Undergraduate clinical skill education-Experience in Kaohsiung Medical University ?????????-?????????

1
Undergraduate clinical skill education-Experience
in Kaohsiung Medical University?????????-????????
?

• Chung-Sheng Lai ???,
• M.D., E.M.B.A., Ph.D
• ?????????????
• ????????????

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Overview of the content

• Infrastructures for clinical skill education
• Organ system-based clinical skill teaching
  GOSCE
• Department-based clinical skill teaching
  assessment
• Standardized patient training emphasized on
  effective feedback
• Current OSCE in Taiwan
• The next step of OSCE
• Interprofessional GOSCE
• Summary

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Infrastructures for Clinical Skill Instruction
(????????????)
(???????????)
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2005 OSCE in KMU
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Importance in 3 elements of data collection for
diagnosis

• 70 by history taking
• 20 by physical examination
• 10 by laboratory other tests

Medicine is a science of uncertainty
and an art of probability. ?????????
Sir William
Osler
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New Curriculum ltsince 2005gt
???????????????? ????
Clinical skills education PBL General education Include humanities, sociology, arts, business and management, traditional Chinese medicine, language, service learning and other health-related courses. General education Include humanities, sociology, arts, business and management, traditional Chinese medicine, language, service learning and other health-related courses. M1-2
Clinical skills education PBL EBM Integrated curriculum Basic science Clinical science M3-4/ BM1-2
Clinical skills education PBL EBM Clerkship Internship M5-7/ BM3-5
New Curriculum
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Integrating clinical skills to the curriculum

• Clinical skills can precisely perform only by
  repeated practices besides the didactic lectures.
• 15 blocks based on organ systems were integrated
  in the new curriculum (2005).
• Organizer of each block is the most important
  key-person for implementation of the organ
  system-based skills instruction assessment.
• Chief of each clinical department is the main
  person responsible for implementation of the
  department-based skills instruction and
  assessment.
• 104 clinical competencies minimally required for
  medical graduates suggested by Taiwan Joint
  Commission on Hospital Accreditation ( ????? )
  were all included.

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???????????????????

• ??????? (Examination Skills)?37?
• ?????? ( Visual Image Interpretation ) ?6?
• ??????? ( Laboratory Skills ) ?8?
• ?????? ( Procedural Skills ) ?29?
• ????? ( Therapeutic Skills ) ?22?
• ??????????????????????????....

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????????
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OSCE?Clinical skill ?????

• OSCE??
• ????????,?????????????????,?6??104??,????????????
• ?????????
• ???clinical skill ???????SOP
• ??
• ?????Organ-based clinical skills
• ?????Department-based clinical skills
• ??Integrated real patient-based clinical skills
  

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New Curriculum
Clinical skill????
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?clinical skill?????
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Assessment and feedback at the end of each
block

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Organ system (Block) - based clinical skills
training and GOSCE

• Establishing the SOP of basic skills related to
  each block
• Practicing various skills by using medical
  models, simulators, standardized patients,
  animals, computer assisted teaching devicesetc.
• Group OSCE was held at the end of the year (M
  3-4, BM 1-2)

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Block 3 (Hematology and neoplasia)-based clinical
skills training
2005.11.08 M3.BM1 clinical skill
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Block 4 (Cardiovascular system)-based clinical
skills training
??????
???
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2006 M3.BM1 GOSCE
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??GOSCE?????(6.19??) Students Satisfaction about
OSCE
  ???() ???? ???? ?? ???? ???? ???? ???? ???? ?? ???? ???? ?? ???? ???? ?? ???? ???? ???? ??
Station 1 ????? 88.3 89.5 83.0 86.9 83.7
Station 2 ??????? 80.4 83.0 78.5 74.5 79.0
Station 3 ????????? 52.7 75.8 71.9 73.2 60.8
Station 4 ??????? 75.8 79.0 77.1 ???4.6 75.2 74.5 73.8
Station 5 ????? 89.6 90.9 84.3 86.2 87.0
Station 6 ?????? 89.5 84.3 85.6 ???5.9 80.4 86.3 87.5
??201?????153?(???76)
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Department based clinical skills training and
assessment

• Instructing the clinical skills related to each
  clinical department ltcore competenciesgt
• Practicing various clinical skills through real
  patients, standardized patients, patients
  scenarios, Lab data, images, multimediaetc.
• Clinical skill assessment was held at the end of
  rotation of each clinical department .

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??????-?????

• ??????????
• ????????
• ????????
• ???????
• ??????
• ?????? ????

???? Department-based clinical skills test
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Basic surgical skills training
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Department-based clincal skill examination

• Internal Medicine
• 28 stations
• 5 minutes per station

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Evaluation form for clinical competence
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Real Patient-based clinical skill
teachingVS-R-Intern-clerk integrated instruction
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Assessment of clinical skills

• OSCE ( Objective Structured Clinical Examination
  )
• DOPS ( Direct Observation of Procedural Skills )
• Mini-CEX (Mini-clinical Evaluation Exercise)
• CBT ( Computer Based Test )
• Check with checklist.
• Videotape recording.
• Feedback by physicians, experts, real patients,
  and SP.

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OSCE???

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• ???????????????
• ?????????

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OSCE??????????

• ?????
• ??????????????
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• ????(????????????)
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• ????,????
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• ??
• ??????,???????,??????????,????????????,??????OSCE?
  
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• ?????????,??OSCE?????
• ??
• S.P.??????1000????,????????1000??
• ??????
• ??????????
• ???????

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Concerns and challenges of standardized patients
(SPs)

• SPs are skilled at simulating historical and
  physical findings, but many find it difficult to
  give effective feedback.
• Effective feedback is the key part of teaching
  and learning process, it helps learners learn
  better, and faster.
• SPs can be taught to give effective feedback by
  using Quality of SP Feedback Form (QSF) to train.
• SPs are like mirrors.

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Principles for giving feedback

• 7-step approach
• Encourage self-reflection. ( ???? )
• Describe specific behaviors. ( ?????? )
• Use the sandwich technique. ( ?? - ?? - ?? )
• Limit negative feedback. ( ?????? )
• Demonstrate empathy. ( ???? )
• Encourage learner questions. ( ???? )
• Verify feedback and thank learner. ( ?? )

2004 Win May, Dixie Fisher
USC keck school of Medicine
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Purpose of Using the quality of SP Feedback Form
(QSF)

• A training tool for SPs, SPs rate each other, and
  learn each other.
• Improving the verbal feedback besides the
  written feedback.
• Better inter-rater reliability is gained after
  training, and SPs appear to better understand how
  to give feedback.

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OSCE ??????

• 2009.10.09?????????
• OSCE??????????????,????????????????????????
• 2009-2010OSCE????????????
• 2010.07.24???????????
• 2010.08.11
• ??????,????,???OSCE??????
• ( Borderline Group Method )
• ?????SP/SP Trainer ??????,?????????????
• 2010.09.262011??OSCE??????
• ????24?????OSCE??????
• 2011????????OSCE???
• 2012????????? OSCE????

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What is the Next Step of OSCE?
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Why Interprofessional Education (IPE) for
Clinical Skills ?

• Health care professionals do not function in
  isolation
• People work together in small interdisciplinary
  group for many aspects of day-to-day patient care
• However learners are typically trained in
  separate disciplines and educational programmes,
  only coming together as a team at the end point
  of clinical care
• For patient safety and holistic care, IPE offers
  benefits to team working outcome

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Summary ( I )

• Better integration between the activities of the
  clinical skill center and the curriculum is
  essential ltnot just to show off to the visitors gt
  to promote the learning effectiveness of the
  students.
• Full supporting system through a well-designed
  infrastructures is of paramount importance to
  embbed numerous transferable skills to students
  both in breadth in depth.
• The range of practice, assessment, and feedback
  of OSCE should be well-planned according to the
  institutions resources and learners need.

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Summary ( II )

• Effective feedback is an important component of
  teaching learning process, quality of feedback
  training system for SPs and tutors is essential.
• Roadmap of clinical skill learning starts from
  general education, organ system-based curriculum,
  department-based core competencies, to real
  patient-based clinical practice should be
  established integrated.
• The trend of OSCE may move from uniprofessional
  OSCE to interprofessional or multiprofessional
  GOSCE based on the team work for holistic care in
  the real world.

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Thank you for your attention!
Find the right way to set the sail of clinical
skill education before the wind!
???????????????????!