● BULDING A BRIDGE BETWEEN BASIC SCIENCES AND WARD CLINICAL TEACHING ISSUE: INCREASE IN STUDENT POPULATION TRADITIONALISTSINNOVATORS 1  Student’s population/Hospital routines Problematic if patients are used Not Problematic 2Communicating with patients RealisticStudents can be conditioned 3Standardization of skills Not possiblePossible 4Repetition of skill practice Not possible on same patient Possible on mannequins 5Patient’s safety Not assuredAssured

٭ 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  THE VISION FOR USING SIMULATION IN UNDERGRADUATE MEDICAL EDUCATION?

 AIMST’S MISSION ٭ To train students using medical and surgical simulation ٭ To use simulation to ensure a high degree of patient’s safety ٭ To utilize simulation tools to support individualized learning both cognitive and procedural skills to attain competence

٭ 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, life- long professional growth ٭ Must provide opportunities to improve physical coordination and cognitive reasoning  AIMST’S MISSION

● 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

٭ 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 ● OBJECTIVES OF THE AIMST PROGRAMME

 THE AIMST APPROACH – THE CURRICULUM cs

BASIC AND ADVANCED CLINICAL SKILLS TRAINING CNS SUTURING

SUPPORTING CLINICAL DEPARTMENTS / UNITS (Clinical Consultants) Medicine Surgery Obstetrics & gynecology Otorhinolaryngology (ORL) Orthopedics Anesthesia Family Medicine Ophthalmology Radiology SUPPORTING BASIC SCIENCE DEPARTMENTS (Resource staff with MD degrees) Physiology Anatomy Chemical Pathology DEPARTMENT OF MEDICAL EDUCATION LABORATORY CLINICAL SKILLS TRAINING (1 st & 3 rd years Medical Students) Using Human Simulators Mannequins WARD CLINICAL SKILLS TRAINING (using Patients in the 4 TH & 5 TH years) CLINICAL SKILLS CENTER STAFF Coordinator Tutor Nurses Assistant SUPPORTING UNITS AUDIO VISUAL GRAPHICS LABORATORY UNDERGRADUATE CLINICAL SKILLS TRAINING INPUT OUTPUT ● INTERACTION WITH DEPARTMENTS / UNITS

 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 Nice to know Good to know  Mirror Cognitive knowledge & Basic generic skills

Year BASIC SKILLS WITH Basic mannequins ADVANCE SKILLS WITH METI 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 IVRevision with Basic mannequins BOTH REPEATED IN YEAR V 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. ● SPIRALFUSION OF BASIC AND ADVANCED CLINICAL SKILLS TRAINING

 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

ELEMENTS i) Procedural skills training- 2 nd and 3 rd years ii) Communication skills - 2nd and 3rd years iii) Clinical judgment - 3 rd 4 th years iv) Team work – 3 rd and 5 th years v) Use of standardized, validated educational tools – for all years ● THE TEACHING PROCESS

Hand outs Facilitators: Consultants CSC Staff Students Pre-assessment questionnaire Complementary To PBL Evaluation of the Clinical skills programme SELF DIRECTED LEARNING MATERIALS AT CSC  Mannequins  CDs  Video clips  X-ray Films  CSC Staff Assessment of Each system - OSCE RESULTS Post-assessment questionnaire Feedback Next level PASS FAIL CLINICAL SKILLS TRAINING counseling THE TEACHING PROCESS – ‘SODO’

STUDENTCONTENTTUTORS Student cohort 50 – 120 Learning needs defined Motivate ? Briefing / Study Guide Objectives& Outcomes of each skill defined in Handouts One tutor – one station Preliminary briefing 20 mins Teaching sessions -2hrs 20hrs / organ-system How many students can be supervised at a time during training sessions? Stations – 4 to 5 Prelim. Lecture / Demo 20 mins Group size 7 -8 / room Practice 2hrs & free time Promotion of interactive teaching Assessment OSCE Reassess programme Evaluation (Questionnaire) “SODO” TEACHING SESSIONS

٭ 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

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