of their respectivesurgical clerkships. We compared the evaluation results betweenstudents tested one week after training and those tested atthree later dates for statistically significant differences in scoredistribution using a one-tailed Wilcoxon Mann-Whitney U-testfor non-parametric rank-sum analysis.Results: Retention rates were shown to have a statisticallysignificant decline between six and 12 weeks for all threeprocedural skills.Conclusion: In the instruction of medical students, skilldegradation should be considered when teaching complextechnical skills. Based on the statistically significant decline inprocedural skills noted in our investigation, instructors shouldconsider administering a refresher course between six and twelveweeks from initial training.Keywords: Clinical skills, Assessment, Medical education