In the current study, a comprehensive researcher-made questionnaire was prepared based on the opinions of experts and curriculum designers while considering all relevant resources and literature which is a unique tool in Iran regarding the expansiveness of the scope. The prepared tool was then used to evaluate the activities of the clinical skills training center in 5 areas 1) program goals and content, 2) tools and equipment, 3) educational processes, 4) environment and physical location and 5) long-term effects of the curriculum.
The first part of the evaluation tool prepared in the current study aims to assess the achievement of program goals according to the consumers. CSTC is suitable for training basic and practical skills which are often neglected due to time constraints during the students’ presence in clinical environments (6). The factors investigated in this area using the current tool included basic skills such as patient interview, basic resuscitation, clinical examination, practical clinical activities, interpretation of essential clinical findings, prescription skills and patient management.
Other studies have also investigated similar factors. For example, Imrani et.al. in their study evaluated the attitude of students towards this center and stated that participation in Skill Lab sessions in the pre-clinical years will assist students in their clinical year to achieve better overall performance, as well as better communication skills and self-esteem (1). Another study showed that the majority of students prefer participation in skill lab for learning essential clinical skills such as venous blood sampling, catheterization, endotracheal intubation, listening to respiratory sounds, genital examination, etc. compared to directly performing these procedures on patients (2). The current study investigated some of these factors. According to previous studies, the majority of students preferred participation in pre-clinical straining in these centers due to the advantages of skill labs for learning clinical skills (3).
The second area of an evaluation tool for CSTC included the assessment of educational tools and equipment such as educational mannequins and models, medical examination devices (Stethoscope, sphygmomanometer, otoscope and ophthalmoscope), medical consumables, audio-visual equipment and information technology facilities. According to the studies, a common factor in CSTCs is access to a wide range of tools in each university as well as using updated technologies for education. These innovations have even resulted in the improved academic ranking of some colleges and medical universities in the world (11).
The third area of educational processes consisted of evaluating factors such as the length and number of workshops, the effect of CSTC on teaching in a clinical environment, the effect of the center on increasing the motivation and interest in clinical topics, use of volunteer patients and actors and use of modern teaching and assessment methods. This area evaluates the educational process as an important part of clinical training. The importance of this area is also confirmed in other studies. CSTC enables students, including interns and new students, to practice procedures without fearing the consequences. Furthermore, there is also no time of ethical constraints in these practices, enabling the students to be trained in treatment procedures and physical examinations which can be dangerous or painful for the patient (2). In this regard, the standardized patient is one of the popular methods used in universities around the world. For example, the University of Massachusetts had been using standardized patients as an education and assessment tool and even as clinical trainers for more than 20 years (8). Another example is the simulation center of Grand Valley State University, which provides significant tools for the management of standardized patients, including registration and deployment of standardized patients as needed. This center has designed a website for the registration of standardized patients, which allows individuals to register based on certain criteria, before being trained and deployed according to the protocols (8).
The effectiveness of clinical skill training centers on motivation was presented in a study by Hashimi et.al on the effects of clinical skill training centers on medical education. According to the results of this study, 84 to 89 per cent of students believed that these centers increase the motivation for medical education as well as interest in learning clinical skills (3). In regards to the use of modern methods, one of the most recent examples is the use of clinical simulations using multimedia tools and software which can be used for improving psychological and psychomotor skills. Studies have shown that these centers also lead to improved motivation and independent learning tendencies among students (12).
In the section related to the evaluation of the environment and physical location in the current tool, accessibility, flexibility in application, similarity to a real environment, specialized training spaces, receiving feedback and use of multimedia technologies are evaluated. These factors are extracted according to the opinions of experts and stakeholders and have been used in similar studies. According to the standard for clinical skill training centers presented by the Ministry of Health, Treatment and Medical Education, the preferred physical location for a clinical skill training center includes a large area with a flexible application as well as a wardroom, nursing station, ICU or smaller rooms with specialized applications such as operation room and resuscitation room. Furthermore, a clinical skill training center must have access to a suitable location for providing students with multimedia education (8). In
Some of the largest students in the world, such as John Hopkins University, have access to equipment for the simulation of large operations, equipped with monitoring and video systems (11). Furthermore, certain clinical skill Another example is the study done by James et al., which has shown effectiveness of an experimental pharmacology skill lab to facilitate training of specific modules for development of core competencies of parenteral drug administration and intravenous drip settings using mannequins for development of skills in administering injections for undergraduate medical students (12). These factors were included in the evaluation questionnaire prepared in the current study. In the study by Heshimi et.al., 62 participants believed that the time constraints and pressure of the clinical environment were not present in CSTC during learning clinical skills. Therefore, these centers can help students improve their skills by making them feel secure and resolve their concerns about the consequences of their actions. According to the students participating in this study, approximately 70 to 75 per cent of students felt more secure regarding mistakes and less worried about harming patients during clinical procedures after training clinical skills on mannequins available at clinical skill training centers (3).
The fifth area includes evaluating the long-term effects of education and evaluating the conformity between the center’s curriculum and educational needs, the effect of the center on improving essential skills, the effect of curriculum on interest, stress and facilitating clinical procedures. Ji He Yu et.al. observed that after training in a clinical skill training center and simulations, students show a significantly lower level of anxiety and a significantly higher level of self-esteem compared to before the training. Furthermore, after experiencing the simulation, students without previous simulation experiences showed lower anxiety and higher self-esteem (13). In a systematic review by Alanazi et.al., evidence showed that participation in CSTC and using simulation can significantly improve the knowledge, skill and self-esteem of medical students (14). Furthermore, a study by Younes et.al. showed that adding a simulation program to a normal psychology curriculum improves the quality of education and the self-esteem of medical students (15). In another study, Heshimi et.al. showed a positive attitude among the students regarding the effectiveness of clinical skill training centers for improving skills, self-esteem as well as learning new clinical skills (3). Therefore, based on the role of clinical skill training centers in improving the motivation and self-esteem of students presented in previous studies, these factors can be important in the evaluation of clinical skill training centers and therefore included in the evaluation questionnaire.