EBM and Clinical Support Librarians@UCHC

A blog for medical students, faculty and librarians about their use of evidence based medicine, clinical literature, Web 2.0, sources and search strategies

Education, Instruction: Developing Clinical Skills on Patients both Real and Latex

A faculty member invited me last month to the opening of the Health Center’s newly renovated, hi-tech Clinical Skills Assessment program (CSA) laboratory/office, where UConn medical students and residents receive hands-on training in effective patient assessment, clinical interviewing, physical exam and skilled communications by working with real, living “patient-instructors”.

The patient-instructors are coached to simulate a particular disease-state or injury, and follow a specific written script during the exam. Many have been working at UCHC for years (sometimes, even decades); they have been intensively trained to interact with students and residents. They are highly-valued and well-paid. Associate professor Dr. Carol Pfeiffer, who pioneered the program starting in 1987, administers the Clinical Skills Assessment program.

Each patient-student encounter at CSA is filmed using cameras and sound devices that are mounted high on the ceiling of every exam room. After the session is complete, students receive an informal, friendly verbal critique from their simulated patient. Then the students watch their video recording of the session in order to assess the effectiveness of their “bedside manner” – body language, listening skills, thoroughness of the hands-on exam, interpretation of the patients’ chief complaint, pacing of office visit, etc. Clinical exams can also be sent electronically to remote locations for external teaching purposes.

Another unique acquisition in 2007 for the Clinical Skills Assessment laboratory were two virtual patients SimMan® and Sim-Baby® – who “live” in their own dedicated situation room/laboratory for the teaching and training of students, EMTs and other clinical health personnel. Cameras and audio also film these encounters, so that students can watch their actions after a practice Code Blue (for example).

The UCHC Sims will be a subject of a future posting on the blog. Meanwhile, here is a stock photo of SimMan®, found on the manufacturers’ (Laerdal Inc.) website:

stocksimman.jpg
Photo credit: Laerdal, Inc. – Copyright 2008 – All rights reserved

In Jan 2008, I read about two quite different approaches to teaching and learning in medicine on the BBC.com website. The first article reports on zippable surgical gowns (see photo below) used at Durham University. There, medical students put these gowns on – which come with nine simulated surgical incisions (or “zips”) – in order to get a more realistic sense of what a patient undergoing surgery may be experiencing.

bbcsurgicalsuit.jpg

Caption and Photo Credit – Copyright BBC.com – 2008 – All rights reserved

Read the full story from this BBC link: http://news.bbc.co.uk/1/hi/health/7213757.stm

The other article from the BBC site was published in July 2007. It describes work by Dr. Carla M. Pugh, an assistant professor of surgery at Feinberg School of Medicine of Northwestern University, Chicago, where she teaches clinical skills. In addition to an MD degree, she also earned a doctoral degree in education from Stanford University.

Dr. Pugh was unhappy with the poor quality and design of commercially available human anatomical models. Students, as she said, were “sweating bullets” over performing exams in those sensitive genital areas. Her goal was to provide a better clinical exam experience for students to practice on, prior to conducting a real clinical exam on a living person. Part of the solution was for Dr. Pugh to travel around to local Illinois exotica (read: porn) shops or toy stores during the summer months, in order to purchase latex replicas of male or female genitalia and baby dolls, which she then cut up and adapted for classroom use.

Link to the BBC article here: http://news.bbc.co.uk/1/hi/health/6503187.stm. Dr. Pugh was also featured in an article published in the Northwestern University Observer on Mar 8, 2007 (here).

She and the company she is affiliated with produce a latex pelvic exam simulator using sensor technology, which was patented by Dr. Pugh in 2001. These simulators are in use at over 60 medical and nursing schools. Dr. Pugh is continuing to develop other exam simulators including prostate, breast and a baby birthing model.

These facilitative technologies and forward-thinking, creative and innovative faculty offer so many ideas for teaching and learning in medicine!

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