Learning the facts in medical school is not enough: which factors predict successful application of procedural knowledge in a laboratory setting?

Background: Medical knowledge encompasses both conceptual (facts or
``what{''} information) and procedural knowledge ({''}how{''} and
``why{''} information). Conceptual knowledge is known to be an
essential prerequisite for clinical problem solving. Primarily,
medical students learn from textbooks and often struggle with the
process of applying their conceptual knowledge to clinical
problems. Recent studies address the question of how to foster the
acquisition of procedural knowledge and its application in medical
education. However, little is known about the factors which predict
performance in procedural knowledge tasks. Which additional factors
of the learner predict performance in procedural knowledge?
Methods: Domain specific conceptual knowledge (facts) in clinical
nephrology was provided to 80 medical students (3rd to 5th year)
using electronic flashcards in a laboratory setting. Learner
characteristics were obtained by questionnaires. Procedural
knowledge in clinical nephrology was assessed by key feature
problems (KFP) and problem solving tasks (PST) reflecting strategic
and conditional knowledge, respectively. Results: Results in
procedural knowledge tests (KFP and PST) correlated significantly
with each other. In univariate analysis, performance in procedural
knowledge (sum of KFP+PST) was significantly correlated with the
results in (1) the conceptual knowledge test (CKT), (2) the
intended future career as hospital based doctor, (3) the duration
of clinical clerkships, and (4) the results in the written German
National Medical Examination Part I on preclinical subjects
(NME-I). After multiple regression analysis only clinical clerkship
experience and NME-I performance remained independent influencing
factors. Conclusions: Performance in procedural knowledge tests
seems independent from the degree of domain specific conceptual
knowledge above a certain level. Procedural knowledge may be
fostered by clinical experience. More attention should be paid to
the interplay of individual clinical clerkship experiences and
structured teaching of procedural knowledge and its assessment in
medical education curricula.