Producing Competent Doctors - The Art and Science of Teaching Clinical Skills

Comparison of Peyton's Four-Step Approach With the Conventional Bedside Technique in Teaching Clinical Examination Skills to Medical Students

BACKGROUND

 Conventional bedside teaching (CBT) is an integral and classical method for imparting clinical skills to undergraduates in medical schools. It is a traditionally successful approach, especially when it comes to imparting patient-doctor relationship skills and knowledge on clinical management. Peyton's four-step approach (PFSA) is one of the newer structured instructional approaches for teaching-learning, especially for imparting procedural and complex psychomotor skills. The present study compares the application of PFSA in teaching complex systemic examination skills to the CBT technique in teaching the same skill to MBBS students. The impact of the acquisition of this examination skill was assessed statistically to compare PFSA and CBT methodologies.

METHODOLOGY

 The target population was MBBS (Bachelor of Medicine and Bachelor of Surgery) students; for this study, the phase II MBBS students were considered as the study population since they were relatively naïve to clinical bedside examination skills. Students were allotted groups and they were taught clinical skills through CBT and PFSA separately. Using the OpenEpi toolkit Version 3 open-source sample size calculator for comparing two means, the sample size was 30 students in each group. The students were assessed for their competency and were also made to fill out a feedback questionnaire to compare the two methods of education dispensing.  Results: The results of this study showed that PFSA is definitely suitable for teaching clinical examination skills. The acquisition of skills was found non-inferior to CBT while the retention of these skills was found to be equally good or even superior with PFSA than with CBT.  Conclusion: PFSA has already been proven to be a good teaching method for the acquisition of complex procedural skills. This study expands the role of PFSA in teaching clinical bedside examination skills to medical students. Further large-scale studies may clarify the learning impact and outcomes of PFSA in clinical bedside teaching.

Frequently Used Conceptual Frameworks and Design Principles for Extended Reality in Health Professions Education

Health professions education (HPE) has witnessed a dramatic increase in the use of extended reality (XR), but there is limited evidence that conceptual frameworks are being effectively employed in the design and implementation of XR. This paper introduces commonly utilized conceptual frameworks that can support the integration of XR into the learning process and design principles that can be helpful for the development and evaluation of XR educational applications. Each framework and design principle is summarized briefly, followed by a description of its applicability to XR for HPE and an example of such application.

Clinical Skills Day: A Novel Approach to Enhancing Procedural Skills Teaching for Foundation Year One Doctors

Background Completion of the Foundation Year One (FY1) doctor training is a requirement for full General Medical Council registration in the United Kingdom. Training during this year is mapped to a curriculum with one of the key elements being safe procedural skills. The objective of this project was to improve the teaching of procedural skills through the means of a Clinical Skills Day (CSD) and to quantify any improvement. Materials and methods A one-group pretest-posttest design was conducted on 32 doctors who completed a confidence inventory before and after four core procedural stations: suturing, urethral catheterisation (both male and female), lumbar puncture, and bimanual and speculum examinations. The intervention of simulated procedural skills occurred under the supervision of senior clinicians, with FY1 doctors receiving teaching and practising the four skills. The primary outcome was the impact of a CSD on trainees' confidence in performing certain skills. Pre- and post-CSD trainees' confidence levels were collected via an online-focused questionnaire and descriptive statistics, paired t-test, and one-way analysis of variance (ANOVA) with post-hoc Bonferroni comparisons were undertaken for statistical analysis. Results The difference in the mean scores of confidence post-intervention was significant in all four procedural stations with or without supervision (p <0.0001). Conclusions The use of CSDs impacted positively on the FY1 doctors' confidence in performing certain skills. Wider implementation of this promising approach for Foundation Doctors is recommended.

A conceptual model for clinical psychomotor skill development in an era of simulated and virtual reality

Psychomotor skill development is central to a beginner practitioner's learning pathway. Curriculum constraints around time, access to facilities and resources in health professions education have prompted the growth in alternative approaches to clinical skill development in both simulation and direct patient care. Among these is the increased incorporation of virtual reality (VR) systems with haptic feedback alongside traditional, solid simulations. Given the rapid growth in the adoption of technological affordances to support skill development, it is cogent to pause and examine whether the underpinning concepts regarding psychomotor skill development that have driven much of the approaches to teach clinical skill acquisition in dentistry remain fit-for-purpose. This conceptual paper proposes a new taxonomy for clinical simulation psychomotor skill development in the era of increasing variety of simulation modalities.

Simulated Patients for Competency-Based Undergraduate Medical Education Post COVID-19: A New Normal in India

The conventional medical curriculum in India needed more focus on explicit teaching and assessment of interpersonal and communication skills, professionalism, team-work and reflection for prevention and better management of increasing incidences of violence against doctors by building good doctor-patient relationships. Increasing number of seats in Indian medical colleges, decreasing hospital stay of patients, and decrease in faculty requirements will hamper adequate supervised authentic clinical experiences of undergraduates for developing clinical skills. The recent COVID-19 pandemic has led to a significant decrease in student-patient encounters. Simulated patients are being used in many countries to address many of these issues. To make the Indian medical graduates competent to function as primary physician of first contact, competency-based medical education along with guidelines for use of skill-lab and simulation has been introduced from 2019. The current review is focused on the need and use of simulated patients; their advantages, limitations and role in students’ teaching and assessment. It also gives a brief outline of their training process. Simulated patients should be used to supplement day-to-day learning, help in transition to attending real patients and also save enormous faculty time in the post-COVID-19 new normal. However, simulated patients are unlikely to completely replace real patients’ experiences.

Clinical Skill: The Ebbing Art of Medicine

Clinical history taking and physical examination are the essence of clinical medicine. However, the glare of modern diagnostic tools and techniques has overshadowed these basic but indispensable steps of diagnosis. Deterioration of clinical skills is a burning issue in this era due to over-reliance on high-end technology. Poor clinical judgment not only leads to mismanagement but also results in over-utilisation of health care resources. Moreover, with lesser time at the bedside, the physician-patient relationship is also getting compromised.

Simulated Patients for Competency-Based Undergraduate Medical Education Post COVID-19: A New Normal in India

The conventional medical curriculum in India needed more focus on explicit teaching and assessment of interpersonal and communication skills, professionalism, team-work and reflection for prevention and better management of increasing incidences of violence against doctors by building good doctor-patient relationships. Increasing number of seats in Indian medical colleges, decreasing hospital stay of patients, and decrease in faculty requirements will hamper adequate supervised authentic clinical experiences of undergraduates for developing clinical skills. The recent COVID-19 pandemic has led to a significant decrease in student-patient encounters. Simulated patients are being used in many countries to address many of these issues. To make the Indian medical graduates competent to function as primary physician of first contact, competency-based medical education along with guidelines for use of skill-lab and simulation has been introduced from 2019. The current review is focused on the need and use of simulated patients; their advantages, limitations and role in students' teaching and assessment. It also gives a brief outline of their training process. Simulated patients should be used to supplement day-to-day learning, help in transition to attending real patients and also save enormous faculty time in the post-COVID-19 new normal. However, simulated patients are unlikely to completely replace real patients' experiences.