Skip to content. Skip to navigation

Faculty Development

You are here: Home / Teaching Clinical Skills / A brief history of clinical skills

A brief history of clinical skills

Clinical is derived from the Greek ‘klinikos’, which means ‘pertaining to or around the sick bed’. Throughout this module the term ‘clinical skills’ refers to those clinical examination and procedural skills commonly performed in real or simulated clinical environments.

Clinical examination developed from several sources from 2000BC, including the practice of the Ancient Egyptians and Ayurvedic practitioners. The basic examination procedures were developed further by the schools of Hippocrates (450BC) and Galen (200AD), who introduced the concept of ‘taking a history’ or more pertinently, listening to the patient’s story, progressing to a ‘focused’ examination of the patient. These ancient scholars gave us the concept of using the five senses (tasting, observing, touching, listening and smelling) to diagnose what was wrong with the patient. With the exception of tasting (!), they still form the basis of a physical examination.

Over the next 1,000 years, influenced by the great Islamic physicians Avicenna and Razi in Baghdad (900–1000AD), today’s approach developed: taking a history followed by a systematic clinical examination. The examination procedures in use today have changed little since the formalisation of medical education in Europe and North America in the 19th century, although during the past 50 years clinical procedures and investigations have become increasingly augmented by the various technologies involved.

Until recently, the teaching and learning of clinical skills invariably occurred at the patients’ bedside or other clinical areas, augmented by small and large group teaching in the classroom and lecture theatre. This ‘apprenticeship model’ (Hays, 1999) allowed direct observation and performance of skills overseen by senior clinicians. This was not always ideal. Patients were often talked about or over, rather than talked to or with, and the guiding principle of ‘see one, do one, teach one’ was not always the easiest (or safest) method for the patient.

The past 20 years has seen a changing clinical environment and working practices, the introduction of ‘clinical skills labs’ and the dominance of the objective structured clinical examination (OSCE) as the main clinical assessment tool. Students have been encouraged to seek other methods of acquiring clinical skills and we now have a generation of young doctors who have increasingly substituted rather than augmented clinical experience. In doing so, we have removed some key elements of the clinical experience that cannot be replicated by the safety and protection that simulation offers. This is particularly true of intimate examinations including breast, external genitalia and rectal examination.

Thinking point

Think of your own preferences as to when and where you teach clinical skills. How does your practice reinforce the needs to examine ‘real patients’ as well as ensuring students/trainees are competent and safe before doing so? How do you assess this learning?

Print module to PDF

Save a PDF of this module, so you can print it and read it in your own time.

Email your comments

Let us know what you think about this module or give us your feedback.

Further information

More information about this module, further reading and a complete list of glossary terms.

Learning activities

Read about the recommended learning activities for this module.