Clinical skills education: outcomes of relationships between junior medical students, senior peers and simulated patients

Background: The COVID-19 pandemic has restricted in-person clinical training for medical students. Simulation-based teaching is a promising tool to introduce learners to the clinical environment. MacSim is a student-led simulation workshop for learners to develop clinical competencies. The objective of this study was to assess the impacts of MacSim and participants' perspectives regarding simulation-based teaching. Methods: A comprehensive simulation, representative of a virtual care scenario, was delivered to 42 pre-clerkship medical students via video conferencing. In pairs, participants obtained histories and carried out management plans for simulated patients. Participants were surveyed and interviewed. Survey data were analyzed using the Wilcoxon signed-ranks test. Interview transcript data were thematically analyzed. Results: Post-simulation, participants (n=24) felt more prepared to make clinical decisions, collaborate, and communicate in a virtual setting. 92% of respondents agreed MacSim was a valuable learning experience and 96% agreed more simulation-based learning should be integrated into curricula. Emergent themes from interviews (n=12) included: 1) value of simulation fidelity, 2) value of physician feedback, and 3) effectiveness of MacSim in improving virtual clinical skills. Conclusion: Simulation-based teaching is of importance and educational value to medical students. It may play an increasingly prevalent role in education as virtual care is likely to become more prevalent.

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Limitations in virtual clinical skills education for medical students during COVID-19

Canadian Medical Education Journal ◽

10.36834/cmej.70240 ◽

2020 ◽

Author(s):

Yaanu Jeyakumar ◽

Deepanshu Sharma ◽

Giovanna Sirianni ◽

Joyce Nyhof-Young ◽

Mirek Otremba ◽

...

Keyword(s):

Medical Students ◽

Clinical Skills ◽

Skills Education

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Metadiscourse, materiality and morality in communication skills training with simulated patients

Communication & Medicine ◽

10.1558/cam.39725 ◽

2021 ◽

Vol 16 (3) ◽

Author(s):

Grace Peters

Keyword(s):

Medical Education ◽

Medical Students ◽

Communication Skills ◽

Clinical Skills ◽

Standardized Patients ◽

Skills Training ◽

The United States ◽

Simulated Patient ◽

Simulated Patients ◽

Communication Skills Training

Simulated patients (also known as standardized patients) are commonly employed by institutions of medical education to train medical students and assess their communication skills. This article demonstrates that such patients are not translational devices that enact prima facie standards of communication skills as laid out by the institutions that use them, but rather metadiscursively transform communication practices. This is shown via a case study that closely examines a series of interactions between a simulated patient and a third-year medical student during a practice exam designed for the United States Medical Licensing Examination Step 2 Clinical Skills. I use discourse analysis to show how communication skills are transformed in three practices: (1) simulated consultations between standardized patients and medical students; (2) spoken evaluations offered by standardized patients after simulated consultations between standardized patients and medical students; and (3) written evaluations offered by standardized patients in assessment forms. In particular, by attending to how a simulated patient makes the act of draping the patient a relevant communication skill, I explicate the material elements and moral implications of clinical communication. Finally, I consider the instructive role simulated patients play in medical education and how their standards build on and often stand in contrast to communication skills techniques. I conclude by making practical suggestions for communication skills training with simulated patients in medical education.

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Alternative approaches for clinical clerkship during the COVID-19 pandemic: online simulated clinical practice for inpatients and outpatients—A mixed method

BMC Medical Education ◽

10.1186/s12909-021-02586-y ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Hajime Kasai ◽

Kiyoshi Shikino ◽

Go Saito ◽

Tomoko Tsukamoto ◽

Yukiko Takahashi ◽

...

Keyword(s):

Clinical Practice ◽

Medical Students ◽

Learning Environment ◽

Mixed Method ◽

Clinical Skills ◽

Simulated Patients ◽

Memory Retention ◽

Advantages And Disadvantages ◽

Medical Interviews ◽

The Impact

Abstract Background The COVID-19 pandemic has created a need for educational materials and methods that can replace clinical clerkships (CCs) for online simulated clinical practice (online-sCP). This study evaluates the impact of using simulated electronic health records (sEHR) for inpatients, and electronic problem-based learning (e-PBL) and online virtual medical interviews (online-VMI) for outpatients, for an online-sCP using a learning management system (LMS) and online meeting system facilitated by a supervising physician. Methods The sEHR was reviewed by medical students and subsequently discussed with a supervising physician using an online meeting system. In the e-PBL, medical students reviewed the simulated patients and discussed on the LMS. For the online-VMI, a faculty member acted as an outpatient and a student acted as the doctor. Small groups of students discussed the clinical reasoning process using the online meeting system. A mixed-method design was implemented. Medical students self-assessed their clinical competence before and after the online-sCP. They answered questionnaires and participated in semi-structured focus group interviews (FGIs) regarding the advantages and disadvantages of the practice. Results Forty-three students completed the online-sCP during May and June 2020. All students indicated significant improvement in all aspects of self-evaluation of clinical performance after the online-sCP. Students using sEHR reported significant improvement in writing daily medical records and medical summaries. Students using e-PBL and online-VMI reported significant improvement in medical interviews and counseling. Students also indicated CCs as more useful for learning associated with medical interviews, physical examinations, and humanistic qualities like professionalism than the online-sCP. Eight FGIs were conducted (n = 42). The advantages of online-sCP were segregated into five categories (learning environment, efficiency, accessibility, self-paced learning, and interactivity); meanwhile, the disadvantages of online-sCP were classified into seven categories (clinical practice experience, learning environment, interactivity, motivation, memory retention, accessibility, and extraneous cognitive load). Conclusions Online-sCP with sEHR, e-PBL, and online-VMI could be useful in learning some of the clinical skills acquired through CC. These methods can be implemented with limited preparation and resources.

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Study protocol for the ETMED-L project: longitudinal study of mental health and interpersonal competence of medical students in a Swiss university using a comprehensive framework of empathy

BMJ Open ◽

10.1136/bmjopen-2021-053070 ◽

2021 ◽

Vol 11 (12) ◽

pp. e053070

Author(s):

Alexandre Berney ◽

Valerie Carrard ◽

Sylvie Berney ◽

Katja Schlegel ◽

Jacques Gaume ◽

...

Keyword(s):

Mental Health ◽

Longitudinal Study ◽

Medical Students ◽

Medical School ◽

Clinical Skills ◽

Reciprocal Relationship ◽

Simulated Patients ◽

Interpersonal Competence ◽

Comprehensive Framework ◽

The Impact

IntroductionPhysician interpersonal competence is crucial for patient care. How interpersonal competence develops during undergraduate medical education is thus a key issue. Literature on the topic consists predominantly of studies on empathy showing a trend of decline over the course of medical school. However, most existing studies have focused on narrow measures of empathy. The first aim of this project is to study medical students’ interpersonal competence with a comprehensive framework of empathy that includes self-reported cognitive and affective empathy, performance-based assessments of emotion recognition accuracy, and a behavioural dimension of empathy. The second aim of the present project is to investigate the evolution of mental health during medical school and its putative link to the studied components of interpersonal competence. Indeed, studies documented a high prevalence of mental health issues among medical students that could potentially impact their interpersonal competence. Finally, this project will enable to test the impact of mental health and interpersonal competence on clinical skills as evaluated by experts and simulated patients.Methods and analysisThis project consists of an observational longitudinal study with an open cohort design. Each year during the four consecutive years of the project, every medical student (curriculum years 1–6) of the University of Lausanne in Switzerland will be asked to complete an online questionnaire including several interpersonal competence and mental health measures. Clinical skills assessments from examinations and training courses with simulated patients will also be included. Linear mixed models will be used to explore the longitudinal evolutions of the studied components of interpersonal competence and mental health as well as their reciprocal relationship and their link to clinical skills.Ethics and disseminationThe project has received ethical approval from the competent authorities. Findings will be disseminated through internal, regional, national and international conferences, news and peer-reviewed journals.

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The Role of Simulated Patient in Physiotherapy Education: A Review Article

Journal of Modern Rehabilitation ◽

10.18502/jmr.v14i2.7704 ◽

2021 ◽

Author(s):

Mohammad Javaherian ◽

Narges Dabbaghipour ◽

Mahboobeh Khabaz Mafinejad ◽

Nastaran Ghotbi ◽

Amir Ali Khakneshin ◽

...

Keyword(s):

Physical Therapy ◽

Full Text ◽

Learning Strategy ◽

Clinical Skills ◽

Simulated Patients ◽

Simulation Based ◽

Skills Education ◽

Clinical Reasoning Skills ◽

Real Patients

Introduction: Using Simulated Patients (SPs) in clinical skills education is a common method of training students to improve their skills for future client encounters. This systematic review aims to provide an overview of the SP strategy in Physical Therapy (PT) education. Materials and Methods: PubMed, Scopus, and Web of Science databases were searched from January 1980 up to November 2019. Different keywords related to the topic were selected using MeSH. Any types of quantitative study design which had used simulation-based learning in physical therapy were eligible for inclusion. Two reviewers read studies and appraised them critically. Results: A total of 1049 abstracts were retrieved and after reviewing the full-text paper, 11 full- text articles met the inclusion criteria. These studies had used simulated patients for various objectives, including replicate different aspects of knowledge, self-perceived skills, real clinical practice, attitudes, and feasibility. Based on the result of studies, SP as an educational technique can improve student’s clinical reasoning skills, communication, and motivation in a safe environment. Conclusion: SP is a useful learning strategy to deliver learning activities in medical education and physical therapy curricula, facilitating feedback on students’ performance with opportunities to interact with real patients and environments.

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Alternative approaches for clinical clerkship during the COVID-19 pandemic: Online clinical practice for inpatients and outpatients—A mixed method

10.21203/rs.3.rs-68477/v2 ◽

2020 ◽

Author(s):

Hajime Kasai ◽

Kiyoshi Shikino ◽

Go Saito ◽

Tomoko Tsukamoto ◽

Yukiko Takahashi ◽

...

Keyword(s):

Clinical Practice ◽

Medical Students ◽

Learning Environment ◽

Mixed Method ◽

Clinical Skills ◽

Simulated Patients ◽

Memory Retention ◽

Advantages And Disadvantages ◽

Medical Interviews ◽

The Impact

Abstract Background: The COVID-19 pandemic has created a need for educational materials and methods that can replace clinical clerkships (CCs) for online simulated clinical practice (online-sCP). This study evaluates the impact of using simulated electronic health records (sEHR) for inpatients, and electronic problem-based learning (e-PBL) and online virtual medical interviews (online-VMI) for outpatients, for an online-sCP using a learning management system (LMS) and online meeting system facilitated by a supervising physician.Methods: The sEHR was reviewed by medical students and subsequently discussed with a supervising physician using an online meeting system. In the e-PBL, medical students reviewed the simulated patients and discussed on the LMS. For the online-VMI, a faculty member acted as an outpatient and a student acted as the doctor. Small groups of students discussed the clinical reasoning process using the online meeting system. A mixed-method design was implemented. Medical students self-assessed their clinical competence before and after the online-sCP. They answered questionnaires and participated in semi-structured focus group interviews (FGIs) regarding the advantages and disadvantages of the practice.Results: Forty-three students completed the online-sCP during May and June 2020. All students indicated significant improvement in all aspects of self-evaluation of clinical performance after the online-sCP. Students using sEHR reported significant improvement in writing daily medical records and medical summaries. Students using e-PBL and online-VMI reported significant improvement in medical interviews and counseling. Students also indicated CCs as more useful for learning associated with medical interviews, physical examinations, and humanistic qualities like professionalism than the online-sCP. Eight FGIs were conducted (n = 42). The advantages of online-sCP were segregated into five categories (learning environment, efficiency, accessibility, self-paced learning, and interactivity); meanwhile, the disadvantages of online-sCP were classified into seven categories (clinical practice experience, learning environment, interactivity, motivation, memory retention, accessibility, and extraneous cognitive load).Conclusions: Online-sCP with sEHR, e-PBL, and online-VMI could be useful in learning some of the clinical skills acquired through CC. These methods can be implemented with limited preparation and resources.

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Novice and Advanced Learners' Satisfaction and Perceptions from an E-Learning Module to teach Renal Semiology during COVID19 Pandemic: A Qualitative Study (Preprint)

10.2196/preprints.29216 ◽

2021 ◽

Author(s):

Ido Zamberg ◽

Eduardo Schiffer ◽

Catherine Stoermann-Chopard

Keyword(s):

Medical Students ◽

Clinical Skills ◽

Learning Activities ◽

Learning Activity ◽

Advanced Learners ◽

Unique Challenge ◽

Novice Learners ◽

E Learning ◽

Skills Education ◽

Case Based

BACKGROUND The Nephrotic syndrome is a unique clinical entity providing interesting teaching opportunities to connect physiological and pathological aspects to clinical practice. During current COVID19 outbreak, in-person teaching in our institution was held thus creating a unique challenge for clinical skills’ teaching. A Case-Based E-Learning activity was designed to replace traditional in-person teaching of renal semiology. E-Learning activities were shown to be effective for knowledge retention and increasing novice learners’ performance. However, major knowledge gaps exist concerning the satisfaction of learners with E-Learning activities as a sole mean of teaching, specifically for undergraduate clinical skills education. OBJECTIVE Our study aimed to prospectively assess undergraduate medical students’ perceptions and satisfaction from an E-Learning activity teaching renal semiology. METHODS All second-year medical students (Novice Learners) from the medical faculty of the University undertook the E-Learning activity and were invited to participate in a non-mandatory validated web-based survey using a 1-10 Likert-Scale rating. Seventeen fourth to sixth year students (Advanced learners) were as well prospectively recruited and undertook both E-Learning activity and evaluation. RESULTS Eighty-eight out of 141 (63%) novice learners and all of advanced learners (100%) responded to the evaluation survey. Advanced learners reported significantly higher satisfaction (8.7 ± 1.0 Vs. 7.3 ± 1.8), p < 0.01), objectives clarity (9.6 ± 0.8 Vs. 7.7 ± 1.7, p < 0.01) and objectives attainability (9.8 ± 0.5 Vs. 7.3 ± 1.3, p < 0.01) from the e-learning activity. Both groups showed high interest in the inclusion of the activity as part of blended learning however low interest in the activity as a sole mean of teaching. CONCLUSIONS Case-Based E-Learning activities might be better suited for advanced learners and could increase learners’ satisfaction within blended teaching instructional design. More research concerning students’ satisfaction from E-Learning activities in the field of clinical skills education should be done. Moreover, more effort should be put in finding alternative teaching tools for clinical skills education in light of ongoing and future pandemics.

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