Virtual Integrated Patient: An AI supplementary tool for second-year medical students

Introduction: With the COVID-19 pandemic, Singapore underwent a national lockdown in which most organisations, including schools were closed. Halting face-to-face tutorials resulting in decreased clinical contact for medical students. Prior to the pandemic, we had developed the Virtual Integrated Patient (VIP). Equipped with conversational technology, it provides students online practice in various clinical skills such as history-taking, physical examination and investigations. The aim of this paper is to describe the supplementary use of VIP in the second-year class, in which a pilot study was conducted. Methods: The VIP platform was introduced to the cohort and used to supplement the teaching of history-taking in the “Communication with Patients” (CWP) module for second-year students. Traditionally, CWP tutorials involve face-to-face history-taking from standardised patients (SPs). Students, who consented to participating in the trial, had an additional 3 weeks’ access to VIP to practice their history-taking skills. They completed a survey on their user experience and satisfaction at the end of the 3 weeks. Results: Out of the 106 participants, 87% strongly agreed or agreed that using VIP helped in remembering the content while 69% of them felt that VIP increased their confidence and competence in history-taking. Conclusion: VIP was well-received by students and showed promise as a tool to supplement history-taking tutorials, prior to students’ encounter with SPs and real patients. Hence, this trend showed its potential as an alternative when clinical rotations were delayed or cancelled. Further research can be done to evaluate its effectiveness in this context.

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Evaluation of simulation methods for teaching peripheral arterial examination to medical students

BMJ Simulation and Technology Enhanced Learning ◽

10.1136/bmjstel-2017-000200 ◽

2017 ◽

Vol 5 (1) ◽

pp. 49-51

Author(s):

Syed Ali Naqi ◽

Abdel Monim Salih ◽

Anthony Hoban ◽

Firas Ayoub ◽

Michael Quirke ◽

...

Keyword(s):

Medical Students ◽

Arterial Disease ◽

Clinical Findings ◽

Pass Rate ◽

Simulated Patients ◽

Clinical Rotations ◽

Repeated Practice ◽

Second Year ◽

Peripheral Arterial ◽

Real Patients

Physical examination is a critical component of medical practice yet the focus on efficient patient turnover has impacted the availability of patients with clinical findings willing to be examined by students and skills' teaching is not consistent across clinical rotations. This work evaluates simulation methodologies for teaching of the peripheral arterial examination and evaluates whether skills learnt are transferable to clinical practice.Second-year medical students were taught peripheral arterial examination on a SimMan 3G or with simulated patients (SPs). Both groups were assessed by Objective Structured Clinical Examination (OSCE) with outpatients who have been diagnosed with peripheral arterial disease.There was no difference in the pass rate at OSCE between the two groups. SimMan better facilitated repeated practice, group learning, peer teaching and discussion, which were highly valued by the students. Students felt that the SImMan tutorial did not facilitate development of spatial cognition or pattern recognition. They also felt less well prepared to deal with real patients in terms of having practised appropriate language, issuing instructions and attempting to reassure patients.Both methods of simulation teaching have distinct merits and the ideal approach maybe to use the SimMan in combination with SPs.

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Evaluating the feasibility and effectiveness of e- OSCE in the COVID- 19 era

10.21203/rs.3.rs-506145/v1 ◽

2021 ◽

Author(s):

Sarra Shorbagi ◽

Nabil Sulaiman ◽

Ahmad Hasswan ◽

Mujtaba Kaouas ◽

Mona M. Al-Dijani ◽

...

Keyword(s):

Medical Students ◽

Physical Examination ◽

Clinical Training ◽

Clinical Skills ◽

Real Life ◽

Procedural Skills ◽

Face To Face ◽

Global Pandemic ◽

The Face

Abstract Background: The emergence of coronavirus disease 2019 (COVID-19) and its quick progress to a global pandemic has urged medical schools to shift from didactic to distance learning and assessment approaches. The quality of clinical training and assessment have been jeopardized due to the regulatory restrictions and potential hazards to human lives. The aim of this paper is to evaluate the feasibility and effectiveness of an electronic Objective Structured Clinical Examination (e-OSCE), which attempted to transform the format of a face-to-face OSCE to an e-OSCE.Methods: We conducted three end of clerkship e-OSCEs for final year medical students in Surgery, Medicine and Family Medicine using teleconferencing application of Microsoft Teams (MST). The e-OSCE blueprint included the assessment of all clinical skills except physical examination and procedural skills. Examiners supervised e-OSCE from the college campus while all students were remotely assessed through the MST channels. During the exam, the students stayed in their specified MST channels, examiners rotated across all students. The feasibility and effectiveness of e-OSCE was evaluated using a self-administered questionnaire to students, examiners and e-OSCE team. Results: The data analysis showed that 93.4% students and 92.2% examiners agreed with the quality and process of e-OSCE. Similarly, 83.6% students and 98% examiners agreed with the fairness, smoothness and organization of e-OSCE. As many as 45.9% students and 74.5% examiners agreed that e-OSCE was close to real life practice. Approximately one fifth of students and one third of examiners preferred e-OSCE over the face-to-face OSCE. The analysis of qualitative data generated themes of e-OSCE structure and technology. While majority of participants were satisfied with e-OSCE, students were concerned about examiners’ training and e-OSCE contents. Examiners and e-OSCE team recognized the paper-less, tech-savy, fast and reliable e-OSCE format. Conclusion: During and beyond COVID- 19 era, e-OSCE is a feasible and effective modality for assessing clinical competence except for physical examination and procedural skills. The planning and implementation of e-OSCE reflects an ingenuity in assessment of clinical competencies of medical students.

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Relationship Between Faculty and Standardized Patient Assessment Scores of Podiatric Medical Students During a Standardized Performance Assessment Laboratory

Journal of the American Podiatric Medical Association ◽

10.7547/14-149 ◽

2016 ◽

Vol 106 (2) ◽

pp. 116-120 ◽

Cited By ~ 1

Author(s):

James M. Mahoney ◽

Vassilios Vardaxis ◽

Noreen Anwar ◽

Jacob Hagenbucher

Keyword(s):

Medical Students ◽

Physical Examination ◽

Health Professional ◽

Faculty Member ◽

Performance Assessment ◽

Clinical Skills ◽

Pearson Correlation ◽

Faculty Assessment ◽

Assessment Scores ◽

Second Year

Background: Direct assessment of health professional student performance of clinical skills can be accurately performed in the standardized performance assessment laboratory (SPAL), typically by health professional faculty. However, owing to time and economic considerations, nonmedical individuals have been specially trained to perform the same function (standardized patients [SPs]). This study compared the assessment scores of the history and physical examination components of a SPAL designed for second-year podiatric medical students at Des Moines University (DMU) by a podiatry medical faculty member and SPs. Methods: A total of 101 students from the classes of 2015 and 2016 were evaluated in 2013 and 2014 by 11 to 13 SPs from the DMU SPAL program. The video recordings of these 101 students were then evaluated by one faculty member from the College of Podiatric Medicine and Surgery at DMU. Results: The Pearson correlation coefficient for each class showed a strong linear relationship between SP and faculty assessment scores. The associations between SP and faculty assessment scores in the history, physical examination, and combined history and physical examination components for the 2016 class (0.706, 0.925, and 0.911, respectively) were found to be stronger than those for the 2015 class (0.697, 0.791, and 0.791, respectively). Conclusions: This study indicated that there are strong associations between the assessment scores of trained SPs and faculty for the history, physical examination, and combined history and physical examination components of second-year SPAL activity for podiatric medical students.

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Assessing The Utility and Efficacy of e-OSCE Among Undergraduate Medical Students During The COVID-19 pandemic

10.21203/rs.3.rs-1016014/v1 ◽

2021 ◽

Author(s):

Sarra Shorbagi ◽

Nabil Sulaiman ◽

Ahmad Hasswan ◽

Mujtaba Kaouas ◽

Mona M. Al-Dijani ◽

...

Keyword(s):

Medical Students ◽

Physical Examination ◽

Clinical Training ◽

Clinical Skills ◽

Real Life ◽

Undergraduate Medical Students ◽

Procedural Skills ◽

Face To Face ◽

Global Pandemic ◽

The Face

Abstract Background The outbreak of coronavirus disease 2019 (COVID-19) and its quick progression to a global pandemic has urged medical schools to shift from didactic to distance learning and assessment approaches. The quality of clinical training and assessment have been jeopardized due to the regulatory restrictions and potential hazards to human lives. The aim of this paper is to evaluate the utility and efficacy of an electronic Objective Structured Clinical Examination (e-OSCE), which attempted to transform the format of a face-to-face OSCE to an e-OSCE. Methods We conducted three end of clerkship e-OSCEs for final year medical students in Surgery, Medicine and Family Medicine using the teleconferencing application of Microsoft Teams (MST). The e-OSCE blueprint included the assessment of all clinical skills except physical examination and procedural skills. Examiners supervised e-OSCE from the college campus, while all students were remotely assessed through the MST channels. During the exam, the students stayed in their specified MST channel and examiners rotated across all students. The utility and efficacy of e-OSCE was evaluated using a self-administered questionnaire for students, examiners and e-OSCE team. Results The data analysis showed that 93.4% students and 92.2% examiners agreed with the quality and process of e-OSCE. Similarly, 83.6% students and 98% examiners agreed with the seamless organization of e-OSCE. As many as 45.9% students and 74.5% examiners agreed that e-OSCE was close to real life practice. Approximately one fifth of students and one third of examiners preferred e-OSCE over the face-to-face OSCE. The analysis of qualitative data generated the themes of e-OSCE structure and technology. While majority of participants were satisfied with e-OSCE, students were concerned about examiners’ training and e-OSCE contents. Examiners and e-OSCE team recognized the paper-less, tech-savy, fast and reliable format of e-OSCE. Conclusion During and beyond COVID- 19 era, e-OSCE is a strong substitute to standard OSCE for assessing clinical competence except for physical examination and procedural skills. The planning and implementation of e-OSCE reflects an ingenuity in the assessment of clinical competencies of medical students.

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Flipping the Medical School Classroom

Encyclopedia of Information Science and Technology, Fourth Edition ◽

10.4018/978-1-5225-2255-3.ch504 ◽

2018 ◽

pp. 5800-5809

Author(s):

Kristina Kaljo ◽

Laura Jacques

Keyword(s):

Medical Education ◽

Medical Student ◽

Medical Students ◽

Clinical Skills ◽

Medical Knowledge ◽

Hybrid Learning ◽

Teaching Methodologies ◽

Face To Face ◽

Content Acquisition ◽

Hybrid Learning Environment

The preparation of today's physicians is a tremendous responsibility. For medical students to be successful, they must experience a multitude of opportunities to develop appropriate clinical skills, problem solving acumen, and medical knowledge. Due to various barriers, medical students may develop gaps in critical and foundational knowledge. The use of flipped lectures has the capacity to “mobilize” education and ensure for versatility and improved content acquisition through the implementation of both online and face-to-face teaching methodologies. This hybrid learning environment has the capacity to also address the increasingly diverse needs of today's matriculating medical student. This article identifies tools and strategies of how to incorporate flipped lectures into medical education.

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S-Vest: a novel hybrid method to allow standardised patients to put on the objective physical examination findings of a disease

BMJ Innovations ◽

10.1136/bmjinnov-2018-000312 ◽

2019 ◽

Vol 5 (2-3) ◽

pp. 78-81

Author(s):

Dale Berg ◽

Katherine Berg

Keyword(s):

Aortic Stenosis ◽

Physical Examination ◽

Clinical Skills ◽

Low Cost ◽

Simulated Patients ◽

Teaching Tool ◽

Educational Tools ◽

Standardised Patients ◽

Single Modality

BackgroundSimulation hybrids combine single modality simulation such as simulated patients (SP) with low-fidelity simulation to create a potentially more powerful set of educational tools. To make a hybrid that is credible, standardised and inexpensive remains a challenge. We describe the development of the simulation vest (S-Vest), an inexpensive, standardised teaching tool that is ‘worn’ by an SP to form a hybrid.MethodsWe have created a vest which contains a set of speakers placed in an anatomical manner and produce sounds. The sounds played from a multitrack audio player are recorded in vivo from a patient with the real disease findings. The SP provides history while the vest provides the objective palpable and auscultatory findings. The speakers are placed in the routine standardised locations taught in physical examination.ResultsWe have developed several case scenarios designed for the vest. One of these cases is an elderly patient with aortic stenosis. The aortic stenosis case audio file has four unique tracks recorded over the precordium. Each track is played at the speaker appropriate to the physical exam findings. The SP plays an elderly man with chest pain. The vest provides the sounds of a loud systolic murmur with marked diminishment of S2 and a palpable thrill.ConclusionsThe S-Vest is a low-fidelity, low-cost simulator to use in hybrid and simulation. The S-Vest can be used in a formative and summative Objective Structured Clinical Examination (OSCE) station and in skills attainment for learners in healthcare. We believe these tools will be of significant import to teaching clinical skills.

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Accuracy of second-year medical students?? self-assessment of clinical skills

Academic Medicine ◽

10.1097/00001888-199710000-00045 ◽

1997 ◽

Vol 72 (10) ◽

pp. S63???5 ◽

Cited By ~ 6

Author(s):

M A Antonelli

Keyword(s):

Medical Students ◽

Clinical Skills ◽

Self Assessment ◽

Second Year

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Peer assessment platform of clinical skills in undergraduate medical education

Journal of International Medical Research ◽

10.1177/0300060519861025 ◽

2019 ◽

Vol 47 (11) ◽

pp. 5526-5535 ◽

Cited By ~ 2

Author(s):

Liling Chen ◽

Hong Chen ◽

Di Xu ◽

Yan Yang ◽

Huiming Li ◽

...

Keyword(s):

Medical Students ◽

Physical Examination ◽

Clinical Medicine ◽

Clinical Skills ◽

Peer Assessment ◽

Control Group ◽

Study Group ◽

Study Objective ◽

Assessment Scores ◽

Year 2013

Objective The study objective was to enhance clinical skills among undergraduate students majoring in clinical medicine in performing physical examination by establishing a novel platform for peer assessment of clinical skills. Methods A total 126 Year 2012 students majoring in medicine and receiving traditional training were assigned to the control group, and 126 Year 2013 students receiving instruction via the peer assessment platform of clinical skills were allocated to the study group. Scores of the physical examination, paper exam, and peer assessment were compared using a t-test, and we performed linear correlation analysis of the data. Results Scores of the physical examination and peer assessment among Year 2013 students (the study group) were significantly higher than those in the control group. Paper exam scores in the study group were also significantly higher than those in the controls. The three assessment scores did not differ significantly according to sex. Conclusions The peer assessment platform can not only improve medical students’ skills and capabilities in physical examination, it can also enhance their theoretical knowledge of basic clinical principles. We determined that sex was not related to the assessment scores obtained by medical students.

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The Effect of 360° Virtual Reality versus 2-Dimensional Video Reviews on History Taking and Physical Examination Skills Learning in Undergraduate Medical Students: A Randomized Controlled Trial (Preprint)

10.2196/preprints.18173 ◽

2020 ◽

Author(s):

Yi-Ping Chao ◽

Chung-Jan Kang ◽

Ming-Ju Hsieh ◽

Yu-Che Chang ◽

Tuan-Jen Fang ◽

...

Keyword(s):

Virtual Reality ◽

Standard Deviation ◽

Medical Students ◽

Physical Examination ◽

Cognitive Load ◽

Learning Outcome ◽

History Taking ◽

Undergraduate Medical Students ◽

Video Review ◽

Video Group

BACKGROUND History taking and physical examination (H&P) is an important core competency of undergraduate medical education. Recent advances in virtual reality (VR) simulation, lowering the complexity of learning tasks and the cognitive load of the learners, make this novel technology well suited for the initial training of novices. Reduced heart rate variation (HRV) is associated with decreased cognitive efficiency. Whether a 360° VR video review can impact learning outcome, cognitive load, and HRV while learning H&P skills in undergraduate medical students is unknown. OBJECTIVE We explored the effectiveness of 360° VR versus 2-dimensional (2D) video review to learn H&P skills with regards to learning outcome, cognitive load, and HRV. METHODS In 2018, we randomly assigned (1:1) 64 undergraduate medical students to either a 360° VR or 2D video group (matched by age, sex, and cognitive style) with allocation concealment to learn H&P skills using VR headsets and controllers. Subsequently, the participants each performed a focused H&P with a real outpatient. Two raters used the Mini-Clinical Evaluation Exercise (Mini-CEX) and Direct Observation of Procedural Skills (DOPS) questionnaires to assess the participants’ performance blindly. The Cognitive Load Component questionnaire and a portable electrocardiogram monitor were used to measure cognitive load and HRV, respectively. RESULTS All participants completed the study (mean age=24.2 years, standard deviation=0.9 years; 44 [69%] males and 20 [31%] females). The physical examination and student’s satisfaction scores (Mini-CEX), total DOPS score, total and intrinsic cognitive load scores, and standard deviation of normal to normal R-R intervals in the 360° VR video group were significantly higher than those in the 2D video group (effect size=0.63, 0.56, 0.72, 0.53, 0.67, and 0.52, respectively). Differences in the other aspects of the Mini-CEX and cognitive loads of both groups were not statistically significant. CONCLUSIONS This study provides a high level of evidence to confirm that 360° VR video review can help undergraduate medical students to perform fundamental H&P skills as effectively as traditional 2D video review. Furthermore, a 360° VR video review could be used to more efficiently examine the body of a real patient with higher learner’s satisfaction. These findings may inspire the design of 360° VR video-based training protocols to enhance competencies other than history taking. CLINICALTRIAL Clinicaltrials.gov NCT03501641; https://clinicaltrials.gov/ct2/show/NCT03501641 (Archived by WebCite at http://www.webcitation.org/72f59ImWm)

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