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The Expert Skills Program (ESP) at Texas Tech was implemented in March, 2012, as a free access professional skill development opportunity for all interested students regardless of their institution. The ESP is named to reflect the broad goal of acquiring expert skills in areas ranging from clinical reasoning, patient examination, and communication to the fine motor skills employed in clinical procedures. We have been able to initiate skill development prior to formal clinical training by matching the steps used in clinical skills to the steps involved in higher order thinking skills.

"To describe the essential components of the medical model of substance use disorders. To delineate the interviewing skills necessary to screen effectively for substance use and abuse. To understand the high rate of psychiatric and medical co-morbidity and more effectively screen patients for these disorders. To demonstrate skills for evaluating patients' stage of change, readiness to accept the diagnosis, and readiness to undertake behavior change. To clearly and supportively recommend treatment to patients with substance use disorders. To describe the skills required for addiction prevention counseling. To define the skills that help set respectful limits on patient requests for prescription medication. To demonstrate awareness of how physician/clinician attitudes toward patients with substance use disorders impact recognition, diagnosis, and treatment of patients. To demonstrate knowledge of substance use disorder treatment standards and the ability to recommend appropriate referrals."

"Patient communication skills need to be taught as part of residency training. With limited training, case-specific skills (herein, involving patients with cancer) are likely to improve more than general communication skills."

"Students receiving the professional development training showed significant improvements in certain communication skills, but students in both cohorts improved over time. The lack of a relationship between observed communication skills and patient-centred attitudes may be a reflection of students' inexperience in working with patients, resulting in 'patient-centredness' being an abstract concept. Students in the early years of their medical course may benefit from further opportunities to practise basic communication skills on a one-to-one basis with patients. "

Clinical Skills Online is a St George's Medical School, London, project that developed a series of clinical skills videos which can be used freely for educational pruposes and are made available under the creative commons licence.

"The renewed emphasis on clinical skills in medical education comes at a time when there is also increasing focus on the need to provide better care for populations that experience health disparities.2,3,10 SPs provide a unique opportunity to meet both the general goals of medical education in developing students' clinical skills and goals specific to enhancing and evaluating students' knowledge, attitudes, and skills with regard to patients with disabilities."

There's currently a healthy debate raging on the MMSA Standing Committee on Medical Education (SCOME) email server about clinical skills. Granted that the discussion is being held solely by students, it still makes interesting reading (members-only access). The gist of it is whether appropriate training in clinical skills is being afforded to students, how it could improve, and when/where it should be given. I'll quickly run you through the main points of the discussion.

"The object of Face the Case is to acquire the skills to solve a variety of health and human services cases. Case descriptions are delivered to you through the PDA. The PDA also keeps track of the skills, skill points and collaborators for each player. "

There is a need for a cultural change in clinical education, in which those involved with the professional training of healthcare professionals perceive teaching as more than the transmission of knowledge and technical skills. Process-oriented teaching practices that integrate technology as part of a carefully designed curriculum may have the potential to facilitate the development of capable healthcare graduates who are able to navigate the complexity of health systems and patient management in ways that go beyond the application of knowledge and skills.

"A patient-centered communication curriculum can improve student knowledge and skills. While some intervention students perceived that they made too many calls, our data suggest that more calls, an increased sense of patient ownership, and role modeling by clerkship faculty may ensure incorporation and application of skills."

The Clinical Skills Online (CSO) is a project aimed at providing online videos demonstrating core clinical skills common to a wide range of medical and health-based courses. This project has been funded by the Higher Education Academy Subject Centre for Medicine, Dentistry and Veterinary Medicine.

"Talking to colleagues is an essential skill especially as we advocate for our patients. We should not only know what's going on with our patients, but also how to communicate our thoughts effectively and succinctly with our colleagues."

"COMFORT is an acronym that stands for the basic principles of palliative care communication and comprises seven modules (Communication, Orientation/Opportunity, Mindfulness, Family, Openings, Relating, Team). These communication skills training modules are designed to highlight interprofessional care and communication. Each module of the COMFORT curriculum can stand alone as a teaching activity or can be integrated into a new or existing course. Modules C (narrative clinical communication) and F (family caregivers) provide beginner level instruction, while M (mindfulness), O/O (orientation), and T (team) provide intermediate instruction and O (openings) and R (relating) provide advanced communication skills and are intended for learners who have clinical observation experience."

Clinical Skills videos

Clinical Skills videos from Northern Ontario School of Medicine

"linical teachers differ from clinicians in a fundamental way. They must simultaneously foster high-quality patient care and assess the clinical skills and reasoning of learners in order to promote their progress toward independence in the clinical setting.1 Clinical teachers must diagnose both the patient's clinical problem and the learner's ability and skill."

"When it comes to OSCE exams and presenting cases, practice is essential. In order to develop these vital skills, doctors and students need to gain vital experience. Thankfully, there is now an app to help do this."

By considering clinical reasoning as a skill to be learnt rather than a concept to be understood, a framework for teaching this skill can be developed.

"Here are some of the reasons why students should be taking notes for themselves. The practice of note-taking develops several important skills-starting with listening. You can't take notes if you aren't listening. You need to be able to take decent notes because in most professional contexts, indeed in life, you are regularly in situations that require taking in and processing information that you need to remember and later apply. You can't always be asking people to give you a copy of what they just told you."

By considering clinical reasoning as a skill to be learnt rather than a concept to be understood, a framework for teaching this skill can be developed. The learner initially observes a consultation by the teaching clinician, followed by the teacher explaining the reasoning processes used including hypothesising, hypothesis testing, re-analysis and differential diagnosis. The student then comments on the reasoning of the teacher in a subsequent consultation, followed by feedback from the teacher on the student's reasoning in a third consultation.

St Georges School of Mediine London's YouTube channel which includes videos on clinical skills