Back to the future: teaching medical students clinical procedures.

Over the last decade undergraduate training in clinical procedures has moved from 'learning on patients' towards simulation-based training. Simulation was intended to be an adjunct rather than a replacement for experiential learning and several initiatives have emerged to redress this balance. With these initiatives in mind, we evaluated the impact of our undergraduate skills training programme and considered the need to change our teaching and learning strategy in this area. Outcomes-based data was accrued from the performance-based assessment of 64 medical students in four key procedures. Attitudinal data was gleaned from 130 responses to an electronic questionnaire and student self-efficacy ratings taken immediately before assessment. Students performed best in venepuncture. Performance in the other skills revealed 1 in 3 did not reach competence in i.v. cannulation and more than 1 in 2 were below standard when measuring a BM stix and priming an i.v. giving set. The data on self-efficacy and competence was analysed and a Spearman's Rank Correlation coefficient of 0.36 calculated. Students in final year were poor self-assessors and unaware that their skills often fell below standard. These results suggest a need to increase students' self-awareness and promote ward-based learning. This article considers how these objectives might be achieved.