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Year : 2008  |  Volume : 21  |  Issue : 1  |  Page : 191

In the News! An Opinion - Not in the News (2)

Associate Editor, Education for Health, The Netherlands

Date of Web Publication12-Jan-2013

Correspondence Address:
J van Dalen
POB 616, 6200 MD Maastricht
The Netherlands
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Source of Support: None, Conflict of Interest: None

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How to cite this article:
van Dalen J. In the News! An Opinion - Not in the News (2). Educ Health 2008;21:191

How to cite this URL:
van Dalen J. In the News! An Opinion - Not in the News (2). Educ Health [serial online] 2008 [cited 2023 Jun 4];21:191. Available from:

At an earlier occasion I addressed the knowledge base underpinning the clinical skills that we train at health professions schools (van Dalen, 2007). It is fairly shocking to see that for many clinical skills the evidence is not very strong or sometimes even lacking at all. I promised that the next time I would address the evidence of how we train clinical skills.

Here we go.

In the past decades health professions education has been in a revolution. Many new insights, mainly from cognitive psychology, have been put into practice to renovate our educational formats. We now know much more about how people learn, how we store new information in our memories and how we find stored information back. The strong influence of 'giving meaning' to new information has become clear: we remember new things better when we can connect the new information to prior knowledge. We can better retrieve information in situations that resemble the place and circumstances where we learned the new information.

'Elaboration' and 'transfer' have become keywords in shaping our curricula. Building upon prior knowledge is more likely when a curriculum is integrated, compared to a compilation of isolated components. Learning should not (only) be directed at reproducing factual knowledge but also at understanding the new information.

Teachers' roles are changing accordingly. From our initial task of lecturing (presenting) and demonstrating (modeling) there is now an increased demand for coaching, to help the students discover new information and connect it to their prior knowledge. Eventually the teachers should reduce their influence (fading), so that students become self-directed life-long learners. These insights have been used to create the new educational paradigm, known as constructivism. The constructivistic principles have led to the new educational format: problem-based learning (PBL). Nowadays PBL has been realized in many health professions schools world-wide.

When we look at the curricula of PBL-schools we see that the constructivistic principles have mostly been realized for the theoretical part of the curriculum or cognitive domain. But next to the teaching of knowledge, most of the 'PBL-schools' provide a clinical skills training facility, often known as the Skills Lab.

Looking into the teaching formats of clinical skills training facilities, we see that skills training is conducted and described with fixed guidelines.

  1. Before the training students are supposed to prepare for the topic of training;
  2. The training starts with a demonstration, most often by the teacher;
  3. Students then have the opportunity to practice;
  4. Practicing is possible in increasingly complex circumstances:
    1. with manikins;
    2. with each other;
    3. with simulated patients; and finally
    4. with patients;
    While the students practice the teacher gives formative feedback. The teacher compares the students' performance to the pre-defined criteria: the 'golden standard';
  5. The students' performance is summatively assessed with an Objective Structured Clinical Examination, usually once a year.
In these guidelines (lesson plans, training manuals) very few of the constructivistic educational principles can be recognized.

Interestingly, the constructivistic principles are well recognized in the teaching of knowledge, but apparently have not found their way into the training of clinical skills. This is particularly striking since clinical skills training centers are most often found in 'PBL-schools'.

I don't want to advocate that we make a change uncritically and start adopting constructivism as the best educational paradigm for skills training per se. We don't know if it is. However, I do want to make a plea for conducting research to find out which educational approach might work better for which type of skill. Or perhaps we should aim to be flexible, and have alternative approaches for all skills trainings…?

Jan van Dalen

Associate Editor Education for Health


van Dalen, J. (2007). In the News! An Opinion - Not in the News. Education for Health, 20:3. Available from:


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