clinical skill program

7/27/2019 Clinical Skill Program

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CLINICAL SKILLS PROGRAMAn Introduction

EMIR T PASARIBUClinical Skills Program, Medical Education Unit

Medical School, Universitas Sumatera Utara.


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Objectives:

To explain Clinical Skills Program in a PBLbased curriculum in Medical School, whichinclude:

Definition

Backgrounds and philosophy

The objectives and scoop of the program

The structures of the program


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Definition:

The Clinical Skills Program is a portion of theMedical School of Universitas Sumatera Utaracurriculum designed to develop and refine the clinical

skills of medical students, including : Human interaction skills

Physical examination behaviors

Procedural skills

education of a sensitive and effective physician.


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Goals

To develop the clinical skills competency of medicalstudents in preparation for patient contact incommunity office practice programs, clinicalclerkship/internship, residency and future personaloffice practice.

To prepare students to apply their basic scienceconcepts in primary care context.


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Why Clinical Skills Program?

Harden & Ledingham (1998): Medical Schools cannotrely on clerkship experience alone to provide adequatebasic skills teaching.

It poses several advantages, because it:

is independent of real patient availability

allows clinical teaching to be scheduled controls the complexity of the learning situation

permits mistakes to be made within a safe environment


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Why Clinical Skills Program?

encourages direct feedback

allows repeat consultations & physical examinations

permit fewer cases of actual patient for the student

to master the skill reduces the difficulties encountered in medical

colleges in ensuring adequate exposure to clinicalproblems (Dacre et al, 1996)

help regaining students confidence in performingclinical tasks to minimize psychological distress(Williams et al, 1997)


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Simple model of competence

Miller GE. The assessment of clinical

skills/competence/performance. AcademicMedicine (Supplement) 1990; 65: S63-S7.

Knows

Shows how

Knows how

Does

Professionalauthe

nticity

Acquisition

Competency

Proficiency


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The CSP System

Input:

students

Facilities:

Lab, Phantoms, SPs

Staff :

Clinical Trainers

Output:

SKed/MD

CSP Process:

Training session

Self practices

Assessment

Curriculum:Blocks of system

Administration:

Staff, financing


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Curriculum (Process):

Based on National Competency BasedCurriculum which is implemented in 10 blocks:

Reproductive, Neurobehavior & special senses,Endocrine, Genito-urinary,Dermatomuskuloskeletal, Hematoimmunology,

Cardiovascular, Respiratory, and Gastro-intestinalsystems, and Tropical Medicine block.

Other programs : BHP, CRP, CHOP, etc.


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Learning objectives (level of

competence on phantoms/SPs)

Taking a medical history.(P5) Performing physical examinations.(P5)

Providing patient education.(P5)

Documenting and reporting the history andphysical diagnosis.(P5)


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Learning objectives (level of

competence on phantoms/SPs)

Developing a good patient/physician

relationship, including data gathering andinterpersonal aspects.(P5)

Performing basic office lab and therapeuticprocedures .(P5)


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Curriculum: Type of Skills

Communication skills:

History taking : how to say or to ask

Physical examination skills

Procedural skills:

Laboratory skills:


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Examples : Block Construction

Semester VII:Respiratory system (8 weeks)

Gastrointestinal (8 weeks)

Gastrointestinal :

1. Digestive surgery :H & PD: Acute Abdomen, groin lump; DRE.

2. Pediatric GI : Clinical Examination of Diarrhea & dehydration

3. Pediatric Nutrition : Breast feeding counseling

4. Internal Medicine : H & PD of jaundice, NGT insertion,

5. Anesthesiology: I.V. catheter insertion


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Week Cases Resource

Person/s

Supporting

activities

Resource

Person/s

I

Tutorial I

Tutorial II

Tutorial III

Perforated Pepticulcer

Perforated Peptic

ulcer

Perforated Peptic

ulcer

Kiki Lukman, dr,MSc., SpB-KBD

Julianto Widjojo

dr, SpPD-KGEH

Armaya Ariyoga,

Drs Med, Mkes

CSP I: History taking &PE of acute abdomen

Lab I: Anatomy of

peritoneal cavity &upper

gastrointestinal tract

LectureI: Dysphagia

LectureII: Pharmacology

of peptic ulcer diseases

Kiki Lukman, dr,MSc., SpB-KBD

Arifin

Soenggono,dr

Nur Akbar, dr.,

SpTHT

Ongka M.S., dr.,

SpTHT

Armaya Ariyoga,

Drs Med, Mkes


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Methods

Competency Based Training in Skills Lab.(Teaching in the Clinical Skills Center)

Adult learning

Mastery learning:

Skill acquisition: Presentation, Demonstration

Skill competence : Coaching, self practice


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Methods

Humanistic : the use of phantoms,

standardized patient Learning materials: Standardized Modules,

references, videos, learning guides

Coincide with the case in BiomedicalProblems Program


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Harrows psychomotor taxonomy:

Level of competence

Observing

Watching a process; paying attention to steps ortechniques and to finished product or behavior;

potential for reading instructions.

Imitating

Following directions; carrying out steps withconscious awareness of efforts; hesitantperformance.


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Harrows psychomotor taxonomy:

Levels of competence

Practicing

Repeating steps until some or all aspects of the

process become habitual, requiring little consciouseffort; performing a task or process smoothly.

Adapting Making individual modifications and changes in the

process to better suit oneself or one's situation.


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Presentation

Microteaching :

Lesson plan :

Objectives

Timing : 2030 minutes

Topics : Content & steps of the process

References : Evidence Based Medicine

Audio-visual aids: Power point, video. Feed back : discussion


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Presentation


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Demonstration

Clinical instructor/s demonstrate the skill

Time allocation: 1020 minutes

Using phantom models, Standardized Patient, RealPatient, audio-visual aids.

Divided in groups

The Students observe the demonstration.

Feed back


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Demonstration


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Coaching & Point Nodal Evaluation

Students imitate and practice the skills onphantoms/SPs/real patient under instructorssupervision

Student performance is evaluated by directfeedback from instructors & other students until

the student masters the skill.

Time allocation: 120150 minutes


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Coaching & Point Nodal Evaluation


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Self Practices

Conducted outside predetermined schedules(Skills Lab class)

Self practice is done in Skills Lab

Students may consult resource person/s


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Self Practices


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Standardized Patients (SP)

A standardized patient is a healthy person who hasbeen trained to do any or all of the folowing:

Portray in a realistic manner the significant historical,physical and emotional characteristics of an actual patient

Be a model for a physical examination

Give constructive feedback about how they were affected

by the encounter Coach and evaluate students as they prepare for History

and Physical examination


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Standardized Patient (Humanistic)

Resources : volunteer,

instructors, students,

Incentives are provided

for SPs


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Academic Staff

Resource Persons

Consultants of clinical Department

Members of blocks of system

Clinical instructors

Resource Person/s

Other qualified physician (GP, other specialists)


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Staff: Terms & condition

Every instructor must attend TOT & PBLworkshops and be certified by the Medical

School. Other physicians who are not RPs:

Must attach to RPs

To obtain adequate competency of the skillsTo gain more experiences in training sessions

Must follow the staff development program


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Training of Trainer

Clinical Instructor Training : Competency BasedTraining methods

Conducted by MSPU team of asset managementunit

A two separated two day training, and a specific

training in pertaining system.

1015 staff every batch


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Training of Trainer


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Training of Trainer


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Facilities: Skills Lab

Learning materials :

Program handbook

Course Study Guide

Learning Guide

References : books, CDs, Movies.

Teaching aids:

Standardized/Simulated Patients

Simulators/Phantoms/Manikins/Sp. equipment


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Exams : OSCE


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Definition

Objective

Each student is graded by the same checklist

comprised of behaviorally measurable criteria.

Structured

Each student has the same tasks and the same time

to complete those tasks. Each patient is trained to

role-play identical symptoms in a standard fashion.


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Definition

Clinical

Clinical skills are measured, reflecting a

practitioners ability to take a relevant history,conduct a focused physical examination, and

provide appropriate counselling to a patient.

Examination

It is a test.


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Station 8 Station 7 Station 6 Station 5

Station 4Station 3Station 2Station 1

Interstation

Rest station


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