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Medical School Strategies for Teaching and Assessing Student Competencies Using Live Patient Simulations and Patient Simulators Tony Errichetti, Ph.D.

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Presentation on theme: "Medical School Strategies for Teaching and Assessing Student Competencies Using Live Patient Simulations and Patient Simulators Tony Errichetti, Ph.D."— Presentation transcript:

1 Medical School Strategies for Teaching and Assessing Student Competencies Using Live Patient Simulations and Patient Simulators Tony Errichetti, Ph.D. PCOM

2 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

3 Simulation Placing people in realistic settings for the purpose of training and / or performance assessment


5 Varieties of Med Ed Simulations Standardized / simulated patients Robotics Virtual reality / computer simulations

6 Changing the model OJT Systematic Training Because medical training is too important to be left to chance

7 Models War Games

8 Models Flight Simulators

9 Whats Driving the Change (urgency)? Public demanding quality

10 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

11 Performance-based board exams ECFMG / USMLE in June 2004 COMLEX-USA-PE

12 Why simulate? Control of Training and Assess

13 Logistical Issues in Pre-Clinical Training Getting students the training they need when they need it Getting them to a training site, and back

14 In-School Possibilities…. Bring the community / hospital / clinic into the school via… Simulated clinics using standardized / robotic patients Computer simulations

15 Allowing For… Creating patient cases, scenarios as needed Patients available as needed Videotaping to review performance Feedback from SPs and faculty

16 Why simulate? #2: Provides Standardized Basic Clinical Training Most med students have had little or insubstantial previous patient contact prior to clinical years

17 PCOM Student Survey

18 Why simulate? #3: Standardization of Clinical Training and Assessment

19 Pedagogical Issues Faculty often not trained as educators, dont understand educational objectives and outcome measures Dont agree on whats important to teach and how to teach it Cant get faculty to show up for a meeting

20 Losing Control of Curriculum Med schools lose control of the student during clinical years Evaluating clinical performance from 3 rd year through residency years is inconsistent, non-standardized

21 Gaining Control of Curriculum Bring students back periodically for standardized performance exam, but logistically difficult

22 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

23 Training Objectives

24 Why simulate? #4: Development and Control of Assessment Protocols

25 Changing the conversation What are the core competencies How will students demonstrate them? What does their performance say about our teaching?

26 Assessment Issues Technical skills Asking the right questions Performing the right PEs correctly Exam quality Asking the right questions the right way Performing a quality PE

27 Clinical Training Strategy Communicate the objectives (competencies) Test the competencies (outcome assessment) Provide feedback Remediate / re-test as needed

28 Skills / Exam Blueprint Case 1Case 2Case 3Case 4 HxXXXX PxXXXX DxXXXX CommunXX LabsXX Tx PlanX OMTXXXX WellnessX

29 Skills / Exam Blueprint History Questions The student asked… Yes / No About location of pain About quality of pain About diet Asked about previous treatment

30 Skills / Exam Blueprint ENT Examination The student … Yes / No Palpated external ear and mastoid process Examined inner ear Palpated frontal and maxillary sinuses Internal examination of nose

31 Skills / Exam Blueprint Exam Quality The student … Scale 1-6 Asked questions clearly Performed a smooth PE Treated me with respect Was not crabby, rude

32 Why simulate? #5: Patient Safety Simulations leave actual patients unhurt / not left untreated by inexperienced clinicians

33 Why simulate? #6: Building Competence Through Confidence Simulations reduce anxiety Failure is a great teacher, but its better to make mistakes in a simulation lab than in the clinic

34 GOAL: Reduce the You stupid motherfucker syndrome in clinical education Reduce the abuse, the smoking gun of medical errors

35 Learning Model

36 Simulation Considerations Expenses Hardware Software Space Human Resources (SPs, staff) Verisimilitude How realistic does it need to be?

37 Authentic Simulations Standardized Patients

38 Standardized Patients Individuals who like to: Lie Take their clothes off Get touched by strangers David Blackmore, Med. Council of Canada

39 Standardized Patients Individuals trained to portray a health problem or condition in a standardized repeatable manner

40 SP Types Individuals with real health problems, fixed findings Hypertension to AIDS

41 SP Types Healthy individuals trained to simulate medical problems, conditions

42 Disadvantages Theyre fake patients! Actually, theyre real patients but the situation is simulated

43 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

44 Training Topics History-taking Comprehensive physical exam, including genital, breast and rectal exams Communication Assessment and treatment planning Documentation Reporting Multicultural competence House calls

45 How Do You Standardized PE Training on Campus Use SPs trained as physical teaching associates

46 SPs as Physical Teaching Associates SPs trained to teach PE skills Frees clinicians to teach medicine Standardizes the teaching of PE skills

47 Costs 1 $100, % = 7,055 SP $18./hr

48 Robotics Human Simulators

49 Robotics Were in a medical education arms race! Ken Veit, DO Dean, PCOM

50 Model-Driven Simulators Programmed to have real time physiologic and pharmacologic reactions to interventions and therapies Produce a realistic patient response

51 METI Human Patient Simulator Normal, abnormal breath sounds Chest excursion Palpable pulses Airway patency Heart Sounds Urine excretion

52 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.

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