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      A qualitative evaluation of scalpel skill teaching of podiatry students

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          Abstract

          Background

          Degrees in health disciplines need a balance of theoretical knowledge and sufficient clinical practice to meet registration requirements, in particular those requiring specialist skills such as the use of scalpels and other small instruments, such as podiatry. However, despite this requirement there is a scarcity of literature and research to inform teaching of these particular manual clinical skills. Therefore, the aims of this study were to determine the current approaches being used to teach manual skills, in particular scalpel skills, in university podiatry programs in Australia and New Zealand, and to explore what issues, challenges and innovations exist.

          Methods

          A qualitative study, consisting of semi-structured interviews with staff at eight university podiatry programs in Australia and New Zealand was undertaken to determine how these skills are taught and evaluated, and how poor performers are managed. A conventional content analysis technique was used to analyse and code interview data, with the resultant categories reported.

          Results

          Approaches to teaching manual clinical skills, in particular scalpel skills, appear to be consistent between university programs in Australia and New Zealand in utilising didactic-style content, demonstration, physical practice on inanimate objects and real skin, and often the use of supplementary audio-visual material. The main reported differences between programs were in methods and processes of practice, with controversy regarding the use of inanimate objects versus real skin for practice.

          Conclusions

          Despite a lack of research and literature surrounding this topic, the approach to teaching is relatively consistent between programs with greatest disparity being the structure and duration of practice. Key issues for teaching staff in teaching manual skills were students’ clinical exposure, motivation, levels of anxiety and dexterity.

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          Most cited references35

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          Qualitative research and evaluation methods.

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            Motor skill learning and performance: a review of influential factors.

            Findings from the contemporary psychological and movement science literature that appear to have implications for medical training are reviewed. Specifically, the review focuses on four factors that have been shown to enhance the learning of motor skills: observational practice; the learner's focus of attention; feedback, and self-controlled practice. Observation of others, particularly when it is combined with physical practice, can make important contributions to learning. This includes dyad practice (i.e. practice in pairs), which is not only cost-effective, but can also enhance learning. Studies examining the role of the performer's focus of attention have consistently demonstrated that instructions inducing an external focus (directed at the movement effect) are more effective than those promoting an internal focus (directed at the performer's body movements). An external focus facilitates automaticity in motor control and promotes movement efficiency. Feedback not only has an informational function, but also has motivational properties that have an important influence on learning. For example, feedback after successful trials and social-comparative (normative) feedback indicating better than average performance have been shown to have a beneficial effect on learning. SELF-CONTROLLED PRACTICE: Self-controlled practice, including feedback and model demonstrations controlled by the learner, has been found to be more effective than externally controlled practice conditions. All factors reviewed in this article appear to have both informational and motivational influences on learning. The findings seem to reflect general learning principles and are assumed to have relatively broad applicability. Therefore, the consideration of these factors in designing procedures for medical training has the potential to enhance the effectiveness and efficiency of training.
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              Principles derived from the study of simple skills do not generalize to complex skill learning.

              We review research related to the learning of complex motor skills with respect to principles developed on the basis of simple skill learning. Although some factors seem to have opposite effects on the learning of simple and of complex skills, other factors appear to be relevant mainly for the learning of more complex skills. We interpret these apparently contradictory findings as suggesting that situations with low processing demands benefit from practice conditions that increase the load and challenge the performer, whereas practice conditions that result in extremely high load should benefit from conditions that reduce the load to more manageable levels. The findings reviewed here call into question the generalizability of results from studies using simple laboratory tasks to the learning of complex motor skills. They also demonstrate the need to use more complex skills in motor-learning research in order to gain further insights into the learning process.
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                Author and article information

                Contributors
                +61 8 8302 1274 , Ryan.Causby@unisa.edu.au
                Michelle.McDonnell@unisa.edu.au
                l.reed@qut.edu.au
                Caroline.Fryer@unisa.edu.au
                Susan.Hillier@unisa.edu.au
                Journal
                J Foot Ankle Res
                J Foot Ankle Res
                Journal of Foot and Ankle Research
                BioMed Central (London )
                1757-1146
                2 May 2017
                2 May 2017
                2017
                : 10
                : 21
                Affiliations
                [1 ]ISNI 0000 0000 8994 5086, GRID grid.1026.5, Sansom Institute for Health Research, , University of South Australia, ; GPO Box 2471, Adelaide, SA 5001 Australia
                [2 ]ISNI 0000 0000 8994 5086, GRID grid.1026.5, Alliance for Research in Exercise, Nutrition and Activity, , University of South Australia, ; Adelaide, SA 5000 Australia
                [3 ]ISNI 0000000089150953, GRID grid.1024.7, School of Clinical Sciences, , Queensland University of Technology, ; Kelvin Grove, QLD 4059 Australia
                Author information
                http://orcid.org/0000-0002-9236-9379
                Article
                202
                10.1186/s13047-017-0202-9
                5414220
                28469709
                d5f7289a-ef90-48d6-b4e5-eec0e4bf1dfd
                © The Author(s). 2017

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                : 2 December 2016
                : 24 April 2017
                Categories
                Research
                Custom metadata
                © The Author(s) 2017

                Orthopedics
                clinical education,manual clinical skills,skills acquisition,low-fidelity simulation,qualitative research,scalpel skill teaching

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