medical school strategies for teaching and assessing student competencies using live patient...
TRANSCRIPT
Medical School Strategies for Teaching and Assessing Student Competencies Using Live Patient Simulations and Patient Simulators
Tony Errichetti, Ph.D. PCOM
Q: How do you create an osteopathic “patient-centered”
physician when medical education is “teacher-centered”?
A: Include patients actively in the teaching process via simulations
Simulation
Placing people in realistic settings for the purpose of training and / or performance assessment
Varieties of Med Ed Simulations
Standardized / simulated patients
Robotics
Virtual reality / computer simulations
Changing the model
OJT Systematic Training
Because medical training is too important to be left to chance
Models
War Games
Models
Flight Simulators
What’s Driving the Change (urgency)?
• Public demanding quality
Need to reduce medical errors
•44,000 – 98,000 die in hospitals due to medical errors
•If airline industry had the same record as the medical profession ,
there would be 63 airline crashes / day
Performance-based board exams
• ECFMG / USMLE in June 2004
•COMLEX-USA-PE
Why simulate?
Control of Training and Assess
Logistical Issues in Pre-Clinical Training
Getting students the training they need when they need it
Getting them to a training site, and back
In-School Possibilities….
Bring the community / hospital / clinic into the school via…
Simulated clinics using standardized / robotic patients
Computer simulations
Allowing For…
Creating patient cases, scenarios as needed
Patients available as needed
Videotaping to review performance
Feedback from SPs and faculty
Why simulate?
#2: Provides StandardizedBasic Clinical Training
Most med students have had little or insubstantial previous patient contact prior to clinical years
PCOM Student Survey1999-2001
0
5
10
15
20
25
30
35
40
PaidExperience
Volunteer Passive NoExperience
Why simulate?
#3: Standardization of Clinical Training and
Assessment
Pedagogical Issues
Faculty often not trained as educators, don’t understand “educational objectives” and “outcome measures”
Don’t agree on what’s important to teach and how to teach it
Can’t get faculty to show up for a meeting
Losing Control of Curriculum
Med schools lose control of the student during clinical years
Evaluating clinical performance from 3rd year through residency years is inconsistent, non-standardized
Gaining Control of Curriculum
Bring students back periodically for standardized performance exam, but logistically difficult
Possible Solution
Standardized within school clinical training program (I.e. get all faculty on same page)
Individual school approaches to teaching
Standardized assessment between schools
Compare results
Training Objectives
Why simulate?
#4: Development and Control of Assessment Protocols
Changing the conversation
“What are the core competencies”“How will students demonstrate them?”What does their performance say about
our teaching?”
Assessment Issues
Technical skillsAsking the right questionsPerforming the right PEs correctly
Exam qualityAsking the right questions the right wayPerforming a quality PE
Clinical Training Strategy
Communicate the objectives
(competencies)
Test the competencies
(outcome assessment)
Provide feedback
Remediate / re-test as needed
Skills / Exam BlueprintCase 1 Case 2 Case 3 Case 4
Hx X X X X
Px X X X X
Dx X X X X
Commun X X
Labs X X
Tx Plan X
OMT X X X X
Wellness X
Skills / Exam BlueprintHistory Questions
The student asked…
Yes / No
About location of pain
About quality of pain
About diet
Asked about previous treatment
Skills / Exam BlueprintENT Examination
The student …
Yes / No
Palpated external ear and mastoid process
Examined inner ear
Palpated frontal and maxillary sinuses
Internal examination of nose
Skills / Exam BlueprintExam Quality
The student …
Scale
1-6
Asked questions clearly
Performed a smooth PE
Treated me with respect
Was not crabby, rude
Why simulate?
#5: Patient Safety
Simulations leave actual patients unhurt / not left untreated by inexperienced clinicians
Why simulate?
#6: Building Competence Through Confidence
Simulations reduce anxiety
Failure is a great teacher, but it’s better to make mistakes in a simulation lab than in the clinic
GOAL: Reduce the “You stupid motherfucker” syndrome in clinical
education
Reduce the abuse, the smoking gun of medical errors
Learning Model
Simulation Considerations
Expenses
Hardware
Software
Space
Human Resources (SPs, staff)
Verisimilitude
How realistic does it need to be?
Authentic SimulationsStandardized Patients
Standardized Patients
Individuals who like to:
LieTake their clothes offGet touched by strangers
David Blackmore, Med. Council of Canada
Standardized Patients
Individuals trained to portray a health problem or condition in a standardized repeatable manner
SP Types
Individuals with real health problems, fixed findings
Hypertension to AIDS
SP Types
Healthy individuals trained to simulate medical problems, conditions
Disadvantages
“They’re fake patients!”
Actually, they’re real patients but the situation is simulated
SP Programs
90% of U.S. medical schools use SPs to teach and / or assess clinical skills
In the osteopathic system, 14 of 20 schools
Training Topics
History-takingComprehensive physical exam, including genital, breast and rectal examsCommunicationAssessment and treatment planningDocumentationReportingMulticultural competenceHouse calls
How Do You Standardized PE Training on Campus
Use SPs trained as physical teaching associates
SPs as Physical Teaching Associates
SPs trained to teach PE skills
Frees clinicians to teach medicine
Standardizes the teaching of PE skills
Costs
1 professor @ $100,000 + 27%
= 7,055 SP hours @ $18./hr
RoboticsHuman Simulators
Robotics
“We’re in a medical education arms race!”
Ken Veit, DO
Dean, PCOM
Model-Driven Simulators
Programmed to have real time physiologic and pharmacologic reactions to interventions and therapies
Produce a realistic patient response
METI Human Patient Simulator
Normal, abnormal breath sounds
Chest excursion
Palpable pulses
Airway patency
Heart Sounds
Urine excretion
Human Patient Simulator(HPS)
ALS, BLS, ACLS, ATLS
50 intravenous drugs (bolus and infusion) and 5 inhalation agents (anesthetics)
Over 100 physiologic parameters can be adjusted to simulate a disease state's signs and symptoms.