Abstracts

Developing the continuum of clinical skills teaching and learning; from simulation to reality

 

Background: Clinical Skills Centres have been adopted throughout the world to teach a range of practical skills on manikins. However this model can have limited fidelity to real practice and encourage students to memorise the steps of the process rather than thinking about the patient as a whole. The emerging emphasis on patient safety and patient centred care reinforces the need for a holistic approach to teaching and learning clinical skills in simulation so that it can be demonstrated in real practice.
Objectives: There are a number of educational innovations that are moving toward preparing learners better for the transition from learning clinical skills in simulation to delivering them in practice. Three are considered here: interprofessional learning, scenario based teaching and supervised practice from the skills centre to the ward.
Discussion: High fidelity simulation and scenario based teaching models have refocused the educational process on integration and holism. The educational model combines effective communication skills with the ability to perform the task. Teaching clinical skills interprofessionally helps to develop teamwork and reflects the reality of modern healthcare delivery. Providing students with continued support and feedback during the transition from simulation to real practice helps to ground the new knowledge in experience, gives them confidence in their ability and enhances patient safety. All of these elements bring the educational world of simulation much closer to how healthcare practitioners work in real life.

Medico-legal consequences in surgery due to inadequate training in anatomy

Based on a paper given at the Royal College of Surgeons symposium on Anatomy teaching, 20 March, 2007.

Development of a clinical skills bus: making simulation mobile

The Clinical Skills Bus was developed in order to meet the needs of healthcare students in distributed two university campuses, and also when working in clinical placements that are often geographically distant from the Skills Centre. It was developed as part of the Centre for Excellence in Teaching & Learning (CETL): Clinical and Communication Skills funded by HEFCE. This paper describes the various stages of development: choosing the vehicle and converter, writing the invitation to tender, design issues to consider and recruiting the driver/facilitator.

Clinical Communication: the emergence of a clinical discipline

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“See one, do one, teach one!” - the uphill struggle for clinical skills acquisition

The transformation from medical student to physician is a gradual process, requiring the assimilation of vast amounts of knowledge as well as the development of clinical skills. The junior trainee however, is expected to make several independent decisions during the course of their day to day practice including performing clinical procedures. Experience has shown that each doctor comes with a variety of skill mixes depending on previous training, exposure and experience. No two doctors will have the same abilities. Each doctor also has different degrees of competence for the variety of skills they possess. These inequalities do create anxieties both for the trainees and the trainers. Quality assurance and safety in patient care is the ultimate goal in clinical skills acquisition. How does a stark novice become proficient, or at least competent in the “required” skills expected for their practice? What are the challenges in the way towards utopia? This article focuses on the anecdotal scenarios, and trainee experiences, and also includes narratives of literature review.

Feedback to enhance student learning: facilitating interactive feedback on clinical skills

Increasing the amount and quality of feedback offered by clinical educators to students and trainees should lead to long term benefits in patient care. This paper highlights the importance of giving interactive feedback to learners on their clinical skills. The role of feedback in student learning is explored through an examination of a range of models of education. The planning and preparation needed for effective feedback is described and a model for identifying the most valuable feedback content is provided. Three approaches to facilitating feedback are described and details are given of the interactive approach supported by current research findings. The final section deals with managing the response to feedback from students and trainees.

COMET: Clinically Observed Medical Education Tutorial - a novel educational method in clinical skills

Introduction: The modern clinical environment demands clear evidence of competency in core clinical skills for the sake of both patient safety and delivery of effective and evidence-based clinical care. Lecture and tutorials both suffer from variability in student attention and often information overload. Clinical teachers often have too much to teach and want to “share all the pearls of ones wisdom”
The COMET educational method attempted to teach and evaluate core clinical skills required to sort out a common clinical problem.
Objective: To critically assess the use of a novel approach, COMET (Clinical Objective medical education tutorial) in teaching medical students.
Design: Evaluate and teach at a four station OSCE based on a common clinical problem: - Chronic obstructive Airways disease
Setting: George Eliot Hospital Teaching Education centre.
Students: Warwick Medical students (Phase II) Year three Medical students.
Main Outcome measures: Students own perceptions of learning prior to tutorial and after tutorial with educational feedback provided at each station.
Results: Students reported low levels of confidence prior to exercise particularly with regards to acute management, oxygen therapy and writing a discharge summary, with marked improvement after the session. Profiency in Communication skills to a large extent predicted overall competence to a greater degree. Students rated the tutorial highly and were keen to see it being used in other clinical settings.
Conclusion: This study has demonstrated that it is both practical and feasible to conduct an OSCE as an evaluation and teaching model for common clinical problems.

Preparing for practice - use of simulation to identify sub-optimal levels of care with junior medical students

In the foundation years of clinical practice following graduation from a UK medical school, doctors are expected to participate in multidisciplinary team meetings both for their service contribution and as part of their educational programme.
There is evidence that students benefit from the early introduction to team work and the role of other health care professionals in patient care. There is also emerging evidence that the early introduction to patient safety and the prevention of adverse events is beneficial.
In response to these findings a simulated multidisciplinary meeting in relation to a patient with rectal carcinoma was designed for a cohort of second year medical students. Taking on the roles within the simulated multidisciplinary teams students were required to analyse patient information and to identify sub optimal points of care in the patients journey.
The results demonstrated that even with limited clinical experience it is possible for students to apply their theoretical knowledge of rectal carcinoma to the care of a patient with rectal carcinoma and to identify standards of care expected in accordance with evidence based guidelines.

Assessment of final year medical students in a simulated ward: developing content validity for an assessment instrument

Performance assessment is becoming increasingly important in both undergraduate and postgraduate assessment. At present, the tools used to assess a medical student’s performance evaluate only their care for one patient at a time. The development of the simulated ward has provided an opportunity to assess how a final year medical student would perform caring for a variety of patients simultaneously in a realistic ward environment, without risk to patients. This paper describes the development of valid assessment criteria using a modified Delphi method.

The use of medium fidelity simulation to develop technical and non-technical acute care skills early in the undergraduate curriculum

This paper describes the use of medium fidelity simulation to introduce technical and non technical acute care skills to medical students early in the curriculum. 165 second year students took part in the programme in groups of 8-12. The paper describes the programme and the students’ evaluation which demonstrates the value of medium fidelity simulation in this setting, in developing non technical skills.

Reducing errors in laboratory test requests

Errors in laboratory test requests can lead to adverse consequences for patients. There is increasing evidence that integrating safety concepts early in the curriculum is beneficial. This paper describes the development of an integrated skills programme using simulation which reduced errors in laboratory requests by medical students.
All second year medical students, as part of their clinical skills core programme, received training on laboratory test requesting. The training included both paper based laboratory requesting and laboratory test requesting using an electronic system. A convenient sample of students completed both paper and electronic laboratory test requests as part of the training session and again six weeks later and the error rates were compared. The number of errors in the electronic versions was reduced and the reduction maintained over time. Incorporating IT and paper based simulated exercises early in clinical learning may have a role in error reduction in laboratory requests and in other areas of clinical practice.

Shibboleths of incompetence

For examination of the hands “I am looking for palmar arrhythmia”

Patient Safety Skills

Over the last few years the world has become increasingly intolerant of medical error. The increasing litigious nature of society, consumerism and the improved ability to gather data are all contributing factors. People seem no longer prepared to accept that sometimes things go wrong. Commercials on American TV offer the services of ‘no-win-no-fee’ lawyers but rather than the usual work-based personal injury theme, these were directed at those who had experienced an adverse event in hospital. The British experience is not so extreme but, given the way we have followed the USA in terms of personal injury claims, I wonder how long it will be before British lawyers follow suit.

‘Face to Face’: a training DVD-Rom to develop skills to diagnose patients presenting with mental health problems

Like most other areas of medicine good history taking and communication skills are essential for arriving at a differential diagnosis in patients who present with a mental health problem. Unlike other specialties, psychiatrists place a high value on a thorough examination of the patient’s mental state to facilitate the diagnostic process. The mental state examination requires students to ask questions which are unfamiliar to them. Some students perceive them as embarrassing and can feel self conscious when asking a patient whether, for example, they ever hear voices.

Interview with Kuldip Birdi, author of ‘Clinical Skills for OSCEs’

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