Medical education plays a pivotal role in cultivating skilled healthcare professionals capable of delivering high-quality patient care. A key component of this training involves the mastery of clinical procedural skills, which requires both theoretical understanding and hands-on practice. Undergraduate training competes with patient care and experimental research, mostly to the disadvantage of the training of clinical skills and competencies [1]. Historically, medical education has predominantly relied on didactic lectures and observational learning as the main methods for teaching procedural skills to undergraduate medical students. However, questions have been raised about the effectiveness of these traditional methods in ensuring comprehensive skill acquisition. Self-directed learning is difficult in clinical clerkship, the experimental studies demonstrated remarkable advantages to peer-learning in skills-lab [2].

The recent incorporation of skill laboratories into medical curricula represents an innovative approach to improving clinical procedure training. Skills lab training follows a structured teaching concept, takes place under supervision and in consideration of methodological-didactic concepts, ideally creating an atmosphere that allows the repeated, anxiety- and risk-free practice of targeted skills [3].

Simulation plays an important role in many fields of medical education [4]. Medical simulation offers numerous potential strategies for comprehensive and practical training, and safer patient care [5]. Using simulation to train students to perform better in emergencies and improve their decision-making shows promise but a further quantitative study is required [6].

There is a lack of well-designed trials addressing the crucial issues of transferability to clinical practice and retention of skills over time [7].

To address this gap, rigorous research is needed to evaluate the impact of skill laboratory training on students' acquisition of clinical procedural knowledge.

This study aims to explore the effectiveness of skill laboratory training versus conventional teaching methods in instructing third-year MBBS students on the insertion of Ryle’s tube, or nasogastric tube (NGT), in patients. Conducted at Gouri Devi Institute of Medical Sciences & Hospital (GIMSH), Rajbandh, West Bengal, the research involved 80 undergraduate MBBS students. Using standardized testing and statistical measures such as p-tests, the study systematically assessed the outcomes of these different teaching approaches.

The goal of this research is to provide evidence-based insights into the most effective methods for teaching procedural skills in medical education. The findings have the potential to inform curricular development and contribute to the continuous improvement of medical education practices in India and other regions.

AIMS AND OBJECTIVES

Aim: To investigate the significance of skill laboratory training on the academic performance of medical students.

Objectives

1. To assess the efficacy of skill laboratory training as a method of teaching as compared to standard didactic lecture by analyzing performance of third year undergraduate students of MBBS Batch in insertion of Ryle’s tube or NGT in manikins.
2. To assess the efficacy of skill laboratory training as a method of teaching as compared to standard didactic lecture by analyzing score obtained by students in multiple choice questions and practical demonstration of the procedure.

Research Question: Whether skill laboratory training can enhance learning of practical procedures in third year MBBS students at GIMSH, Rajbandh.

Null hypothesis (H0): Skill laboratory training does not enhance learning of practical procedures in MBBS students.

Alternate hypothesis (H1): Skill laboratory training enhances learning of practical procedures in MBBS students.

Study Design: Randomized Control Trial

Study duration: 8 months (February 2024 – September 2024)

Study participants and place: 80 MBBS Students enrolled at GIMSH, Rajbandh, West Bengal

Sampling and Measures

Randomization: Participants will be assigned to two groups, A and B, using a computer-generated randomization sequence or a lottery-based system. Allocation concealment will be implemented to reduce the potential for selection bias.

Intervention: Group A will receive traditional instruction through lecture slides and demonstration videos, while Group B will participate in training at the Skill Laboratory in GIMSH, Rajbandh. This training will involve lecture slides, demonstration videos, live demonstrations by an instructor using a mannequin, and hands-on practice by students on the mannequin.

Procedural Proficiency:

1. Scores on Practical Demonstration of Ryle's Tube Insertion: Each student will be evaluated based on their competence in executing the technique on a mannequin.
2. Objective Structured Clinical Examination (OSCE) scores: Students' performance will be assessed using an OSCE station specifically designed to measure their ability to insert a Ryle's tube.

3. Duration of procedure completion: The time taken by each student to finish the operation will be documented

Result: Comparison of the results between students who underwent conventional training and skill laboratory training for insertion of Ryle’s tube.

Mean marks obtained out of 20

10. Conventional group: 10.22
11. Skill lab group: 12.02

Figure 1: Comparison of the results between students who underwent conventional training and skill laboratory training for insertion of Ryle’s tube.

GROUP DESCRIPTION

INDEPENDENT SAMPLES T – TEST

The primary objective of this study was to evaluate the efficacy of skill laboratory training compared to conventional teaching methods in the acquisition of clinical procedural skills, specifically the insertion of Ryle’s tube (nasogastric tube, NGT), among third-year MBBS students. Conducted at Gouri Devi Institute of Medical Sciences & Hospital (GIMSH), Rajbandh, West Bengal, the study involved 80 students, divided equally between the two training modalities. The findings from this study are pivotal in understanding the benefits of modern educational interventions in medical training.

The skill laboratory group demonstrated superior performance in Ryle’s tube insertion compared to the conventional training group. The mean score for the skill lab group was significantly higher (12.02) compared to the conventional group (10.22), with a mean difference of 1.8. The median scores, identical to the means for the skill lab group and slightly higher than the mean for the conventional group, further emphasize the improved consistency and performance among students trained in the skill laboratory. Statistical analysis using an independent samples t-test revealed a tvalue of -5.292 and a highly significant p-value (<0.0001), indicating that the difference in performance between the two groups is not due to chance.

Skill laboratories offer a controlled environment where students can practice and perfect their procedural skills using advanced simulation technologies and anatomically accurate models.

The statistical analysis in this study supports the efficacy of skill lab training. The significant t-value (-5.292) and the p-value (<0.0001) indicate that the observed differences in performance are

statistically significant. The lower standard deviation (1.46) in the skill lab group compared to the conventional group (1.58) suggests that skill lab training produces more consistent results among

students. Additionally, the standard error of the mean difference (0.34) underscores the precision of our findings.

This study highlights the significant benefits of skill laboratory training over conventional methods for teaching clinical procedures, such as Ryle’s tube insertion, to medical students. The results indicate that skill lab training leads to higher performance, greater consistency, and increased confidence among students.

LIMITATIONS

Despite the promising results, this study has several limitations:

1. Small Sample Size: The study involved only 80 students, which may not be representative of the broader student population. A larger sample size would provide more robust data and improve the generalizability of the findings.
2. Single Institution: Conducting the study at a single institution (GIMSH) limits the external validity of the results. Future studies should include multiple institutions to capture a more diverse student population and learning environments.
3. Short-Term Evaluation: The study assessed students’ skills immediately after the training. Long-term follow-up studies are needed to evaluate the retention of skills and their application in clinical settings over time.
4. Limited Scope: The study focused solely on the insertion of Ryle’s tube. Including a broader range of clinical procedures would provide a more comprehensive evaluation of the effectiveness of skill labs.

This study aimed to evaluate the effectiveness of skill laboratory training compared to conventional teaching methods in the acquisition of clinical procedural skills among third-year MBBS students, specifically focusing on the insertion of Ryle’s tube (nasogastric tube, NGT). The findings clearly indicate that skill laboratory training significantly enhances students' performance and consistency in clinical procedures. The skill lab group outperformed the conventional training group, as evidenced by higher mean scores, more consistent results, and statistically significant differences in performance.

The advantages of skill labs are well-supported by existing literature, highlighting improvements in learning retention, confidence, and practical application. This study reinforces these benefits, demonstrating that interactive, hands-on training in a controlled environment better prepares students for clinical practice. The results suggest that integrating skill laboratories into medical curricula can bridge the gap between theoretical knowledge and practical expertise, ultimately leading to more competent and confident healthcare professionals.

In conclusion, this research provides compelling evidence supporting the incorporation of skill laboratories into medical education. While further studies with larger, more diverse samples are necessary, the current findings lay a strong foundation for rethinking and enhancing the methods used to train future healthcare professionals.

1. Ruesseler M, Schill A, Stibane T, Damanakis A, Schleicher I, Menzler S, Braunbeck A, Walcher F. "Praktische klinische Kompetenz" - ein Verbundprojekt zur Verbesserung der chirurgischen Lehre ["Practical clinical competence" - a joint programme to improve training in surgery]. Zentralbl Chir. 2013 Dec;138(6):663-8. German. doi: 10.1055/s-0032- 1328180. Epub 2013 Apr 10. PMID: 23575519
2. Tolsgaard MG. Clinical skills training in undergraduate medical education using a studentcentered approach. Dan Med J. 2013 Aug;60(8):B4690. PMID: 23905573.
3. Bugaj TJ, Nikendei C. Practical Clinical Training in Skills Labs: Theory and Practice. GMS J Med Educ. 2016 Aug 15;33(4):Doc63. doi: 10.3205/zma001062. PMID: 27579363; PMCID: PMC5003146.
4. Nikendei C, Zeuch A, Dieckmann P, Roth C, Schafer S, Volkl M, Schellberg D, Herzog W, Jünger J. Role-playing for more realistic technical skills training. Med Teach. 2005;27(2):122-126. DOI: 10.1080/01421590400019484
5. Datta R, Upadhyay K,Jaideep C. Simulation and its role in medical education. Med J Armed Forces India. 2012;68(2):167-172. DOI: 10.1016/S0377-1237(12)60040-9
6. Everson J, Gao A, Roder C, Kinnear J. Impact of Simulation Training on Undergraduate Clinical Decision-making in Emergencies: A Non-blinded, Single-centre, Randomised Pilot Study. Cureus. 2020 Apr 12;12(4):e7650. doi: 10.7759/cureus.7650. PMID: 32411551; PMCID: PMC7217257.
7. Lynagh M, Burton R, Sanson-Fisher R. A systematic review of medical skills laboratory training: where to from here? Med Educ. 2007 Sep;41(9):879-87. doi: 10.1111/j.1365- 2923.2007.02821.x. Epub 2007 Aug 13. PMID: 17696985.