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Year : 2011  |  Volume : 24  |  Issue : 2  |  Page : 489

Developing a Self-directed Workbook Package for Clinical Skills Training of Medical Students

Faculty of Medicine, University of Colombo, Sri Lanka

Date of Submission17-May-2010
Date of Acceptance13-May-2011
Date of Web Publication10-Aug-2011

Correspondence Address:
P Ranasinghe
9/2, Sirigal Avenue, Kohuwala
Sri Lanka
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Source of Support: None, Conflict of Interest: None

PMID: 22081653

How to cite this article:
Ranasinghe P, Perera Y S, Lamabadusuriya D A, Constantine G R, Ponnamperuma G G. Developing a Self-directed Workbook Package for Clinical Skills Training of Medical Students. Educ Health 2011;24:489

How to cite this URL:
Ranasinghe P, Perera Y S, Lamabadusuriya D A, Constantine G R, Ponnamperuma G G. Developing a Self-directed Workbook Package for Clinical Skills Training of Medical Students. Educ Health [serial online] 2011 [cited 2022 Jan 24];24:489. Available from:

Dear Editor,

Over the last few decades a significant change has occurred in the focus of medical curricula, from acquisition of knowledge to achievement of competence1. Thus, achievement of competency in clinical and technical skills has become an important facet of present day competency-oriented medical curricula2. The challenge has been to find instruments that formatively support the development of competence in an integrated, coherent and longitudinal fashion, and summatively assess whether competence is being achieved3.

Traditionally, students have found it difficult to make the links between university and clinical-based skills learning. The acquisition of competency is often hindered by obstacles such as lack of proper learning resources, insufficient stimulation for learning and inadequate supervision.†Medical schools in developing countries like Sri Lanka often lack funding to provide skills training using training models, such as mannequins. As a result, skills training and assessments are given a lesser priority in education in developing countries. Workbooks are often used for discipline-specific, self-directed learning in academic institutions, but there is also growing recognition of their potential utility in the clinical setting to promote both learning and professional development.

Students graduating from the Faculty of Medicine, University of Colombo, Sri Lanka complete a five-year training programme, where clinical exposure begins after the third year. This brief report presents the key concepts of the development process of such a skills workbook package for medical undergraduates at the Faculty of Medicine, and shares some tips and guidelines for those clinical staff interested in developing self-directed learning programmes using a workbook approach.

The outcome-based curriculum design model was utilized for the development of skills workbook packages. Traditional educational practices center on 'inputs', where learners are exposed to a segment of the curriculum over a specified time. In contrast, the outcome-based approach specifies the 'outcomes' students are expected to demonstrate upon completion of a specific learning task4. In recent years this approach has received increasing attention worldwide1. In the outcome-based approach, the educational outcomes are clearly and unambiguously specified, which also provides the framework for evaluation5.

Before embarking upon workbook development, it is important to identify the target group and determine their needs to establish priorities as well as set programme goals and objectives.†Medical undergraduates engaged in clinical training (3rd to 5th year) at the Faculty of Medicine, University of Colombo were the target group. A needs assessment, using a survey, was conducted in a cohort of 100 student representatives of the target group to examine study habits, perceptions of learning, previous participation in self-directed learning, pre-existing study skills and abilities, and barriers to skills development. A stakeholder analysis, based on the needs assessment, identified essential stakeholders in the development process.

A working committee of eight members with a nominated coordinator from each stakeholder group was involved in the development. The contents of the skills workbook package were designed allowing for individual flexibility by using a series of exercises. The workbook contained an overview on how to use the book, core objectives and a table of contents, followed by the educational content and finally by a brief list of references. A list of skills was categorized into chronological order based upon the current teaching schedule. Each skill was preceded by a brief one-page introduction, with an adjacent page to be filled out by the students who were expected to practise skills during their clinical training sessions. The students were required to describe the preparation, precautions taken, how the procedure was performed and problems encountered. The level of competence required for each skill was highlighted (Table†1).

Table†1:††Required competence level for each skill

After triangulation of the data collected from the seven stakeholder groups, core competencies, goals, objectives and outcomes were developed. The overall goal was: 'Producing a medical graduate who is prepared to serve the fundamental purposes of medicine with competency'.

  • Corresponding objectives were: Nurture a medical graduate competent in performing skills required of a medical practitioner.
  • Help prepare for assessments by using the workbook as a learning resource.
  • Provide a flexible, self-paced learning tool to allow for individual learning styles.
  • Agree upon outcomes were: Ability to perform routine technical procedures with competency and interpret results of commonly used diagnostic tests.
  • Knowledge of the most frequent clinical, laboratory and pathological manifestations of common maladies.
  • Ability to reason deductively in solving clinical problems and to construct appropriate management strategies (both diagnostic and therapeutic) for patients with common diseases.
  • Ability to recognize patients with immediately life-threatening conditions regardless of etiology

The skills workbook package was approved by the curriculum development committee at the Faculty of Medicine, Colombo and was recommended for students after incorporating modifications recommended by the committee. The development of the package was a lengthy process. Project development, along with being costly in terms of time, also stretched existing abilities and resources. The study substantiates the educational value of the package as a flexible, self-paced, self-directed additional teaching and learning resource. Yet, it is inherently difficult during vocational programmes to provide students with a true representation of what they are likely to encounter.

Further long-term evaluation through measurement of quantifiable objectives and improvements in patient care attributable to knowledge acquired from the clinical skill workbook will be undertaken by the authors in the future. Evaluation of the studentsí perceptions following a clinical placement would provide additional insight into the degree to which the package has aided in their development. The package will also require further evaluation by clinical educators of students in order to further validate the relevance and currency of the package.

Priyanga Ranasinghe, MBBS
Yashasvi Sanja Perera, MBBS
Dilusha Amiriti Lamabadusuriya, MBBS
Godwin Roger Constantine, MBBS, MD
Gominda Ponnamperuma, MBBS
Faculty of Medicine, University of Colombo, Sri Lanka


1.†Association of American Medical Colleges. Report 1. Learning Objectives for Medical Student Education, Guidelines for Medical Schools. Medical Schools Objectives Project. Washington, DC: AAMC; 1998.

2.†Schwarz MR., Wojtczak A. Global minimum essential requirements: A road towards competence-oriented medical education. Medical Teacher. 2002; 24(2):125-129.

3.†Miller GE. The assessment of clinical skills/competence/performance. Academic Medicine. 1990; 65(9):63-67.

4.†Harden RM. AMEE Guide No. 14: Outcome-based education: Part 1-An introduction to outcome-based education. Medical Teacher. 1999; 21(1):7-14.

5.†Ben-David MR. AMEE Guide No. 14: Outcome-based education: Part 3-Assessment in outcome-based education. Medical Teacher. 1999; 21(1):23-25.


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