|Year : 2020 | Volume
| Issue : 2 | Page : 77-81
Early clinical exposure during medical school: Omani medical students and interns experience
Tariq Al-Saadi1, Ali Al-Sharqi2, Al-Salt Al Kharosi2, Malik Alshaqsi2, Mattar Al Badi2, Taha Al-Kalbani2
1 Department of Neurology and Neurosurgery, Montreal Neurological Institute, McGill University, Montreal, Canada; Department of Neurosurgery, Khoula Hospital, Muscat, Oman
2 College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Oman
|Date of Submission||24-Apr-2020|
|Date of Acceptance||04-May-2020|
|Date of Web Publication||27-Jul-2020|
Dr. Tariq Al-Saadi
3801 Rue University, Montreal, QC H3A 2B4
Source of Support: None, Conflict of Interest: None
Introduction: Early clinical exposure (ECE) is a teaching learning methodology, which fosters the exposure of the medical students to the patients as early as the 1st year of medical college. A hospital-based educational system provides the exposure to the clinical environment by direct contact with patients, including bedside teaching and applying skills and knowledge. Aim: evaluate the impact of ECE of Omani medical students on their attitude, knowledge, and skills. Methods: A cross-sectional study. A designed questionnaire was sent to more than 500 Omani medical students in Sultan Qaboos University (SQU) and National University (NU). The questionnaire consists two sections. The first section included personal demographic information. The second part included questions to evaluate the quantity and quality of ECE and questions directed toward knowing the current perception of Omani students toward the importance of ECE in terms of developing knowledge and skills. Fifteen questions were asked in the questionnaire. Results: There were a total number of 191 students who participated in this study with a response rate of 44%. The vast majority of them were females represented 73.8. Nearly 63.4% were from SQU and 31.8% were from NU. Sixty-eight percent of the participants are in their 5th, 6th, 7th year, intern, and postintern academic status. There is a significant relationship between getting clinical exposure during preclinical years and fast adaptation in early clinical years with P < 0.05. Conclusion: ECE is a vital part of the preclinical curriculum and should be further enhanced by creating more opportunities to receive clinical and practical training in hospitals.
Keywords: Education, interns, knowledge, medical students, Oman, skills
|How to cite this article:|
Al-Saadi T, Al-Sharqi A, Al Kharosi AS, Alshaqsi M, Al Badi M, Al-Kalbani T. Early clinical exposure during medical school: Omani medical students and interns experience. Educ Health Prof 2020;3:77-81
|How to cite this URL:|
Al-Saadi T, Al-Sharqi A, Al Kharosi AS, Alshaqsi M, Al Badi M, Al-Kalbani T. Early clinical exposure during medical school: Omani medical students and interns experience. Educ Health Prof [serial online] 2020 [cited 2020 Aug 14];3:77-81. Available from: http://www.ehpjournal.com/text.asp?2020/3/2/77/290917
| Introduction|| |
Early clinical exposure (ECE) is a teaching learning methodology, which fosters the exposure of the medical students to the patients as early as the 1st year of medical college., The clinical training is an essential part of the medical profession education process as most of the physician's clinical skills are obtained from the clinical experiences., Hospital-based educational system provides the exposure to the clinical environment by direct contact with patients, including bedside teaching and applying skills and knowledge.,, The clinical exposure of medical students is organized by the guided program provided by each facility. The main goals of those programs are helping students to cope with stress and improving their clinical skills.,,, Furthermore, ECE helps students in the integration between their knowledge and clinical skills which enhances their understanding and interest.,,
The 1st year of medical education are important in the training of medical student by providing the essential knowledge and implanting their clinical skills. However, most of medical curricula provided the theoretical knowledge without direct exposure to patients. On the other hand, medical students tend to have difficulties in recalling basic science in their clinical training which eventually creating a gap between their knowledge and skills.,, Moreover, inadequate psychological preparation of students for stressful working environment makes them more anxious and stressed. The incoordination between the theoretical knowledge and clinical training prevents students from being able to efficiently and effectively incorporate in the hospital environment.
In Oman, there are two facilities for medical education: College of Medicine in Sultan Qaboos University (SQU) and Oman Medical College at National University (NU). The curriculum consists of foundation program, 6 years of medical education and an internship year after graduation. The 6-years medical education is divided into 3-years of theoretical knowledge and another 3-years of full clinical training. Although the program in SQU differs from that in NU, the amount of clinical exposure is being almost the same. SQU and NU curricula consist of elective program, maximum of 2 months, which allow the students to be trained as intern doctors in Oman or outside the country as per the student's choice.
The barriers of ECE include the clinical setting limitation of facility, theoretical exposure dominating over clinical exposure, lack of appropriate excess to health providers, stressful environment and lack of attention to medical students., The success of ECE programs requires stated specific learning objectives, optimal classroom setting, observation guides, and feasible projects for community setting.
There is various paper studied the quality and impact of ECE from the viewpoint of medical students. Some of those studies reported that students who exposed to early clinical experience before the clinical phase were more comfortable in hospital, more confident in performing clinical tasks, and had more educationally valuable rotations. In contrast, those who had less clinical exposure were less comfortable, less confident, and less educationally valuable rotations.
Long-term evaluation and assessment can be done using comparing the result of class with and without ECE or using Objective Structured Practical Examination/Objective Structured Clinical Examination for the assessment of clinical skill., However, there is a lack of experimental papers on the impact of ECE. There is no documented paper studied the impact of ECE on students' skills in Oman. The present paper is designed to evaluate the impact of ECE of Omani medical students on their attitude, knowledge, and skills. However, it isn't discussing the difference of clinical exposure between SQU and NU.
| Methodology and Study Design|| |
This research was done using a cross-sectional survey. A designed questionnaire was sent to more than 500 Omani medical students in SQU and NU. The questionnaire was of two sections. The first section included personal demographic information, including gender, year, and place of study. The second part included questions to evaluate the quantity and quality of ECE and questions directed toward knowing the current perception of Omani students toward the importance of ECE in terms of developing knowledge and skills. Fifteen questions were asked in the questionnaire. With (yes or no) questions dichotomous agreement scale (1: Agree and 2: Disagree) were used for scoring, as it is shown in [Table 1] which represents the survey.
Collected data were analyzed by using the IBM Statistical Package for the Social Sciences 23 program (SPSS v21 Inc, Chicago, Illinois, USA). The participants were categorized according to gender (male and female), place of study into two groups (SQU students and NU students). In addition, they were grouped according to the year of study into eight groups. Sample t-test was used to find the relationship between ECE during preclinical years and its impact during clinical years. P<0.05 was considered for the statistical significance.
| Results|| |
[Table 2] shows the demographics information of the participants. There was a total number of 191 students participated in this study with response rate of 44%. The vast majority of them were female. Nearly 63.4% were from SQU and 31.8% were from NU. Sixty-eight percent of the participants are in their 5th, 6th, and 7th year intern and postintern academic status.
The following bar chart [Figure 1] represents the percentage of students who are in their clinical years (i.e., 5th and above) who got clinical exposure during their preclinical year according to place of study. Thirty-nine (41.4%) students out of 94 who participated from SQU got clinical exposure during preclinical year and 55 (58.6) students did not get exposure. This is considering high in comparison to the medical students in NU.
|Figure 1: Percentage of students who are in clinical phase and got clinical exposure during preclinical year|
Click here to view
[Table 3] represents the relationship between ECE during preclinical years and its impact during clinical years. As it is shown in the table, there is no significant relationship between getting clinical exposure and better understanding of topics, fast adaptation in early clinical years, and presenting cases to senior doctors (P = 0.193, 0.221, 0.645 respectively). However, there is significant relationship between getting clinical exposure during preclinical years and fast adaptation in early clinical years with P < 0.05.
|Table 3: Relationship between early clinical exposure during preclinical years and its impact during clinical years|
Click here to view
[Table 4] shows the impact of ECE on different skills and abilities of the participants. As it is demonstrated, 95.4% of participant agreed that ECE creates interest and motivation in reading more about clinical topics and 96.9% agreed that it is important to makes students more familiar of different medical fields. Around 83% of the participant agreed that ECE has an impact in deciding future career. In addition, 71.8% agreed that ECE helps in stress reduction during studying.
|Table 4: Impact of early clinical exposure on different skills and abilities of the participant|
Click here to view
| Discussion|| |
As medical education being updated to new modules and curricula, including ECE with defined objectives and outcomes, there is a need to understand the importance of the phase and to set an effective objectives to achieve the stipulated goals., By integrating student's basic sciences and clinical application, will enable them to obtain wider and much deeper understanding of their theory medical knowledge.
The present study was designed to evaluate the impact of ECE in the knowledge and skills of Oman medical students and internes. In Oman we have two medical institutes as mentioned previously SQU and NU, both have 7 years curriculum for MD. SQU students start their clinical exposure in their 4th year, while NU's student start at their 5th year, however both start their exposure to simulated patients as early as 3rd year in SQU and 4th year in NU. Having facilities limitation, domination of theoretical exposure, lack of appropriate excess to health providers, stressful environment and lack of attention to medical students could explain why thirty-nine out of ninety-four (55%) of SQU's students did not get any clinical exposure during their preclinical years.
Previous studies showed that ECE increase student's enthusiasm and motivation toward their medical study and helped them understanding their responsibilities.,, Moreover, Results of our study suggested that the educational intervention in ECE is more favorable regardless of their clinical exposure statues. However, approximately 91.5% of the respondents who received some clinical exposure during preclinical years agreed that ECE is better for understanding topics than lecture classes and around 8.5% of the participants disagreed that ECE helps in fast adaptation in early clinical years. In addition, there was small percentages of the participants who disagreed that ECE helps to relate and link basic sciences with clinical findings.
Overall, a vast majority of the participants had good perceptions on the ECE module and there is a significant relationship between ECE and better understanding of theoretical knowledge, responsibilities as a future doctor and impacting their decision of future career which were proven in the previous studies.
Limitations and recommendations
Like other cross-sectional studies, this study had multiple limitations. Among the most important of these limitations is lack of cooperation form students to participate in this study, which limits our sample size. Another limitation was, 1st, 2nd, 3rd and 4th year students who did not complete their preclinical years and the clinical experiences may affect their perception towards ECE module. However, we felt that the participant should at least completed one clinical year to allow for adequate reflection. As this was cross-sectional study, we couldn't measure the effectiveness of ECE which also consider as limitation.
This study will help in building a new foundation for the newer generation here in Oman, it will help the directors to notice that students may benefit from ECE during their study. our recommendations as follow:
- More opportunities must be created for students to receive an acceptable clinical and practical training in local hospital and health centers, with continuous evaluation to overcome any limitation or shortcoming
- We encourage medical curriculum directors to conduct an experimental study to measure the efficacy of ECE in preclinical years' students.
| Conclusion|| |
ECE is a vital part of the preclinical curriculum and should be further enhanced by creating more opportunities to receive the clinical and practical training in hospitals.
Lastly, we can explain the importance of the ECE in one line by Benjamin Franklin's words of wisdom: “Tell me and I forget, teach me and I may remember, involve me and I learn.”
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Elizabeth K. Observation during early clinical exposure – An effective instructional tool or a bore. Med Educ 2003;37:88-9.
Shah C. Early clinical exposure – Why and how? J Educ Technol Health Sci 2018;5:2-7. McLean M. Sometimes we do get it right! Early clinical contact is a rewarding experience. Educ Health 2004;17:42-52.
Afra B, Alizadeh M, Taghavi S, Bayrami HJ, Yari J. The impact of early clinical exposure on the knowledge and attitude of basic sciences medical students at Tabriz University of Medical Sciences. Res Dev Med Educ 2015;4:55-60. Sandra JL. Multiple-format sessions for teaching endocrine physiology. Adv Physiol Educ 2001;25:228-32. Dornan T, Bundy C. What can experience add to early medical education? Consensus survey. BMJ 2004;329:834.
Dornan T, Bundy C. What can experience add to early medical education? Consensus survey. BMJ 2004;329:834.
Rassouli M, Tafreshi MZ, Esmaeil M. Challenges in clinical nursing education in Iran and strategies. J Clin Excell 2014;2:11-22.
Abbasi M. Problems of clinical education according to junior and senior nursing students' viewpoint at Qom nursing and midwifery School in 2008. J Med Educ Dev 2008;2:42-7.
Shuid AN, Yaman MN, Kadir RAA, Hussain RI, Othman SN, Nawi AM, et al
. Effects of early clinical skills teaching on third year medical students' learning: The student perspective. Journal of Taibah University Medical Schemes 2015;10:26-32.
Dreyfus SE. The five-stage model of adult skill acquisition. B Sci Technol Soc 2004;24:177-81.
Schön DA. The Reflective Practitioner: How Professionals Think Inaction. London: Temple Smith; 1983.
Ebrahimi S, Kojuri J, Ashkani-Esfahani S. Early clinical experience: A way for preparing students for clinical setting. GMJ 2012;1:42-7.
Littlewood S, Ypinazar V, Margolis SA, Scherpbier A, Spencer J, Dornan T. Early practical experience and the social responsiveness of clinical education: Systematic review. BMJ 2005;331:387-91.
Dahle LO, Brynhildsen J, Fallsberg MB, Rundquist I, Hammar M. Pros and cons of vertical integration between clinical medicine and basic science within a problem-based undergraduate medical curriculum: Examples and experiences from Linköping, Sweden. Med Teach 2002;24:280-5.
Nello A, Bulaevsky I, Sheflin K, Rivera-Martinez S. Early Clinical Exposure Improves Medical Students Performance in Rotations. Old Westbury, NY: New York Institute of Technology College of Osteopathic Medicine; 2018.
Freeman J, Cash C, Yonke A, Roe B, Foley R. A longitudinal primary care program in an urban public medical school: Three years of experience. Acad Med 1995;70:S64-8.
Miller BM, Moore DE Jr., Stead WW, Balser JR. Beyond flexner: A new model for continuous learning in the health professions. Acad Med 2010;85:266-72.
Frank JR, Snell LS, Cate OT, Holmboe ES, Carraccio C, Swing SR, et al
. Competency-based medical education: Theory to practice. Med Teach 2010;32:638-45.
Abramovitch H, Shenkman L, Schlank E, Shoham S, Borkan J. A tale of two exposures: A comparison of two approachesto early clinical exposure. Educ Health (Abingdon) 2002;15:386-90.
Wartman S, Davis A, Wilson M, Kahn N, Sherwood R, Nowalk A. Curricular change: Recommendations from a national perspective. Acad Med 2001;76:S140-5.
Dyrbye LN, Harris I, Rohren CH. Early clinical experiences from students' perspectives: A qualitative study of narratives. Acad Med 2007;82:979-88.
[Table 1], [Table 2], [Table 3], [Table 4]