Medical Students’ Knowledge of Clinical Practical Procedures: Relationship with Clinical Competence


Clinical competence is an attribute expected of every practicing doctor while proficiency in procedural skills is a requirement by certifying bodies. To attain competency in the performance of procedural/psychomotor skills, possession of conceptual knowledge has been documented as a fundamental pre-requisite in reference to medical education literature. At the University Of Zambia School Of Medicine, the matter of cognitive knowledge in relation to competence in clinical practical skills for undergraduate medical students was investigated in a project which was conducted in 2013. Fifty-six (56) students from a class of 60 (93% response rate) of the final year medical students’ class of 2012/2013 completed a Multiple Choice Question (MCQ) knowledge test which was administered to ascertain the level of knowledge on 14 selected clinical practical procedures. Knowledge levels of clinical practical procedures of the final year medical students were found to be inadequate represented by a 39% pass rate with students’ scores lower than the Angoff determined pass mark on most items. Expectedly, students were more knowledgeable in those procedures where they were formally taught and those where there was a high likelihood of being assessed. The correlation between knowledge and self-perceived competence was positive Spearman rho of 0.360, while a negative correlation was recorded between knowledge and manifest competence (objectively measured competence) Pearson r .116. The positive correlation between knowledge and self-perception of competence is an indication of the role of knowledge in improving self-concept about a skill, which may consequently lead to improved performance.

Share and Cite:

Katowa-Mukwato, P. and Banda, S. (2014) Medical Students’ Knowledge of Clinical Practical Procedures: Relationship with Clinical Competence. Creative Education, 5, 1895-1904. doi: 10.4236/ce.2014.521212.

Conflicts of Interest

The authors declare no conflicts of interest.


[1] AAMC (Association of American Medical Colleges) (2008). Recommendations for Clinical Skills Curricula for Undergraduate Medical Education. Washington, DC: Association of American Medical Colleges.
[2] Amin, Z., & Hoon-Eng, K. (2003). Basics in Medical Education. New Jersey: World Scientific Publication.
[3] Bandura, A. (1997). Self-Efficacy: The Exercise of Control. New York, NY: Freeman
[4] Birnbaumer, D. M. (2011). Teaching Procedures: Improving “See One, Do One, Teach One”. CJEM, 13, 390-394.
[5] Buckley, B. S., Manalo, M., & Lapitan, M. C. M. (2011). Medical Interns’ Knowledge and Training Regarding Urethral Catheter Insertion and Insertion Trelated Urethral Injuries in Male Patients. BMC Medical Education, 11, 73.
[6] Canadian Association of Medical Technologists (2006). Angoff Method of Standard Setting for Licensure and Certification Examination. Canada: Canadian Association of Medical Technologists.
[7] Carr, S. J. (2004). Assessing Clinical Competences in Medical Senior House Officers: How and Why Should We Do It? Postgraduate Medical Journal, 80, 63-66.
[8] Colberly, L., & Goldenhar, L. M. (2006). Ready or Not, Here They Come: Acting Interns, Experience and Perceived Competency Performing Basic Medical Procedures. Society of General Internal Medicine, 22, 491-494.
[9] Duvivier, R. J., van Dalen, J., Muijtjens, A. M., Moulaert, V. R. M. P., Van der Vleuten, C. P. M., & Scherpbier, A. J. J. A. (2011). The Role of Deliberate Practice in Acquisition of Clinical Skills. BMC Medical Education, 11, 1011.
[10] Elango, S., Jutti, C. R., Kandasami, P., Teng, L. C., Loh, L. C., & Motilal, T. (2007). Assessment of Basic Skills in an Undergraduate Medical Curriculum. LeJSME, 1, 41-45.
[11] Epstein, M. (2007). Assessment in Medical Education. New England Journal of Medicine, 356, 387-396.
[12] Epstein, R. M., & Hundert, E. M. (2002). Defining and Assessing Professional Competence. JAMA, 287, 226-235.
[13] Ericsson, K. A. (Ed.) (2006). Cambridge Handbook on Expertise and Expert Performance. Cambridge: Cambridge University Press.
[14] Griffith, C. H., Wilson, J. F., Haist, S. A., & Lucier, M. (1997). Relationship of How Well Attending Physicians Teach to Their Students’ Performance and Residency Choices. Academic Medicine, 72, 118-120.
[15] Hakstian, R. A. (1971). The Effects of Type of Examination Anticipated on Test Preparation and Performance. Journal of Educational Research, 64, 319-324.
[16] Hamdorf, M. J., & Hall, J. C. (2000). Acquiring Surgical Skills. British Journal of Surgery, 87, 28-37.
[17] Institute for Health Care Improvements (2010). Improving Outcomes for High Risk and Critically Ill Patients.
[18] Kopta, J. A. (1971). An Approach to Evaluation of Operative Skills. Surgery, 70, 297-303.
[19] Lai, N. M., Sivalingam, N., & Ramesh, J. C. (2007). Medical Students in Their Final Six Months of Training: Progress in Self-Perceived Clinical Competence, and Relationship between Experience and Confidence in Practical Skills. Singapore Medical Journal, 48, 10178-1027.
[20] Miller, G. (1990). The Assessment of Clinical Skills/Competence/Performance. Academic Medicine, 65, S63-S67.
[21] Moercke, A. M., & Eika, B. (2002). What Are the Clinical Skills Level of Newly Graduated Physicians? Self-Assessment Study of an Intended Curriculum Identified by a Delphi Process. Medical Education, 36, 472-478.
[22] Morris, M. C., Gallagher, T. K., & Ridgway, P. F. (2012). Tools Used to Assess Medical Students Competence in Procedural Skills at the End of Primary Care Medical Degree: A Systematic Review. Medical Education Online, 17, 18398.
[23] Newble, D. I., Joly, B. C., & Workford, R. E. (Eds.) (1994). The Certification and Recertification of Doctors: Issues in the Assessment of Clinical Competence. Cambridge: Cambridge University Press.
[24] Promes, S. B., Chudgar, S. M., Grochowski, O. C., Shayne, P., Isenhour, J., Glickman, S. W., & Charles, C. B. (2009). Gaps in Procedural Skills and Competency in Medical School Graduates. Academic Emergency Medicine, 16, S58-S62.
[25] Wass, V., Van der Vleuten, C., Shatzer, J., & Jones, R. (2001). Assessment of Clinical Competence. The Lancet, 357, 945-949.
[26] Wimmers, P. F., Schmidt, G. H., & Splinter, T. A. (2006). Influence of Clerkship Experience on Clinical Competence. Medical Education, 40, 450-458.
[27] Wu, H. E., Elnicki, M., Alper, E. J., Bost, E. J., Corbett, E. C., Fagan, M. J., Mechaber, A. J., Ogden, E. P., Sebastian, L. J., & Torre, D. M. (2008). Procedural and Interpretive Skills of Medical Students: Experiences and Attitudes of Fourth-Year Students. Academic Medicine, 83, S63-S67.

Copyright © 2023 by authors and Scientific Research Publishing Inc.

Creative Commons License

This work and the related PDF file are licensed under a Creative Commons Attribution 4.0 International License.