Basic Clinical Skills Research Articles

Phytobezoar causing intestinal obstruction in a neonate: A case report

Background: Phytobezoars are concretions of non-digestible vegetative matter in the gastroin­testinal tract and are a rare cause of intestinal obstruction in children. Case presentation: We report a case of intestinal obstruction in a 2-day-old neonate with no specific radiological features pointing to any common etiology. On exploratory laparotomy, a swollen raisin was found impacted in the ileum causing intestinal obstruction. The history taken in retrospect revealed that the elder sibling had witnessed her father perform a traditional ritual of putting a drop of honey into the mouth of the newborn and she imitated the same with a raisin, which led to the obstruction. Conclusion: A careful detailed history of local traditional rituals is at times, the most important pointer towards the etiology of a clinical condition. The basic clinical skill of history taking is still very important, despite the availability of advanced radiological investigations.

Introduction of a skills boot camp for final year undergraduate medical students entering internship in General Medicine in a North Indian medical college: A pilot study

Introduction: During internship students acquire basic clinical skills and hands on clinical experience. Although the interns are supposed to learn these clinical skills under supervision, this is not always possible. Even though the Medical Council of India, in its VISION 2015 Document has emphasised on “Early Clinical Exposure” and clinical training from first year, medical education in India remains highly oriented towards theoretical learning. Theoretical learning of clinical skills and procedures is not sufficient to handle the various clinical scenarios that the interns face everyday. Materials and Methods: A 3 day ‘Skills Boot Camp’ was conducted in the Department of Medicine. The boot camp included skills from (and related to) the speciality of General Medicine. A total of 13 students who entered General Medicine for the first internship posting participated in the boot camp. Results: All 13 participants showed an increase in their knowledge and confidence levels in the targeted skills. All faculty members agreed that after attending the skills boot camp the interns were able to perform their duties efficiently, displayed improved communication skills and were better prepared in dealing with difficult patients and angry relatives. Conclusion: A skills boot camp which targets basic communication and clinical skills was well received by the interns and faculty alike. Both the interns and the faculty agreed that the skills boot camp should be incorporated as a permanent feature of internship and reported high overall satisfaction levels with the camp. Keywords : Internship and residency, Curriculum, Clinical competence, Physician-patient relations.

Medical Education Reform in China: The Shanghai Medical Training Model.

Medical Education Reform in China: The Shanghai Medical Training Model.

P.561 Barriers to the use of long-acting injectable antipsychotics in patients with schizophrenia: a survey to understand clinician educational needs

As the integral role of genetics in health and disease becomes increasingly understood, pediatricians must incorporate genetic principles into their care of patients. Structured exposure to genetics during residency may better equip future pediatricians to meet this goal.Pediatric interns in the Johns Hopkins pediatric residency program have the option to spend one week immersed in clinical genetics by attending outpatient clinics and seeing inpatient consults. A pretest assessing clinical genetics knowledge is given before the rotation and compared with an identical post-test. Interns have a “scavenger hunt” to introduce genetic resources useful to pediatricians and complete a logbook of patient experiences. An evaluation is completed at the end of the rotation.Since the selective started in July 2016, 50 interns have participated. Average pretest score was 2.5/5 compared with a post-test score of 4.3/5, p < 0.0001. Interns saw on average ten patients and four different diagnoses. Overall evaluation was 4.4 on a 5-point scale, 5 being “excellent.”This experience suggests that a structured rotation in genetics provides pediatric interns with an opportunity to learn basic clinical genetics knowledge and skills and see patients whom they may otherwise not encounter during residency.

The Simulated Cardiology Clinic: A Standardized Patient Exercise Supporting Medical Students' Biomedical Knowledge and Clinical Skills Integration.

IntroductionDevelopment of cardiac disease-related diagnostic skills—including hypothesis-driven data gathering, heart sound interpretation, and ECG interpretation—is an important component of medical student training. Prior studies indicate trainees' performance of these skills is limited. Simulation provides students with opportunities to practice integrating their developing knowledge in a relevant clinical context. We developed a simulated clinic activity for second-year medical students consisting of standardized patient (SP) cases representing cardiovascular (CV) diseases.MethodsStudent small groups rotated through four SP encounters. For each case, one student performed the history, after which the whole small group listened to audio files of heart sounds, interpreted an ECG, and collaboratively developed a prioritized differential diagnosis. The CV course director met with students for a large-group debrief, highlighting key learning points. We collected learners' evaluations of the event through an online survey.ResultsOf students, 276 participated in this activity over the course of 2 years. Nearly all students assessed the activity as extremely or quite effective for applying learning content from the CV course (97%, 2018; 93%, 2019), and for practicing how to approach chest pain, shortness of breath, palpitations, and fatigue (100%, 2018; 95%, 2019). The most helpful aspects were reinforcement of CV disease illness scripts, hypothesis-driven data gathering practice, ECG interpretation, and applying knowledge and skills in a realistic context.DiscussionSP encounters representing CV conditions can effectively provide opportunities for students to integrate basic science knowledge and clinical skills. Students assessed the activity as helpful and engaging.

Beyond simulation — Extracurricular volunteering in nursing education: A focus group

BackgroundA reduction in clinical placement hours has seen alternative teaching methods being explored in nursing education in Australia. The use of simulated patients in academic laboratories is highly utilised, however, may still be limiting learning opportunities. ObjectiveThe objective of this research was to describe the learning experiences of nursing students who participated in supervised extracurricular, volunteering opportunities during their nursing studies. DesignA descriptive qualitative design was used to discover and understand learning experiences of a volunteering encounter, described from the nursing student perspective. SettingThe Pit Stop men’s health check program is a collaboration of local health organisations, volunteering their time to provide free health checks at a farming Field Day event in regional Victoria, Australia. ParticipantsTwelve second year undergraduate nursing students volunteered at the 2019 Pit Stop event, over a four day period and outside their normal study requirements. Seven volunteers then participated in post event research, sharing experiences and providing feedback. MethodsOne semi-structured focus group interview was conducted at University campus, using reflective and open ended questioning. Interviews were audio recorded and transcribed. Thematic analysis identified common themes. ResultsStudents unanimously recommended the real life learning experiences and reported an increased confidence and competence in basic communication and clinical skills, not always provided in the simulated environment of the academic laboratory. Their motivation to attend was driven by wanting more real life contact with patients, having time to practice skills and experience diversity within their practice. Students also recommended future volunteering ideas that would potentially provide additional learning opportunities. ConclusionsExperiential learning such as simulation is highly valued in current nursing education, however, students still crave the real life learning experiences from working with human patients. With limited clinical exposure currently offered to students within nursing education programs, additional opportunities such as supervised volunteering may be worth considering when preparing confident and competent nurse graduates.

Defining dental operative skills curricula: An ADEE consensus paper.

This paper reports on the recent activity of the pan-European consensus of the ADEE Special Interest Group for Pre-Clinical Operative Skills. Following the previous recommendations from the group, and in order to support teachers and to harmonise the delivery of skills training across Europe, a more formal curriculum relating to pre-clinical operative skills needs to be created. This paper reports European consensus surrounding the categorisation (level of importance, and difficulty) of basic operative dental clinical skills within the undergraduate curriculum and provides recommendations relating to session structure and timing of curricular elements for basic operative dental clinical skills teaching.

Vertical integration of head, neck, and special senses module in undergraduate medical curriculum.

Vertical integration is believed to increase motivation by providing context for the learning. In this quasi-experimental study, cohort I took two horizontally integrated modules: structure and function of head, neck, and special senses in the second year, and pathophysiology and clinical sciences in the third year. Cohort II took a combined, vertically integrated module in the second year. Data from the questionnaire and examination scores were compared. Response rate was 80.1% (125/156) for cohort I and 57.6% (98/170) for cohort II. Response to the statement that vertical integration provides context to basic sciences was mixed with a higher agreement in cohort II (51.5 vs. 37.2%; P = 0.04). Cohort II was least satisfied with the appropriateness of self-study time (52.0 vs. 34.7%; P = 0.01). However, cohort II felt that the basic sciences lectures (90.8 vs. 69.4%; P < 0.01) and the clinical skills sessions (85.7 vs. 62.1%; P < 0.01) were more effective. Cohort II was less satisfied with clinical lectures (80.6 vs. 56.1%; P < 0.01) and was less confident in achieving clinical learning objectives (72.8 vs. 40.8%; P < 0.01). Mean multiple-choice questions and problem-based learning scores were similar. However, the short-answer question score was higher for cohort I [82.48 (SD 14.9) vs. 70.74 (SD 17.9); P < 0.01]. Overall, the idea of early vertical integration had a mixed response. It improved the effectiveness of basic sciences lectures and clinical skills sessions. Achievement of clinical learning outcomes was compromised. A disparity in the module's duration and curricular content, and students' ability to grasp clinical concepts and faculty's expectations are the possible reasons. Increased duration and better communication with clinical faculty may improve early introduction of vertical integration.

The Brody School of Medicine at East Carolina University.

The Brody School of Medicine at East Carolina University.

Analysis of Medical School Term 1-2-3 Students' Communication and Empathy Skills

Giriş: Bir hekim, bir ömür boyu süren kariyeri süresince 160.000 ile 300.000 görüşme gerçekleştirmekte ve tıbbi görüşmeyi klinik tıpta en sık uygulanan prosedür haline getirmektedir. Bu nedenle iletişim ve empati, hastalarla görüşme yaparken istenilen ve geliştirilmesi gereken önemli bir klinik beceridir. Hekim adayları açısından düşünüldüğünde ise iletişim ve empati, öğretilip öğrenilebilen temel bir klinik beceridir. Bu çalışmada amacımız, hekim adaylarının klinik öncesi iletişim ve empati becerilerinin değerlendirilmesi ve demografik değişkenler açısından incelenmesidir. Bu anlamda elde edilen bulguların tıp eğitimi müfredatı açısından ihtiyaç analizi niteliğinde olabileceği düşünülmektedir.Gereç ve Yöntem: Bu araştırma, tanımlayıcı nitelikte olup, evrenini 2017-2018 öğretim yılında Ankara il merkezinde bulunan bir Vakıf Üniversitesinin Tıp Fakültesi Dönem 1, 2 ve 3 öğrencileri oluşturmuş ve çalışmaya katılmayı kabul eden 90 öğrenci ile tamamlanmıştır. Verilerin toplanmasında; Kişisel Bilgi Formu, Ersanlı ve Balcı tarafından geliştirilen İletişim Becerileri Envanteri ve Dökmen tarafından geliştirilen Empati Beceri Ölçeği B-Formu kullanılmıştır.Bulgular: Öğrencilerin % 61,1’i kadın, % 53,3’ü Anadolu Lisesi mezunu, % 93,3’ü çoğunlukla yaşamını il ortamında geçirmiş, % 70’i evde ailesi ile birlikte yaşamakta, % 86,7’si çekirdek aile yapısına sahiptir. Öğrencilerin iletişim beceri toplam puanı, orta düzeyin biraz üzerindeyken; empati beceri toplam puanı ise orta düzeyin altında kalmıştır. Ayrıca kadınların iletişim ve empati beceri puan ortalamasının erkeklere göre daha yüksek olduğu belirlenmiştir.Sonuç: Hekimlerin hastaları ile etkin iletişim kurabilmesi; hekimlerin daha erken ve daha doğru tanı koymasına yardımcı olacak, hastanın kaygısını azaltıp tedavi sürecinde uyumunu ve memnuniyetini artıracaktır. Bu noktada tıp eğitimi müfredatının, söz konusu etkileşimin hekim adaylarında erken dönemde fark edilmesini sağlayacak içerik ve nitelikte olması gerekmektedir.

Keck School of Medicine of the University of Southern California.

Keck School of Medicine of the University of Southern California.

Hackensack Meridian School of Medicine at Seton Hall University.

Hackensack Meridian School of Medicine at Seton Hall University.

Creation and delivery of a clinical pharmacy practice and education program for international participants in the United States

AbstractIntroductionUniversity of Illinois at Chicago (UIC) College of Pharmacy has a long history of collaborating with institutions around the world to advance pharmacy practice and education through offering programs for practice skills enhancement and curricula transformation.ObjectivesTo develop a short‐term summer program on contemporary clinical pharmacy practice and education for pharmacy students and pharmacists, initially from Taiwan, and subsequently expanded to other countries.MethodsWe developed a month‐long program in 2013 for 25 participants from four different universities, which has continued annually for 7 years, with 349 total participants from 10 regions. The program included topics on basic clinical skills, therapeutic management of common disease states, descriptions of unique clinical pharmacy practice models, and patient case‐based teaching. Baseline self‐evaluations of the participants' skills, clinical understanding, and past experiences were conducted, along with weekly program self‐evaluations of the program content, speaker effectiveness, and overall program satisfaction.ResultsA 89% response rate was received for the program evaluations. The mean overall program content was rated at least a 4.4 out of a 5‐point Likert scale every year. Self‐rated comfort level measured before and after program completion showed improvement in all areas including taking medication histories, interviewing patients, writing SOAP notes, taking blood pressures, interpreting lab values, performing inhaler teaching, monitoring warfarin, and performing pediatric dosing (P &lt; .01 for all pre‐ and post‐comparisons). The participants rated the overall program quality as high every year (mean 4.4‐4.9), and the usefulness and organization as well (mean 4.4‐4.8 and 4.3‐4.8, respectively). In addition, most participants reported a high likelihood of recommending the program to others (mean 4.4‐4.9).ConclusionParticipants reported that the summer program increased their clinical skills and knowledge. The enhanced understanding of clinical practice and education in the United States may help shape their future academic and professional development.

Child psychiatry in China: Present situation and future prospects.

Child psychiatry in China: Present situation and future prospects.

Monitoring Breathing Frequency, Pattern, and Effort.

Monitoring respiratory values such as breathing frequency, minute ventilation, breathing effort, and dyspnea are common in acute care. There is evidence that accurate monitoring and interpretation of these values leads to early identification and treatment of impending respiratory failure. Despite this evidence, some values, such as breathing frequency, are largely undervalued in the clinical setting. The undervaluation of breathing frequency is complex and will require a multifaceted approach, including education and improved technology, to reestablish its clinical potential. Many questions remain regarding how to most efficiently and effectively monitor other respiratory values, like noninvasive minute volume and breathing effort, as well. As technology continues to improve alongside the understanding of respiratory physiology, clinicians are able to apply basic clinical assessment skills and technology together to improve patient safety and outcomes.

‘We need one more hour solely based on anatomy… Give us anatomy!’: Early-year learner perceptions of anatomy within an integrated & case-based learning osteopathy curriculum

BackgroundIntegrated curricula, where the teaching of basic and clinical sciences is combined horizontally and vertically, have received increasing attention in the health professions education literature. This structure is thought to better prepare learners for the clinical learning environment and their future work as a health professional. Our research aimed to explore student perceptions of anatomy within an integrated curriculum underpinned by case-based learning (CBL). MethodsTwo focus groups using semi-structured questions were conducted with year 1 learners. Audio-recorded data was then thematically analysed through a constructivist lens. ResultsThirteen students participated. Participants recognized the value of anatomy for their future work and ascribed it a high priority for their learning, including asking for greater anatomy contact hours. CBL does not assist in learning anatomy per se, rather it provides context, enhances its relevance to future work, and unifies the curriculum. With the exception of anatomy and biomechanics, students had trouble recognizing other components of the integrated biomedical sciences subject (e.g. physiology and pathology). This outward disconnect resulted in confusion. However, participants reported strong links between the basic science and clinical skills units. ConclusionsStudy outcomes suggest learners appreciate the integrated curriculum structure in the early stages of their anatomy learning. Its high value may be related to perceived difficulty of this content, or the hidden curriculum privileging anatomy over subject content. Integrated subjects need to balance content to ensure it is reflective of future practice, and signpost to assist learners to navigate the subject and facilitate their learning.

Rules of Engagement: Implementing Student-Centered Learning in Breast Imaging.

In response to changing learner needs, our institution launched a new translational curriculum wherein basic sciences and clinical skills were integrated, longitudinal patient care experiences provided, and earlier opportunities in specialty fields introduced to better inform residency program decisions. Medical students taking the breast imaging elective were enrolled in a breast imaging immersive experience designed to meet the School of Medicine's core competencies. In focusing the elective on a narrow range of specialized topics and skills, we labeled this experience the Breast Imaging Boot Camp. Outcome data from March 6, 2017, to April 26, 2019, have been analyzed for this report. The modifications made to the elective include: e-mailing a detailed orientation document to students prior to the start of the rotation; assigning students to diagnostic, procedural, and screening roles; the attendance of students at introductory radiology symposia; students' weekly attendance at institutional multidisciplinary and divisional breast radiologic-pathologic correlation conferences; student self-study assignments using faculty-vetted resources; student participation in breast biopsy simulation and small parts ultrasound laboratories; the development of a student-centric radiology educational website; and student-directed publishing of digital case files. Medical student feedback and course analytics indicated superior course evaluation scores reinforced by narrative feedback. In website domain utilization data, the breast file domain is the most viewed subspecialty domain. The Breast Imaging Boot Camp is a successful curriculum. Its novelty lies in both its integrated approach to medical student core competencies and its clinician educators' use of today's student-favored teaching tools.

Introduction to Wilderness Medicine-A Medical School Elective.

This curriculum provides a capstone experience for fourth year medical students, integrating aspects of the basic sciences and clinical skills in the care of wilderness medicine conditions. The duration of this course is 2 weeks. Since passage of the Wilderness Act of 1964, leading to the protection and expansion of wilderness areas, there has been steady growth in participation in outdoor recreational activities.1 Between the years of 2000 to 2009, there was a 7.5% increase in the total number of individuals participating in outdoor recreation. Notably, during this same timeline, there has also been a 7.1% increase in the total number of people participating in "nature-based outdoor recreation." 2 Acknowledging this rising interest in the outdoors, along with increasing accessibility to remote locations, it has become clear that healthcare providers must now attain the ability to both identify and treat conditions unique to these environments.In addition to discrete medical conditions unique to environmental medicine, the practice of wilderness medicine also encompasses the management of the familiar, the "bread-and-butter" medical illnesses, occurring in the unfamiliar, nonclinical environment. Management of these conditions requires both a knowledge of core life support principles and an adaptability and awareness of the non-medical factors affecting a patient's care.Wilderness Medicine also teaches core principles of austere medicine - healthcare administration in a resource-limited environment. The skills acquired in a wilderness medical course provide not only training in the wilderness setting, but also encompass medical care necessary in instances of disaster relief, terrorist events, and international medical missions.3 Additionally, management of discrete wilderness medicine conditions provides a context to review toxicologic biomechanisms and pathophysiology shared by other, more common conditions.For these myriad reasons, a wilderness medicine elective in medical school provides students with more than a divergent experience; it provides a review and expansion of core medical principles increasingly applicable to all specialties. The primary objective of this course is to provide fourth year medical students an introduction to wilderness medicine. Students will be able to: explain fundamental concepts of practicing medicine in austere conditions; identify and initiate treatment for common wilderness medicine conditions; and utilize the non-medical aspects of providing care in austere environments. The educational strategies used in this curriculum include a combination of lecture-based and experiential learning activities, structured through the lens of Kolb's theory of experiential learning. Core knowledge is preferentially imparted during outdoor experiential components, allowing adaptable, true-environment training. Sessions are complemented by assigned pre-reading in Auerbach's Wilderness Medicine4 textbook to create a flipped outdoor-classroom experience. In addition to a final examination, the course will include a final multi-day expedition designed to allow students an opportunity to demonstrate their wilderness medicine knowledge. The course format opens it to adaptation as a longitudinal curriculum. Finally, this course may be adapted to serve resident education purposes. This curriculum has been used and vetted at the authors' institutions with over 50 medical students. All individual comments were reviewed for applicability, trends noted, and the course was further refined. Student final assessment scores were reviewed to refine the content taught and clarity of assessment. The current iteration of the curriculum received the following on a 5-point Likert scale by students on post-course evaluation forms: 4.91 for overall educational experience, 4.82 for curriculum effectiveness, and 5.00 for effective faculty instruction. As a result of comments, the use of the flipped-classroom model throughout the course has increased. Topics frequently encountered in spontaneous discussion due to regional importance have been included. Overall, this course has proven both popular and successful. Due to the dynamic and divergent nature of this as a medical school course, the authors have noted increased levels of student engagement with the material. Increasing reliance on the flipped-classroom model with student-led scenarios and discussions has increased students' ability to recall and apply their knowledge to scenarios during the final expedition. The broad range of conditions included in wilderness medicine provides a unique framework to highlight the relevance of the basic medical sciences and review core medical principles. Wilderness trauma stabilization, patient transportation, acute mountain sickness, high-altitude cerebral edema, high-altitude pulmonary edema, hypothermia, frostbite, orienteering, survival skills, expedition medical kits, marine envenomation, decompression illness, plant toxidromes, snake envenomation, arthropod envenomation, high-angle rescue, search and rescue, heat illness, lightning strike, tick-related illness, disaster response, international medicine.4.

Diseño de una intervención educativa basada en simulación para el desarrollo de la competencia clínica en exploración neurológica

IntroductionGiven the growing demand for neurological care and the importance of the neurological examination for diagnosis, an Educational Intervention Based on Simulation (IEBS) is proposed for the development of Clinical Competence in Neurological Examination (CCEN). MethodsA quasi-experimental study was performed with 34 second-year medical students, selected with non-probabilistic sampling, and excluding those who have had any course in neurology. All received the IEBS, which consisted of a 60-minute session with a neurology expert, 2 hands-on 30 minutes’ sessions with a Standardized Patient and feedback and a general 60-minute feedback. All participants were evaluated before and after the IEBS using the basic clinical skills in neurology rubric (HCBN) that considers 9 aspects of neurological examination. ResultsNo participant had the CCEN prior to the IEBS, and 9 developed it afterwards. Using the McNemar test, the difference in the CCEN between the Pre-test and Post-test groups was statistically significant (0% vs 26.47%, P=.004). Of the 9 sections of the rubric, 8 improved significantly (P<.05). The physician-patient relationship was the only one that did not show statistical significance, however, it did show improvement (88.2% vs. 100%, P=.125). ConclusionThe IEBS is related to a significant increase in the overall CCEN, as well as in each section of it. Thus the IEBS is considered to be useful to improve the performance of students in neurology examinations, for which its use is recommended.

Evaluation of a staged case-based discussion curriculum in standardized residency training.

The standardized residency training in China is continuous medical education for postgraduates, which is designed to master basic knowledge, theory, and clinical skills. Case-based discussion (CBD) is one of the main formative curricula used in standardized residency training. The aim of this study was to assess the impact of a novel CBD curriculum on residents' participation, satisfaction, and confidence in clinical skills. This was a prospective study that included 28 internal medicine residents. The traditional CBD contents were adjusted. The innovative approach let residents at different stages prepare and organize the CBD cases by themselves according to different levels of complexity. The surveys were designed to measure conference occurrence and residents' attendance, participation, and satisfaction, as well as their confidence in their clinical skills. Faculty could further engage the residents at any point to deepen the discussion and learning. The surveys indicated that the residents had a high satisfaction rate with the novel-staged CBD teaching method. Our curriculum improved conference occurrence, attendance, and participation; increased residents' self-report of participation in learning; and raised their confidence in their clinical skills, so the CBD was well received by residents and faculty preceptors. In addition, this study demonstrated that the staged CBD increased the knowledge and evidence usage of internal medicine residents. We expect wider application of this kind of CBD in clinical practice, medical education, residency training, and patient education in the future.