●BULDING A BRIDGE BETWEEN BASIC SCIENCES AND WARD
CLINICAL TEACHING
ISSUE: INCREASE
IN STUDENT
POPULATION
TRADITIONALISTS
INNOVATORS
1
 Student’s
Problematic if patients
population/Hospital are used
routines
Not Problematic
2
Communicating
with patients
Realistic
Students can be
conditioned
3
Standardization of
skills
Not possible
Possible
4
Repetition of skill
practice
Not possible on same
patient
Possible on
mannequins
5
Patient’s safety
Not assured
Assured
 THE VISION FOR USING SIMULATION IN
UNDERGRADUATE MEDICAL EDUCATION?
‫٭‬Provision of a Facility for deliberate practice
(Clinical skills Center for UG &
students)
‫٭‬Consolidation of Basic Clinical Skills
(undergraduate) using: Standardized skill training methods,
Patients, Human simulators, Video technology, CDs, IT etc.
‫٭‬Enhancement of Skills at PG level – through
Specialty training- Advance simulators
‫٭‬Synchronizing with the objectives
of the National Health Delivery
System of Malaysia
 AIMST’S MISSION
‫ ٭‬To train students using medical and
surgical simulation
‫ ٭‬To use simulation to ensure a high
degree of patient’s safety
and
attain
‫ ٭‬To utilize simulation tools to
support individualized
learning both cognitive
procedural skills to
competence
● AIMST’S MISSION
‫٭‬
To use simulation to ensure a high
degree of patient’s safety with
i)
continuous assessment
ii)
constructive feedback and
iii)
more opportunities for deliberate
practice
 AIMST’S MISSION
‫ ٭‬Must promote interdisciplinary teaching,
team training, communication skills and
professionalism
‫ ٭‬Must enable learners to achieve
skills, knowledge and behaviours
necessary for independent, lifelong professional growth
‫ ٭‬Must provide opportunities to
improve physical coordination
and cognitive reasoning
● OBJECTIVES OF THE AIMST
PROGRAMME
DESIGNED TO:
‫٭‬
Improve the clinical skills of
students prior to their clerkship
‫٭‬
Standardize the clinical skill
procedures
‫ ٭‬Encourage students to
learn as individuals and at
their own pace
● OBJECTIVES OF THE AIMST
PROGRAMME
‫٭‬
Encourage students to formulate
their own learning goals
‫٭‬
Inculcate in students a habit of
continuous learning
‫٭‬
Motivate students to acquire more
knowledge about the skills that are
being taught
THE AIMST APPROACH – THE CURRICULUM
cs
LAYOUT OF AIMST CLINICAL SKILLS CENTER
EMERGENCY
DEPARTMENT
INTENSIVE
CARE UNIT
(ICU)
CONTROL ROOM
TUTORIAL
ROOM.
COMPUTER
ROOM
CNS
STORE
STUDENT VIEWING
AREA
ROOM
CORRIDOR
RESP
CVS
SYS.
PEDIATRIC INTENSIVE
CARE UNIT (PICU)
STAFF
COORDINATOR
GENITOURINARY
ROOM
REPRODUCTIVE
SYS.
STAFF
STAFF COMMON
BM
SUTURING
PAEDRIATIC SKILLS
INTENSIVE CARE UNIT (NURSING)
STAFF
OPERATION THEATRE
(OT)
SURGICAL
UNIT
STAIR CASE
CORRIDOR
BASIC AND ADVANCED CLINICAL SKILLS TRAINING
WELCOME
TO
CSC
● INTERACTION WITH DEPARTMENTS / UNITS
INPUT
LABORATORY
CLINICAL SKILLS
TRAINING (1st &
3rd years Medical
Students)
SUPPORTING CLINICAL
DEPARTMENTS / UNITS
(Clinical Consultants)
Medicine
Surgery
Obstetrics & gynecology
Otorhinolaryngology (ORL)
Orthopedics
Anesthesia
Family Medicine Ophthalmology
Radiology
OUTPUT
DEPARTMENT
OF MEDICAL
EDUCATION
WARD CLINICAL SKILLS
TRAINING (using
Patients in the 4TH & 5TH
years)
Using Human
Simulators
Mannequins
CLINICAL
SKILLS
CENTER STAFF
Coordinator
Tutor Nurses
Assistant
SUPPORTING
BASIC SCIENCE
DEPARTMENTS
(Resource staff with MD
degrees)
Physiology
Anatomy
Chemical Pathology
LABORATORY
UNDERGRADUATE
CLINICAL SKILLS
TRAINING
SUPPORTING
UNITS
AUDIO VISUAL
GRAPHICS
 TOOLS NEEDED
1. LOG BOOK
CHARACTER -LOG BOOK. It should:
 mirror the five year program
of AIMST
 be integrated / holistic in
character
 be spiral
 define the dimensions of the
skills to be taught
Must know
Good to
know
 Mirror Cognitive knowledge & Basic generic skills
Nice to
know
● SPIRALFUSION OF BASIC AND ADVANCED CLINICAL SKILLS
TRAINING
Year
BASIC SKILLS WITH
Basic mannequins
I
Basic Life Support skills
II
Basic mannequins for
Organ-based systems Normal basic skills
Scenarios: Heart failure;
COPD /Asthma; GI bleeding;
Raised ICP
III
Abnormal conditions of
organ systems
Venepuncture; Setting IV
line; Suturing; Prostate/
rectal, Breast
examinations, Aseptic
techniques. Cranial nerves
/ LP
O&G pap smear / HSG/ Use
of speculum/Bladder
catheterization
IV
Revision with Basic
mannequins
Medicine: Severe
Burns/CCF/ACS/Pneumonia /
Diabetes / Hypertension /
Asthma
Surgery: Tension
Pneumothorax; Hypovolemia,
Cardiac arrest; trauma survey
Poly trauma, ICP; Acute Head
injury; Spine injury; status
epilepticus.
BOTH REPEATED IN YEAR
V
ADVANCE SKILLS WITH
METI mannequins
-
 TOOLS NEEDED
HANDOUTS – ORGAN-BASED
CONTENTS OF THE
HANDOUTS
Reflects: Skills
Objectives
Outcomes
Anatomy
Physiology
*Pathophysiology
‫٭‬Indications
‫٭‬Procedure
‫٭‬Complication
ORGAN-BASED SYSTEM HANDOUTS
Cardiovascular, Respiratory, Genitourinary, Reproductive, Musculoskeletal, Endocrine,
Central Nervous System and gastrointestinal systems
 TOOLS NEEDED
VIDEO CLIPS / CDs / CAI
STANDARDIZED PATIENTS
● THE TEACHING PROCESS
ELEMENTS
i) Procedural skills training- 2nd and 3rd years
ii) Communication skills - 2nd and 3rd years
iii) Clinical judgment - 3rd 4th
years
iv) Team work – 3rd and 5th years
v) Use of standardized, validated educational
tools – for all years
THE TEACHING PROCESS – ‘SODO’
Next level
Hand outs
Feedback
PASS
Post-assessment
questionnaire
Assessment of
Each system
- OSCE
RESULTS
Facilitators:
• Consultants
Students
• CSC Staff
FAIL
SELF DIRECTED
LEARNING
counseling
Pre-assessment
questionnaire
MATERIALS
AT CSC
 Mannequins
 CDs
 Video clips
 X-ray Films
 CSC Staff
CLINICAL
SKILLS
TRAINING
Complementary
To PBL
Evaluation of the
Clinical skills
programme
“SODO” TEACHING SESSIONS
STUDENT
CONTENT
TUTORS
Student cohort 50 – 120
Learning needs defined
Motivate ?
Briefing / Study Guide
Objectives& Outcomes of One tutor – one station
each skill defined in
Preliminary briefing 20
Handouts
mins
Teaching sessions -2hrs
20hrs / organ-system
Stations – 4 to 5
Prelim. Lecture / Demo 20
mins
Group size 7 -8 / room
Practice 2hrs & free time
How many students can be
supervised at a time during
training sessions?
Assessment
OSCE
Promotion of interactive
teaching
Reassess programme
Evaluation
(Questionnaire)
‫٭‬
It allows skills to be mastered through
repeated practice
‫٭‬
It allows mistakes to be made and
immediate feedback possible
‫٭‬
It allows non-dependence on patients
‫٭‬
It allows chronic medical or complex
problems to be acted out in a short
period of time using Human
Simulators and Computer Aided
Instructional (CAI) programmes
OSCE - CONTENTS
 Clinical scenario - Patient presentation,
Examination, Investigation
 Skill / Procedures - Check list
 Investigation - Radiograph,
Interpretation of
Lab results
 History Taking (Simulated
patient interviews)
‫٭‬
A skills laboratory is an expensive facility
to establish and run, yet
‫٭‬
there is enough evidence that lab
clinical simulation has an impact on
students performance during clerkship
‫٭‬
skills taught on manikins are
transferable
‫ ٭‬the learning environment is safe and informal
STUDENT’S VACTIVITIES
CLINICAL SKILLS CENTRE
IT IS FUN WORKING
WITH ME .
I AM REAL
BELIEVE ME !