Workshop: Clinical teaching using innovative technologies

1. Workshop: Clinical teaching using innovative technologies Henry Averns

3. Communication skills course design • Introduction to a Standardized patient program Today • Developing roles for a Standardized patient program Tomorrow Wednesday • How to run an OSCE

4. Yesterday’s doctors Facts Syllabus-based curriculum What does the graduate know?

5. Tomorrow’s Doctors Competencies Outcome-based curriculum What can the graduate do?

6. The basic requirements Basic science Behavioural science Clinical science Population science Understanding Application Knowledge Scientific method Skills Attitudes Professional Ethical Interprofessional Clinical skills Communication skills

7. Adults • Have a specific purpose in mind • are voluntary participants in learning • require meaning and relevance • require active involvement in learning • need clear goals and objectives • need feedback • need to be reflective

8. Adults • Have a specific purpose in mind • are voluntary participants in learning • require meaning and relevance • require active involvement in learning • need clear goals and objectives • need feedback • need to be reflective

9. Adults • Have a specific purpose in mind • are voluntary participants in learning • require meaning and relevance • require active involvement in learning • need clear goals and objectives • need feedback • need to be reflective

10. Changes in method of teaching over last 20 years Passive Active Didactic Self directed Contextual Sequential Small groups Large group

11. Principle 1: Integration Vertical integration = across years Horizontal integration = between subjects

12. Traditional Curriculum Biological sciences Behavioural science Clinical studies

13. Revised curriculum Basic sciences Clinical studies

14. Principle 2: Logical Progression Material should be presented in a logical order which is discernable by the students

15. Principle 3: Planned Repetition “Spiral curriculum”

17. Definition of clinical skills • Clinical skills refer to the skills required for a clinician to manage a complete patient encounter. These include • Communication skills to allow a clinician to take a thorough history, and also to understand the patient’s experience of illness, negotiate management plans etc. • Physical examination skills • Clinical reasoning skills, including data gathering and interpretation; development of a differential diagnosis and the ability to synthesize this data into a management plan appropriate to the individual patient • Technical (procedural) skills relevant to diagnosis and management • All of the above skills require underlying foundational medical expert knowledge

18. Systematic definition of the skills observation of learners video or audio recording and review well-intentioned feedback rehearsal active small group learning How to teach communication skills – lessons from the evidence

19. In groups Please discuss for 10 minutes • When do you start teaching clinical communication skills? • What resources do you use ? • Please be prepared to share this

20. What experiential material is available to you? • videos of real consultations • real patients • simulated patients • role-play

21. Part 2

22. The Communication Curriculum at QueensThe Calgary Cambridge Model

23. Defining objectives • AFMC Clinical skills document • Medical School’s own curriculum • LMCC objectives • You will have similar objectives

24. Resource constraints Time People Money Space

25. Course Design • The course is based around 10 groups each made up of 10 students and 2 tutors • It runs for a half day per week for two years

26. Year 1 • Term 1 • Introduction to Interviewing • Beginning the Interview • History of the Present Illness & Questioning & Listening • The Patient's Perspective • Completing the History and Putting it all Together

27. Term 1 (continued) • Vital Signs and Routine Practices • General Appearance, ENT and Lymph Nodes • Examination of the Thyroid Mid-Term Formative Assessment • Cardiac Examination • Respiratory Examination • Abdominal Examination  • Breast and Axilla Examination • History Taking and Presenting an Oral Report  • Review of Skills Learned during the Term • Student Assessment and Course Evaluations

28. Faculty-delivered lecture (30 – 45 minutes) flowed by tutor-led small group learning. • Tutor resources: • A dedicated website • A resource manual • A term schedule which includes a description of each session • The physical examination manual

29. Term 2 • Neurological exam • Cranial nerves • Ophthalmology • MSK • Sexual history • Pediatric sessions (x2) • Technical skills (x2)

30. Also in Term 2 • Students conduct full history and physical examination with a standardised patient or real patients

31. Year 2 • The main objectives of year two include: • Development of clinical reasoning • Education of patients about disease and medication • Difficult conversations eg breaking bad news • Written reports • Oral reporting

32. Term 3 • Introduction to clinical reasoning (x3) • Technical skills (x2). Suturing, catheter • Patient education session • Findings in real patients • Simulated patient full history and physical • Community hospital full hx an px • Emergency Room visit

33. Term 4 • Technical skills (x2) : Chest tube, blood gases, IVI insertion • Mini OSCE • Pediatrics – neonatal examination • Real patient findings • Community hospital full history and physical • Clinical education Centre history and physical with simulated patients • Breaking bad news session • Male genital examination

34. We will discuss some of these specific sessions this week when we talk about simulated patients

35. In groups • Discuss the different assessment methods you currently use, and their strengths and weaknesses. • Be prepared to share this

36. Course Assessment • Assessment Term 1 • Student self assessment week one, mid term, end of term • Tutor formative assessment mid term (downloadable forms) • Tutor final assessment • 4 “individual assessments” all mandatory and summative • Basic hx assessed by Standardised patients (SPs) • BP, pulses, and lymph nodes assessed by nurses • Cardiac hx and px assessed by Residents and SPs • Respiratory hx and px assessed by Residents and SPs

37. Assessment Term 2 • Early, Mid and Final tutor assessments as for Term 1 • Formative OSCE – no contribution to final score • Final OSCE

39. Calgary Cambridge Communication Framework

40. What I will discuss • What is the Calgary Cambridge Approach? • The guides • Agreeing what we are trying to teach in Communication

41. communication is a clinical skill it is a series of learnt skills experience alone is a poor teacher Can communication skills be taught?

42.  there is conclusive evidence that communication skills can be taught  and that communication skills teaching is retained Can communication skills be taught?

43. traditional lectures/interactive lectures + exercises paper exercises Video demonstrations Consultations with simulated patients Consultations with real patients Patients stories of the illnesses web-based/e-learning clinic/ward teaching with real patients Visits to patient’s homes/ITU/ward/old peoples’ homes etc Methods of teaching communication

45. Why do we need a framework? • Effective history taking is essential to the practice of high quality medicine • This requires excellent communication skills

46. The Interview is Our Main Diagnostic Tool • 60-80% of medical diagnoses are made after the interview alone • The interview determines the physical exam and investigations

47. The Disease - Illness Model Patient Presents Problem Gathering Information Parallel Search of Two Frameworks The Biomedical Perspective The Patient’s Perspective Symptoms Signs Investigations Underlying Pathology Differential Diagnosis Ideas Concerns Expectations Feelings Effects on life Understand the patient’s unique experience of illness Integration of the two frameworks Collaborative explanation and planning: shared understanding and decision making