Acquisition of Competence in Clinical Practical Procedures: A Model of the University of Zambia Medical School

Aims: To explore how medical students acquired and developed competence in selected clinical practical procedures.

Study Design: Cross sectional qualitative study.

Methodology: Seventeen (17) students from a class of 60 final year University of Zambia Medical students of the 2012/2013 academic year participated in the in-depth interviews. The in-depth interviews were conducted using Grounded Theory approach.

Results: Twelve themes emerge on how medical students of the University of Zambia, learn and develop competency in clinical practical procedures. Eight of the themes describing the process of learning, while the other four describes the process of competency development. The eight themes on learning are: learning through formal teaching, informal teaching, observing/watching, demonstration, apprenticing, and being “put on the spot”. Other were learning passively and learning from reading medical literature. Themes for describing the process of competency development included; personal interest, more practice, reading literature and teaching others. From the twelve themes, a new model has been advanced called “Passive Observation to Peer Teaching Model” of clinical procedural skills acquisition and competency development which describes how Medical students of the University of Zambia-acquired and developed competence in clinical practical procedures.

Conclusion: The model generated from our study can be seen as an expanded version of the “see one, do one and teach one approach” with an expansion of the “doing one” which in our model is first guided then unguided. One notable difference between existing models and that from our study is, while existing models focus on actual manipulations to perform a psychomotor skill, our model focuses on the process of acquiring and developing competency.