Journal of General Internal Medicine

, Volume 28, Issue 8, pp 1072–1077 | Cite as

Improving Efficiency of Clinical Skills Training: A Randomized Trial

  • Martin G. Tolsgaard
  • Sebastian Bjørck
  • Maria B. Rasmussen
  • Amandus Gustafsson
  • Charlotte Ringsted
Original Research



The rising number of medical students and the impact this has on students’ learning of clinical skills is a matter of concern. Cooperative learning in pairs, called dyad training, might help address this situation.


The aim of this study was to evaluate the effect of dyad training on students’ patient encounter skills.


Experimental, randomized, observer-blinded trial.


Forty-nine pre-clerkship medical students without prior clinical experience.


All students underwent a 4-h course on how to manage patient encounters. Subsequently, the students were randomized into a dyad practice group (n = 24) or a single practice group (n = 25). Both groups practiced for 4 h on four different case scenarios, using simulated patients. Students in the dyad group practiced together and took turns as the active participant, whereas students in the single group practiced alone.


Performance tests of patient encounter skills were conducted 2 weeks after the training by two blinded raters. Students had no clinical training during those weeks. A questionnaire-based evaluation surveyed students’ confidence in their patient management skills.


The dyad group scored significantly higher on the performance test, mean 40.7 % (SD 6.6), than the single group, mean 36.9 % (SD 5.8), P = 0.04, effect size 0.61. Inter-rater reliability was 0.69. The dyad group expressed significantly higher confidence in managing future clinical patient encounters than the single group, mean 7.6 (SD 0.9) vs. mean 6.5 (SD 1.1), respectively, P < 0.001, effect size 1.16.


Dyad training of pre-clerkship medical students’ patient encounter skills is effective, efficient, and prompts higher confidence in managing future patient encounters compared to training alone. This training format may help maintain high-quality medical training in the face of an increasing number of students in medical schools.


clinical skills medical students co-operative learning training efficiency 




The authors would like to thank the students participating in this study.


This study was in part funded by the University of Copenhagen and in part funded by the Centre for Clinical Education, Copenhagen University Hospital Rigshospitalet.

Conflict of Interest

The authors declare that they do not have a conflict of interest.


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Copyright information

© Society of General Internal Medicine 2013

Authors and Affiliations

  • Martin G. Tolsgaard
    • 1
  • Sebastian Bjørck
    • 1
  • Maria B. Rasmussen
    • 1
  • Amandus Gustafsson
    • 1
  • Charlotte Ringsted
    • 2
  1. 1.Centre for Clinical EducationUniversity of CopenhagenCopenhagenDenmark
  2. 2.Department of AnesthesiaUniversity of Toronto and The Wilson Centre, University Health NetworkTorontoCanada

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