Clinical Skills TrainingRoles and Skills of a Medical Doctor

Operational skills are defined as the mode of activity composed of a series of body movements executed in a reasonable and perfect procedure [49], often referred to as motor skills. Caiman [8] identified multiple roles for doctors, including advocate, educator, reform spokesman, citizen, and leader. Boelen [5] proposed a concept of the “five-star doctor” who is adept at providing health care, making health decision-making, effective communication, leadership of community health, and management of health resources.

The World Federation for Medical Education [45] outlined global standards for medical graduates, emphasizing the need for graduates to handle patients’ health problems sympathetically, apply basic healthcare knowledge in practice, possess essential interpersonal communication skills, evaluate and apply new scientific insights, guide interactions among healthcare professionals, conduct preliminary research, exhibit professional qualities, advocate for patients’ interests, understand public health and health policy, and possess the ability to understand healthcare systems.

Zhou [50] highlighted that future physicians would embody three roles: scholars and scientists, practitioners, and professionals. The American Medical College Alliance (2010) set educational goals to develop future doctors who pursue excellence in medical technology and humanistic care skills, master the scientific basis of organ systems, apply this knowledge in clinical practice, and lead team-based innovation.

Taxonomies of Professional Development

Fink’s [14] taxonomy presents an interactive approach with six levels: foundational knowledge, application, integration, human dimension, caring, and learning how to learn. This taxonomy emphasizes that each type of learning can catalyze other types. Foundational knowledge involves memorizing and comprehending information, while application encompasses critical, creative, and practical thinking skills. Integration refers to the integration of knowledge, ideas, perspectives, and learning experiences. The human dimension covers personal and social experience, including metacognitive skills and interactive skills with others. Caring involves developing attention and interest in new subjects, and learning how to learn which is based on self-regulation skills for continuous learning.

Krathwohl et al. [25] taxonomy describes an internalizing process where learners gradually align their actions with a set of values. This process includes five levels: receiving, responding, valuing, organization, and characterization. Learners evolve from being sensitive to ideas and phenomena to forming consistent behavior aligned with their value system. On the other hand, a bidimensional skill development model outlines two levels of competencies: intellectual skills and operational skills. Academic skills involve cognitive processes such as calculation and reading, while operational skills develop through stages: cognitive orientation, action imitation, action integration, and skilled operation (Liu et al., 2017).

Assessment MethodsEvaluation Framework of Medical Education

Four levels of training evaluation include reaction, learning, behaviors, and results. Reaction assesses learners’ satisfaction and confidence, learning assesses progress through quizzes and tests, behaviors measure application in clinical settings through Objective Structured Clinical Examinations (OSCE), and results assess professional practice performance [23]. Miller’s pyramid, a widely used model, divides clinical competence into four levels: knows, knows how, shows, and does [29]. Lower levels focus on cognitive knowledge, while upper levels emphasize behavioral application. Studies indicate the complexity of transitioning from cognitive understanding to behavioral execution, highlighting the need for practical evaluation in clinical settings [47].

Clinical Assessments

Introduced the OSCE to evaluate medical students’ clinical practice ability, focusing on cognition, psychomotor skills, and emotion [19]. This comprehensive assessment method is widely adopted because of its high reliability. Ken Cox (1993) emphasized clinical skills training, highlighting the importance of improving students’ clinical thinking and innovation. In the 1990 s, core standards for clinical medical skills training were established, leading to the competency-based clinical training index by the American Accreditation Council for Postgraduate Medical Education [11]. This index includes six core competencies: patient diagnosis and treatment, medical knowledge, interpersonal communication, professional literacy, practice-based learning and improvement, and system-based practice [38]. The International Society of Medical Education’s “Global Minimum Essential Requirements in Medical Education” (GMER) outlined fundamental requirements for medical knowledge, skills, professional attitudes, behaviors, and values [35].

Digitalized Medical EducationThe Digitalized Medical Education

Tudor Car et al. [41] developed a conceptual framework for digital education in health majors comprising six core dimensions: context, infrastructure, education, learners, research, and quality improvement. The context includes sociocultural factors and educational norms, infrastructure refers to physical instruments to deliver content, and learners are central, with unique needs and competencies influenced by their context. Each dimension dynamically interacts with the others.

Modalities of Digitalized Medical Education

Offline education delivers content through external media without requiring internet access, suitable for regions with limited internet infrastructure [21]. Online education requires Internet access and includes multimedia formats such as video conferencing and streaming [32]. Massive open online courses (MOOCs) provide free and accessible programs to large audiences [37]. Mobile education (m-Learning) offers flexible learning through personal devices [12]. Serious games and gamification test knowledge and cognitive skills in a virtual environment [18]. Simulated learning mimics real-life scenarios, using virtual patients and high-fidelity manikins to simulate clinical settings [10], [26]. Blended education combines digital and traditional methods, integrating online and in-person interactions.

The Digitalized Approach Versus Traditional Approach in Medical Education

Studies that compare digital and traditional approaches show mixed results. Bhone et al. [4] found that offline digital learning is as effective as traditional methods for acquiring knowledge and is superior for skill improvement. Zhang et al. [48] demonstrated that digital simulation technology in OSCE exams improves students’ interests, motivation, communication, and operational skills. However, Tudor Car et al. [42] found no significant differences in learning outcomes between digital and traditional methods but noted greater satisfaction with digital education. Gao et al. [15] found no significant improvement in learning outcomes with digital education but noted greater satisfaction with the OSCE information system. While Zhang et al. [48] reported a 15% improvement in OSCE scores with digital simulation, Gao et al. [15] found no significant difference in performance between digital and traditional methods (p = 0.12), highlighting the need for context-specific implementation.

Medical Intern’s Digital Health Competence

The Chinese Medical Digital Health Competence Scale, adapted from Scott et al. [36] competencies for the Royal Australasian College of Physicians (RACP), assesses digital health competency in Chinese medical students. Studies show a moderate level of digital competence and a high level of digital ethics among Chinese medical students [17]. The level predicts digital literacy, but overall competence, including awareness of digital health and information management, remains low [46]. Digital literacy impacts learning motivation and outcomes [16]. Training can improve information literacy and personal abilities [44], but excessive information can cause overload [31].

Studies of the Impact of Social-Ecological Factors on Medical Graduates’ Clinical Performance

Various factors affect the clinical operations skills of medical students. Policy, system, and management issues can contribute to performance declines. He et al. [20] highlighted the need for more clinical rotation opportunities and accurate work rotation. Lu et al. [27] identified the teacher-student ratio as a factor affecting clinical performance.

Assessment standards also impact performance. He et al. [20] called for a well-structured clinical skills assessment system, citing issues with current assessment tools and procedures. Chen and Hu [9] noted the need for standardized assessment scales and refined scoring items.

Meanwhile, cognitive and psychological factors, such as self-regulated learning and anxiety, affect clinical performance. Martin and Naziruddin [28] found a minimal impact of OSCE-related anxiety, while Arain [1] found that anxiety negatively affects academic operational skills, especially in female students. Empathy levels also impact performance [7].

Demographic factors, such as age and gender, influence operational skills. Bai [2] found that female students generally perform better than male students in clinical evaluations. Klein et al. (2019) noted that gender bias in assessments can influence results. Economic factors, such as income and debt, also affect performance [33].

Besides that, teaching approaches and instructor-student interaction significantly affect clinical skill development [7]. Found that participatory teaching methods improve performance compared to traditional methods. Zhang et al. (2022) emphasized the positive impact of instructor motivation and guidance on clinical performance.