Structured Clinical Instruction Module Research Articles

Use of objective structured clinical examination and structured clinical instruction module for interprofessional education on cancer: A focused review

American association for cancer education had emphasized the role of structured educational programs for medical students and residents in primary care specialties in order to improve palliative oncology education. Dissatisfaction with the conventional methods of clinical assessment on the part of teachers and students led assessors to search for appropriate alternatives and in 1975, Harden and his colleagues introduced the objective structured clinical examination (OSCE). OSCE was introduced as a standardized tool for objectively assessing clinical competencies−including history-taking, physical examination, communication skills, data interpretation, etc. It consists of a circuit of stations connected in series, with each station devoted to the assessment of a particular competency using pre-determined guidelines or checklists. The Structured Clinical Instruction Module (SCIM) modifies the OSCE for teaching purposes. The objective of this review is to provide a focused update on the status and applicability of SCIM and OSCE in cancer for educational use in palliative care. From the 12 studies which were on OSCE and 6 studies which were on SCIM, it appears that the two competency-based evaluation methodologies used in cancer education namely the OSCE and the SCIM are well validated and reliably used across settings and samples of students, practitioners, and patients. Future studies in Indian palliative care settings are warranted prior to extrapolation of existing evidence.

Using Structured Clinical Instruction Modules (SCIM) in Teaching Palliative Care to Undergraduate Medical Students

Abstract Background. Student evaluation of the palliative care attachment at The University of Western Australia highlighted certain shortcomings. Methods. A 2-hour Structured Clinical Instruction Module (SCIM) workshop was designed and implemented to address these issues. Results. Preworkshop and postworkshop questionnaires showed a marked increase in self-rated competence and suggested this improvement was directly attributable to the workshop. A follow-up survey of a small number of students demonstrated this increase was sustained over time. Conclusions. SCIMs appear to be an effective instructional format in the small group setting. We covered a broad range of topics in a cost-effective manner and with minimal tutors and resources. J Cancer Educ. 2008; 23:149-155.

Equipping medical students to manage cancer pain: A comparison of three educational methods

A Cancer Pain Structured Clinical Instruction Module (SCIM), with skills stations incorporating actual cancer patients, has been developed to enhance cancer pain education among our medical students. The Cancer Pain SCIM has not been compared with more traditional cancer pain education, thus the purpose of this study was to assess the effectiveness and durability of three educational methods for teaching cancer pain management to medical students compared with a control group. Four consecutive rotations of 32 third-year medical students participated in one of four cancer pain educational strategies: 1) control group with no formal cancer pain education, 2) CD-ROM self-instruction module on cancer pain, 3) a 2-hour Cancer Pain SCIM plus the CD-ROM information, and 4) Cancer Pain SCIM, plus CD-ROM, plus a structured home-hospice patient visit. The effectiveness of the educational interventions was assessed at 4 months post-instruction using a 4-component Cancer Pain Objective Structured Clinical Examination (OSCE). The main findings of this educational study are that: 1) all three educational groups performed better on the Cancer Pain OSCE at 4 months than the control group ( P<0.05); 2) medical students receiving structured education on cancer pain management significantly out-performed students at 4 months compared with control or traditional instructional formats; 3) students receiving the Cancer Pain SCIM plus home visit performed highest on the pain management, physical exam, and communication stations of the OSCE; and 4) the SCIM format of education shows durability as assessed at 4 months post-instruction. The Cancer Pain SCIM has a unique potential to substantially improve the quality of cancer pain education.

Cancer pain education: a structured clinical instruction module for hospice nurses.

The learning experience with the Cancer Pain Structured Clinical Instruction Module (SCIM), a highly structured skills training course for medical students, has been reported favorably. The purpose of this study was to present the Cancer Pain SCIM to registered nurses employed in a hospice setting. The goal of the study was to pilot test a structured cancer pain educational program for hospice nurses and to determine the perceived effectiveness of this course on the participants' cancer pain assessment and management skills. A multidisciplinary Cancer Pain SCIM was presented to 25 hospice nurses to improve their understanding of the management of cancer pain. The development group identified essential aspects of cancer pain management and then developed checklists defining specific station content. During the 2-hour Cancer Pain SCIM, nurses rotated through 8 stations in groups of 3, spending 15 minutes at each station. Eight instructors and 6 standardized patients, 5 of whom were survivors of cancer, participated in the course. All participants (students, instructors, and patients) evaluated the course, using a 5-point Likert scale (1 = strongly disagree; 5 = strongly agree). Nurses provided self-assessments of their perceived competence on important aspects of cancer pain management both before and after the SCIM. The self-assessment items used a 5-point scale ranging from 1 (not competent) to 5 (very competent). Twenty-five hospice nurses, averaging 4.1 years (range 1-30 years) postgraduation, participated in the Cancer Pain SCIM. Overall, nurses agreed that they improved on each of the 8 teaching items (P < 0.001). The average (SD) pretest score of 2.8 (0.72) improved to 3.8 (0.58) on the post-test (P < 0.001). Nurses believed that their mastery of specific clinical skills, taught in all 8 stations, improved as a result of participation in the course. Nurses strongly agreed (mean +/- SD) that it was beneficial to use patients with cancer in the course (4.6 +/- 0.82). Faculty members enjoyed participating in the course (4.9 +/- 0.35) and indicated a willingness to participate in future courses (4.7 +/- 0.49). Significant perceived learning among hospice nurses took place in all aspects of the Cancer Pain SCIM. Participating nurses, instructors, and patients with cancer appreciated the SCIM format. Nurses and faculty considered the participation of actual patients with cancer highly beneficial. The SCIM format has great potential to improve the quality of cancer pain education.

Cancer Pain Education: The Use of a Structured Clinical Instruction Module to Enhance Learning Among Medical Students

The Structured Clinical Instruction Module (SCIM) is an educational format developed for the teaching of clinical and interpersonal skills. The purpose of this study was to develop and pilot-test a SCIM to enhance medical students' learning and understanding about cancer pain assessment and management. The Cancer Pain SCIM was presented to 34 third-year medical students. Eight instructors and six standardized patients (five cancer patients) participated in the course. All participants evaluated the course using a five-point Likert scale (1 = strongly disagree; 5 = strongly agree). Students self-assessed their clinical skills before and after the course using a five-point scale (1 = not competent; 5 = very competent). Students agreed [mean (S.D.)] very strongly that the SCIM was a valuable educational experience [4.4 (0.56)] and that it was beneficial to use actual cancer patients in the SCIM [4.5 (0.63)]. Students believed their skills in the assessment and management of cancer pain significantly improved after the course. The SCIM is a valuable and novel instructional format to teach essential skills in the assessment and management of cancer pain to medical students.

Cancer survivors as standardized patients: an innovative program integrating cancer survivors into structured clinical teaching.

Increasingly, standardized patients are involved in medical education; however, reports of cancer survivors functioning as standardized patients have not been available. This study describes the participation of cancer survivors as standardized patients in structured clinical teaching. Forty-two cancer survivors, 354 trainees, and 54 faculty members took part in the structured clinical instruction modules (SCIMs) at five academic institutions. After completing the SCIMs, the cancer survivors answered evaluation questionnaire items concerning their perceptions of the course, and all participants (cancer survivors, faculty members, medical students, and residents) rated the benefit of the participation of cancer survivors. The evaluation items were rated on a five-point scale ranging from 1 = "strongly disagree" to 5 = "strongly agree. The evaluation responses were very positive, and the cancer survivors expressed a strong willingness to participate in future courses. Faculty members, residents, and medical students all rated the benefit of using cancer survivors highly. The participation of cancer survivors in structured clinical teaching was considered beneficial not only by the cancer survivors themselves, but also by the faculty members, residents, and medical students who were involved in the educational program. The role of cancer survivors in the education of physicians needs to be expanded.

The effectiveness of the structured clinical instruction module

Background: The Structured Clinical Instruction Module (SCIM) provides students with a structured educational experience related to clinical skills on a single clinical topic. This study examined the effect of the SCIM on students’ performances on breast stations in an objective structured clinical examination (OSCE). Methods: Three student groups each experienced a different type of instruction about breast care and treatment (condition A = lecture; condition B = nine-station SCIM, lecture, and manual; and condition C = five-station SCIM). All students subsequently participated in a surgery OSCE that included standardized patient stations on taking a breast history and performing breast examinations. Results: One-way analysis of variance (ANOVA) tests consistently found that the mean scores of students in conditions B and C were significantly ( P <0.05) higher than those of students in condition A. Conclusions: These results suggest that the SCIM is an effective patient-based standardized instructional program that enhances the instruction of clinical skills to students.

Improving residents' clinical skills with the structured clinical instruction module for breast cancer: Results of a multiinstitutional study

Background. The purpose of this study was to determine, in a multiinstitutional setting, the effectiveness of the structured clinical instruction module (SCIM) as an instructional format for surgical residents. Methods. The breast cancer SCIM is an abbreviated (3-hour) clinical skills course that places residents in realistic clinical settings. The curriculum encompasses all aspects of breast cancer patient assessment. The SCIM was administered to 137 residents at five institutions. Sixty-six faculty members and 52 patients participated. All participants were surveyed with multiitem questionnaires. The residents were also asked to perform a self-assessment of their skills before and after the SCIM. Results. The SCIM was delivered at all institutions without difficulty. All participants rated the SCIM highly (from “above average” to “outstanding”). Mean ratings (on a 5-point scale) for the overall effectiveness of the SCIM as an educational format follow: Institution A B C D E Patients 4.75 4.73 4.56 4.56 4.44 Faculty members 4.47 4.57 4.82 4.76 4.25 Residents 4.38 4.75 4.29 4.36 4.68 The pretest mean (on a 5-point scale) on the self-assessment was 2.46 (“less than competent”); the posttest mean was 3.54 (“more than competent”) (p < 0.0001). Conclusions. Residents are acutely aware of their deficiencies in understanding breast cancer. The SCIM is a standardized, reproducible, portable, and effective educational vehicle.

The multidisciplinary structured clinical instruction module as a vehicle for cancer education

The Structured Clinical Instruction Module (SCIM) modifies the Objective Structured Clinical Examination (OSCE) for teaching purposes. This study determined the effectiveness of a breast cancer SCIM in enhancing residents' clinical skills. Twenty-five residents, 15 faculty members, and 12 breast cancer patients (simulated and actual) participated in the multistation, multidisciplinary SCIM. Afterward, faculty members, residents, and patients evaluated the SCIM. Residents completed an 18-item self-assessment of their skills before and after the SCIM. All residents, faculty members, and patients rated the SCIM as either outstanding or above average as an educational experience. The residents' self-assessments of their skills were significantly higher after the SCIM than before. This study shows that residents are aware of their deficiencies in breast cancer management. The SCIM provides an excellent format for residents to improve their clinical skills.

The Structured Clinical Instruction Module: A Novel Strategy for Improving the Instruction of Clinical Skills

We have previously shown that both medical students and residents demonstrate numerous important deficits when evaluating patients with abdominal complaints. To address these deficits, we implemented a pilot instructional program derived from the Objective Structured Clinical Examination. Fifty third-year medical students were presented with a 1-hr Structured Clinical Instruction Module (SCIM) of five stations, each station addressing a different aspect of the surgical evaluation of the abdomen. Simulated patients were present at two of the stations. Faculty from appropriate disciplines were present at the stations to provide standardized instruction according to predetermined curricular objectives. The medical students evaluated the SCIM for its specific characteristics, and they evaluated each of the five stations for its efficacy in increasing their clinical skills. All the specific aspects of the SCIM were given a rating significantly higher than neutral ( P < 0.0001). Students agreed most strongly that the faculty were well prepared for the SCIM and that the faculty were enthusiastic. All of the SCIM stations were given a rating significantly higher than average ( P < 0.0001). When compared to a conventional workshop, the SCIM scored significantly higher on all three common evaluation items. The SCIM was very well received by medical students as a format for clinical instruction. This unique modification of the Objective Structured Clinical Examination has potential for teaching important clinical skills that are not consistently mastered within current surgical curricula.