Document Type: Original Article


Avalon University School of Medicine (AUSOM), Willemstad, Curacao


Introduction: There are two popular methods of clinical skills
teaching. One is Peyton’s method, and the other one is Robert
Gagne’s method. A hybrid model which is a combination of
both teaching methods is developed and implemented at Avalon
University School of Medicine in Clinical Skills. The aim of the
study was to evaluate the hybrid model of clinical skills teaching.
Methods: This is a quasi-experimental study where a control
group with a sample size of 26 was compared with two study
groups; one group included 24 participants, and as the other one
consisting of 16 subjects selected without randomization. All
students in the class were included in the study, except for those
withdrew voluntarily. The quantitative data were gathered in the
form of a questionnaire on the Likert scale which was collected
as the end of course evaluations. The quantitative data for the
responses on the Likert scale was analyzed for descriptive
statistics: Mean, Median, and Mode. The quantitative data also
included the students’ performance on assessments of clinical
skills which was analyzed using ANOVA test. The qualitative
data were gathered in the form of open-ended questions in the
end of course evaluations. The qualitative data were also collected
from the faculty members who were the examiners for the clinical
skills course as the feedback taken from them.
Results: There was a significant improvement in the feedback of
students (end of course evaluations) after implementing the hybrid
model of clinical skills teaching which was shown by increased
Mean, Median, Mode for the most pointers on the Likert scale.
Also, there was a notable improvement in the performance of
students with a significant p-value (p<0.05) on ANOVA test.
Conclusion: The hybrid model is very effective in teaching clinical
skills. This teaching method can be evaluated by replicating this
study at larger institutions with more number of students.


1. Bentall C, Allan H. Learning theories: A critique.
London: FAIMER Centre for Distance Learning,
CenMEDIC; 2017.
2. Race P, Brown S. The Lecturer’s Toolkit. London:
Kogan Page; 1998.
3. Peyton JWR. Teaching and Learning in Medical
Practice. Rickmansworth: Manticore Europe; 1998.
4. Gagné RM. The Conditions of Learning. New York:
Holt, Rinehart and Winston; 1977.
5. Horton B. ‘I hear and I forget, I see and I remember,
I do and I understand’ - putting learning models into
practice. Planet. 2001; 3(1): 12-4.
6. Cleland JA, Abe K, Rethans J. the use of simulated
patients in medical education: AMEE Guide No. 42.
Med Teach. 2009; 31(6): 477-86.
7. LaRochelle JS, Dong T, Durning SJ. Preclerkship
assessment of clinical skills and clinical reasoning:
the longitudinal impact on student performance. Mil
Med. 2015; 180 (4 Suppl):43-6.
8. Kirkpatrick DL. Evaluating training programmes:
The four levels. Philadelphia: Berrett-Koehler; 1998.
9. Kirkpatrick DL. Techniques for evaluation programs
-Part 2: Learning. Journal of the American Society of
Training Directors. 1959; 13(12): 21-6.
10. Norcini,J, Burch V. Workplace-based assessment as
an educational tool: AMEE Guide No. 3. Med Teach.
2007; 29: 855–71.

11. Miller GE. The assessment of clinical skills/
competence/performance. Acad Med. 1990; 65: 563-7.
12. Von Glasersfeld E. Radical constructivism: A way of
knowing and learning. London & Washington: The
Falmer Press; 1995.
13. Von Glaserfeld E. Constructivism in education. New
York: Pergamon Press; 1989.
14. Kolb DA. Experiential Learning: Experience as
the Source of Learning and Development. London:
Prentice-Hall; 1984.
15. Dongre A, Robinson C. Learning in the community.
London: FAIMER Centre for Distance Learning,
CenMEDIC; 2017.
16. Eldin M, Magzoub A, Schmidt HG. A taxonomy of
community-based medical education. Acad Med. 2000;
75(7): 699-707.