National Clinical Skills Competition for Medical Students in China

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To the Editor:
Competency-based medical education has emerged as a core strategy to educate and assess the next generation of physicians. To advocate the advanced educational philosophy and methodology and to guide and promote the development of clinical medical education reform in China, the Research Center of Clinical Medical Education of the Ministry of Education (RCCME), People’ Republic of China, has held a national clinical skills competition for medical students (hereafter referred to as the competition) for 6 consecutive years since 2010. We summarize the competitions and provide the referential experiences for medical education in other countries.
The competitions were sponsored by the RCCME and hosted by different colleges. Use of human patient simulation and validation of the Team Situation Awareness Global Assessment Technique: a multidisciplinary team assessment tool in trauma education. Because it is a college level competition, each college selected four students (448–468 students in total) at the stage of clinical practice to represent their college. The competition was divided into divisional matches and the national final. All colleges participated in the divisional matches held in April each year. The top 29% to 37% of colleges in each divisional match (32–42 colleges with 128–168 students) were selected to enter the national final held in May each year. The college rankings were determined in the final.1
The competition involved simulation-based assessment. It consisted of two forms: Objective Structured Clinical Examination and the “Track Contest.” The Track Contest was similar to a 100-m race, with three to six tracks in parallel and four to six test stations on each track. Each track accommodated one team with four players, who would pass through all the stations sequentially in accordance with the requirements within a specified time. The divisional matches mainly used Objective Structured Clinical Examination with approximately 20 to 30 stations, which might take 1 day to finish all the tests.2 The finals always used the Track Contest with approximately 25 to 36 stations, which might take 2 days to finish all the tests. Each station simulated the clinical scenario through task trainers, high-fidelity simulators, or standardized patients.1
The scope of the competition covered approximately 100 clinical skills from internal medicine, surgery, gynecology and obstetrics, and pediatrics. The RCCME and the hosts asked the experts to design the competition questions and the scoring criteria. Both technical skills (such as history taking, physical examination, thoracocentesis, peritoneocentesis, lumber puncture, bone marrow puncture, incision, sutures, knotting, removal of stitches, changing dressings, basic life support, pelvic examination, and neonatal nursing), nontechnical skills (such as clinical reasoning, communication, and teamwork), and professionalism were evaluated.1 Most of the tests were scenario based. The competition highlighted the evaluation of knowledge, skills, and attitudes. The questions in the finals were more difficult than those in the divisional matches with more comprehensive scenarios. The mean score of the stations varied greatly from 4% to 98% in the finals, with a mean (SD) of 57% (18%). The score was usually high in questions evaluating technical skills only but low in questions evaluating both technical skills and nontechnical skills.
The competition has been well accepted in China.3 It has been organized annually since 2010. To summarize and improve the competition, we conducted a nationwide survey in 2015 to evaluate the effects and difficulties of hosting the competition. Eight hundred eighty questionnaires were distributed to 110 participating colleges. The interviewees included teachers, administrative staff, and students. In total, 752 valid responses were received from 95 colleges. Most interviewees agreed that the competition had a positive role in the adoption of advanced educational principles, promoting faculty development and improving educational resources.
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