Teaching and Assessing Clinical Skills (TACS), University of Nottingham Medical School Course Review

 www.medev.ac.uk  19

01WINTER 2007

In our Medical School at theUniversity of Nottingham we havebeen running the TeachingImprovement Project (TIPs) coursefor over fifteen years, and havetaught basic teaching skills and anintroduction to some assessmentconcepts to well over a thousanddoctors and others during that time.However, the demand for an easilyavailable course directed at doctors who are teaching and assessingclinical skills has now led to thedevelopment of the one-day Teachingand Assessing Clinical Skills (TACS)course.

The TACS course has been developedby the authors from examples of bestpractice in the teaching and assessingof clinical skills and consists of amorning devoted to the theory andpractice of clinical skills teachingfollowed by an afternoon concerned with assessment techniques. Thecourse, aimed at groups of abouttwelve people, uses a variety of activelearning methods including brief interactive presentations, small group

discussions and activities, skilldemonstrations and practice, videoobservations and evaluations.

The table overleaf shows the overallprogramme for the day. Participantsare encouraged to activate their priorknowledge of teaching and learningclinical skills and are asked to bringa simple practical skill to teach in atriad. Participants can bring alongany skill they choose, as long as it

can be taught in about five minutesand is neither messy nor dangerouseither in its execution or product.Within each triad, one person teachesthe skill they have brought along toanother person, while the thirdobserves and then feeds back to both.No rules are given or suggested forthis task and the debriefing revealsthe range of teaching and feedbackstyles. Just in case a participant is in want of inspiration, a sheet of possible skills and instructions onhow to do them is available.

After debriefing this experience,teaching next focuses on describingand explaining recognised techniquesor protocols for teaching clinicalskills, leading to the methodadvocated by the Royal College of Surgeons. This consists of five stages:

 conceptualisation, visualisation, verbalisation, practice and mastery.Many participants are familiar withthis protocol, having been exposed toit during their training, includingILS, ALS and ATLS courses but they

Teaching and assessingclinical skills (TACS)Dr Reg Dennick, Dr Ed Fitzgerald,Dr David Matheson, Medical Education Unit, Medical School, University of Nottingham

The development of practical skill based competence is an

important feature of both undergraduate and

postgraduate medical education; the days of see one, do

one, teach one are over. In the past few years the need has

grown markedly to demonstrate robust mechanisms to

ensure that all undergraduate medical students and F1/F2

doctors are effectively taught and assessed on specific

practical psychomotor skills. However, not all doctors are

experienced in teaching skills effectively and many have

limited knowledge of the variety of competence based

assessment schemes currently in use.

Aims and objectives of TACS course

Aim:To enhance participants’ competencies in teaching and

assessing clinical skills.

Learning objectives:

• Identify the features common to all forms of skills teaching

• Use a protocol for skills teaching

• Use feedback in teaching and assessing clinical skills

• Choose an appropriate form of clinical skills assessment

• Create and use assessment criteria in the assessment of clinical skills

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have not often had an opportunity toreflect on the rationale for its specificsequencing. The TACS course allowsparticipants to analyse this protocoland to explore particular variantsthat might be more relevant to theirown clinical teaching areas. This isfollowed by the highlight of thecourse: Learning how to make anorigami shirt! This task was chosenas it neatly illustrates the steps in theRCS protocol with a degree of humour - especially with regard tothe health and safety and ethicalaspects of making an origami shirt.

The afternoon concentrates onassessment of clinical skills and againbegins by activating participants’own knowledge of the principles of skill assessment including coreconcepts such as validity, reliability,reproducibility and feasibility. Videosof non-clinical and clinical skills areused to encourage the group toexplore the criteria that can be usedto assess practical competence.Several assessment methods arediscussed and evaluated: OSCEs,OSLERs, DOPS and MinCEX.Finally, pairs of participants developa set of criteria that could be used toassess a trainee performing anabdominal examination. These areswapped with other pairs who thenhave to use them to assess a video of this skill. A discussion of theproblems of developing and usingthese criteria is the final phase of thecourse.

It is difficult to construct a simpleone-day course that will cover clinicalskill teaching and assessment in anactive and interesting way but we feelthat the TACS course fits the bill.Evaluations, so far, have been verypositive with participants glad of theopportunity to explore skill teachingand assessment concepts andmethods more deeply. We hope that we are creating a growing number of teachers who can go back intoclinical practice and spread the wordabout skill teaching methods and who can more effectively andthoughtfully apply the assessmenttools that are currently being used.

For more about the TACS and TIPScourses and how to enrol see:www.nottingham.ac.uk/ 

medical-school/tips/home.html

For more information please contactreg.dennick@nott.ac.uk 

Teaching and assessing clinical skills1. Introduction

2. Activation of prior learning

3. Teaching a skill: in threes

4. Identifying common features of skills teaching

BREAK 

5. Theory:RCS skills teaching method

6. Feedback: what does it mean to give feedback in the context of skillsteaching?

7. Show video of skill being taught: discuss

LUNCH BREAK 

8. Assessing practical skills

9. Activation of Prior Learning

10. Shows DOPS video and discuss

11. Outline variety of methods for assessing skills

BREAK 

12. In threes construct assessment criteria for abdominal examination

13. Swap assessment criteria and use while watching abdominal examinationvideo

14. Discuss reliability of assessment criteria

15. Closure

Origami shirt (Photo: D Matheson).