Patients' appreciation of pre-clinical student performance in primary healthcare centres in Indonesia.

INTRODUCTION: In Indonesia, primary healthcare (PHC) centres are among the eligible institutions to provide 'early clinical experiences' (ECE) for pre-clinical medical students. This study explored whether patients of PHC centres would accept third-year pre-clinical students practicing clinical skills with them. METHODS: Immediately after being seen by a pre-clinical student--supervised by a general physician--76 patients of PHC centres participated in a structured, eight-question interview. Interviews were transcribed verbatim and coded to collate and interpret answers to the questions. RESULTS: Most of the patients were satisfied with the clinical performance of their pre-clinical student. Negative comments regarding some students addressed lack of confidence, being nervous, unable to provide satisfactory explanation and education and failure to speak the local language. Some patients suggested more practice for these students in PHC centres. CONCLUSION: Patients in Indonesian PHC centres generally appreciated health services provided by pre-clinical medical students; no significant objections were recorded. This supports the suitability of these PHC centres to offer ECE for pre-clinical students.

Effects of partial substitution of pre-clinical skills training by attachments to primary health care centers: An experimental study.

BACKGROUND: Recent studies indicate that students may encounter problems when they have to apply clinical skills learned in a skills laboratory to patients. To facilitate this transition, it has been advised to include patient contacts early in the pre-clinical curriculum. OBJECTIVE: To compare clinical skills performance and level of preparedness for entering the clerkships between students who were prepared exclusively in a skills laboratory and peers for whom part of their skills training program was substituted by training in a primary health care (PHC) center. METHODS: Pre-clinical students either trained clinical skills exclusively in a skills laboratory while their peers attended a mixed program of laboratory trainings and practice in PHC centers. Students' perception of preparedness for the clerkships was explored through the Preparation for Hospital Practice Questionnaire. Students' clinical skills were assessed by an Objective Structured Clinical Examination (OSCE) and by supervisors in PHC centers. RESULTS: Students following the mixed program felt better prepared for their clerkships than skills lab-trained peers. Students' perceptions were supported by assessments by their supervisors. However, mean OSCE scores of both groups did not differ significantly. CONCLUSION: PHC centers can be involved to better prepare pre-clinical students for their clerkships.

Comparison of three clinical environments for pre-clinical clinical skills training.

OBJECTIVES: Primary health care (PHC), secondary health care (SHC), and tertiary health care (THC) were compared in search of the most suitable setting for clinical skills training of pre-clinical students. METHODS: The Dundee Ready Educational Environment Measure questionnaire was presented to 300 clerkship students of the Faculty of Medicine at Gadjah Mada University, Indonesia who were attached to PHC, SHC, and THC settings. Students were asked to assess their current attachment for suitability for training of pre-clinical students. Semi-structured interviews were held with 46 clinical supervisors based on the three types of settings. RESULTS: Clerkship students preferred PHC centers over SHC and THC hospitals for clinical skills training of pre-clinical students (p < 0.05). PHC staff felt their centers to be well-equipped to train pre-clinical students, including availability of supervisors' time for teaching, adequate physical facilities and equipment, and suitable patient cases. CONCLUSION: In the developing country context, PHC centers seemed more appropriate for clinical skills training of pre-clinical students than SHC and THC hospitals. However, the skills laboratory must guard that clinical skills are trained and performed in the same way in that facility, in PHC centers and in teaching hospitals.

Transfer of medical students' clinical skills learned in a clinical laboratory to the care of real patients in the clinical setting: the challenges and suggestions of students in a developing country.

CONTEXT: Recent studies indicate that medical students may face problems applying clinical skills taught in a skills laboratory setting when they enter their clerkships. This study explores these problems in the context of a developing country, and explores students' suggestions for improving clinical skills training. METHODS: Focus groups discussions (FGDs) were organized with students who had just entered their clerkships. Transcripts of FGDs were digested according to the inductive content analysis protocol. RESULTS: Clerkship students said to have encountered significant problems when they had to perform clinical skills on patients for the first time, in particular with respect to invasive clinical procedures. Differences in context between skills laboratory and clinic, inadequate supervision and unpredictable responses by patients were most common reasons given. Students suggested creating opportunities to practice clinical skills on patients before entering the clerkships. CONCLUSION: Early in their clerkships students may face significant problems when they have to apply skills learned in the skills laboratory on actual patients. Particularly in developing countries, opportunities may exist to follow up on our students' suggestion to arrange for skills training of pre-clinical students in clinical settings.