To identify factors that influence medical students' perceptions of the quality of a clinical skills course; to apply these factors to the course at one hospital; to measure the effect of this change.
Cross sectional questionnaire survey; application of identified factors; repeat questionnaire survey.
Three teaching hospitals and five district general hospitals in north east England.
Third year medical students attending locomotor clinical skills courses in two consecutive years.
Score awarded by students in five categories; numbers of patients seen by each student; comparisons with other clinical skills weeks.
Response rates were 71 of 150 and 89 of 161. Factors associated with a high awarded score were: organisation of the course by a rheumatologist (p < 0.01); teaching from a rheumatologist (p < 0.01); higher number of patients seen (r = 0.76). Mean number of patients seen varied widely, from 7 per student at one hospital to 20.4 at another. Teaching hospitals scored poorly. In the second year, after making changes at one teaching hospital the mean total score improved (p < 0.01), and students saw more patients (p < 0.01). The ranking of this hospital rose from 6 to 1. The additional cost of the modified course was 640 pounds per student.
The standard of teaching of locomotor clinical skills varies widely and can be improved by application of factors identified in this survey, although additional costs are incurred.