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Clinical Skills

Overview

Clinical Skills are taught regularly throughout Phases 1, 2 and 3. The clinical skills sessions in Phase 1 focus on communication with students learning the patient centred clinical method. In Phase 2 students learn about each body system (MSK, Head and Neck, Cardiovascular, Respiratory, Gastrointestinal and Neurology) and expand their communication skills. The clinical skills course in Phase 3 integrates learned material from Phases 1 and 2 and by the end students are expected to perform a full history and physical examination, complete a differential diagnosis and should be able to write up their patient assessment and present their findings orally to their peers and tutors. Students also complete sessions about Breast Health, Psychiatry, Surgery, Pediatrics, Obstetrics and Gynecology, Death and Dying, and Violence.

The following topics are covered in this handbook section about Clinical Skills:

General information for tutors: Phase specific information: Clinical Skills Contacts



General information for tutors

Student learning for Clinical Skills includes class demonstrations and small group sessions. Faculty tutors teach the demonstrations, facilitate students working in small groups and assess student performance. 

Overall objectives for Clinical Skills

After completion of Clinical Skills in Phases 1, 2 and 3, the student will be able to:
  • perform a complete history and physical examination for a given patient.
  • be able to concisely communicate the findings in both oral and written formats.
  • formulate a problem list with probable diagnoses and differential diagnoses.
For information on enabling objectives (communication, physical examination and presentation skills), refer to the Overall Clinical Skills Objectives document. 
For objectives of specific sessions, refer to the objectives section for each individual phase below. 


Teaching Reminders
  • Be aware of the students' level of knowledge and review any pertinent information as required by the students. In the spiral curriculum, anatomy, physiology and pathology are taught throughtout the three phases so students may not yet be familiar with all the relevant material. For example, if you are teaching how to examine a patient who has a pleural effusion, you may be required to review pleural effusion for the students at the beginning of the clinical skills session.
  • The students are new to clinical skills and learning focuses on very basic clinical skills. As an experienced clinician you have learnt additional techniques that you may find more effective, however the Bates Guide should be followed when teaching. This will avoid confusion for the students (getting different advice from different tutors) and the Bates Guide is also the reference for setting the OSCE exams. 
  • Make use of the full time slot for teaching. Sessions should be interactive with tutors demonstrating skills when needed and all students getting an opportunity to practice the demonstrated skills. 

Teaching schedule 
The teaching schedule for Clinical Skills for an academic year is sent in June prior to the start of Clinical Skills in September. The Clinical Skills Co-ordinator sends a schedule template to the administrative contact within each discipline. The discipline is then responsible for designating teaching faculty for the required sessions. Once tutors are assigned to all sessions, the discipline sends that information to the Clinical Skills Co-oridnator to finalize the teaching schedule.

Faculty members who are scheduled to teach will receive an email about the session including any necessary material needed for the session. If you have any further questions regarding content, time and location of the session you are scheduled to teach, contact Clinical Skills Co-oridnator Marilyn MossPlease note that you will not receive any further email reminders about the session. If you would like to have additional reminders sent to you, please contact your discipline administrative staff. 

If you are scheduled to teach a Clinical Skills session and you are unable to do so, it is your responsibility to find a replacement. Please contact Clinical Skills Co-ordinator Marilyn Moss to advise her of the change in schedule.

Missed Clinical Skills sessions
Tutors who are not present or late for their scheduled session will get paged within ten minutes by the Clinical Skills Co-ordinator (or designated Standardized Patient (SP) Educators). If you are scheduled to teach a session and you do not show up within 30 minutes of the scheduled start time, students may leave the session. In this case the entire session has to be rescheduled.  

Please note that the SP Educators record any sessions that a scheduled tutor did not attend and forward the information to the Clinical Skills Co-ordinator. At the end of every month, the Clinical Skills Co-ordinator will forward a list of tutors who did not attend their scheduled sessions to the Associate Dean of Undergraduate Medical Education. 


Student responsibilities
Dress code:
For most Clinical Skills sessions and during patient contact, students are required to wear a white lab coat and photo ID card. Students should also be aware of the scent free policy and refrain from wearing scented products. Refer to the
Dress Code for Clinical Skills document for detailed information. If necessay, tutors should remind students about wearing lab coats during patient visits.
Leave policy:
Student attendance at all Clincal Skills sessions is mandatory. 
Tutors should email Maria Goodridge or Marilyn Moss if a student is not in attendanceStudents need to complete a Student Leave/Exam Deferral form and the leave has to be approved by the Phase Lead. For more details about student attendance and leave guidelines, refer to the Course Attendance Requirements document available on D2L. If you do not have access to D2L, please contact the administrative staff of your discipline. 

Clinical Skills Videos
GI demonstration video
Additional videos such as the Colbourne videos are available on D2L (under course resources).
If you do not have access to D2L, please contact the administrative staff of your discipline.   

Objective Structured Clinical Examination (OSCE)
OSCE are station-based clinical skills examinations that assess students in a simulated clinical encounter with a Standardized Patient. OSCEs are used for student assessment in Phases 2 and 3.
Students are allowed five minutes per station and usually complete ten stations (plus one rest station). OSCE examiners should be aware of the following points:
  • Students are only allowed to enter the room when the buzzer sounds. Students read the question associated with the station before entering the room.
  • Students should introduce themselves to the patient and the examiner upon entering the room.
  • The buzzer also sounds to indicate there are 45 seconds remaining for the examination.
  • Examiners may ask question(s) after the 45 second buzzer sounds. 
  • Examiners should only provide prompts or interrupt the student if 
  • a) the student seems to have misinterpreted the question. The examiner should prompt the student to re-read the question.            
  • b) the student attempts to perform a procedure which will jeopardize the health of the patient. 
  • Examiners need to complete the provided assessment form for each student. Students are marked as competent or unsatisfactory. 
OSCE update for the 2015-16 academic year:
There will be three OSCE’s with the transition to the new curriculum. The OSCE dates are:
  • Wednesday, September 30, 2015
  • Saturday, April 9, 2016
  • Friday, June 17, 2016
The OSCE in September will discontinue in subsequent years. 


Phase 1 Clinical Skills (MED 5720)

Introduction

The focus in Phase 1 Clinical Skills is communication. It introduces students to the basic skills of interviewing, the identification and analysis of issues and dilemmas within the doctor/patient relationship and also provides students with the opportunity to become familiar with the fundamental use of medical instruments. Students learn the patient centred clinical method and have many opportunities to practice communication through role play, interaction with standardized patients as well as patients in a clinic setting. Students are in groups of seven or eight students and meet for three hours on Wednesday mornings. Students have about 20 sessions and they extend into the Phase 2 Clinical Skills course. Sessions are facilitated by a clinical faculty member and either a social worker or psychologist. The same facilitators lead the sessions throughout Phase 1.
Student assessment includes observation within the groups regarding student participation, interviewing skills, general interest and homework.


Objectives for Phase 1
The overall objectives are covered in the Learning Objectives for Phases 1 and 2The complete list of learning objectives for the Clinical Skills course (Communications 1) can be found using the online curriculum map. Using this map, tutors can view the learning objectives for this particular session. Tutors should also be aware of the History Taking Objectives.  

Assessment for Phase 1

Students are assessed using formative and summative assessment throughout the course. The overall assessment process for the Phase 1 Clinical Skills course is outlined in the Phase 1 MED 5720 assessment map

The following forms are used for assessment in Phase 1:


Formative assessment
Summative assessment
*This forms is for information only. All necessary forms are provided to tutors by the Clinical Skills Co-ordinator or completed online using One45.


 Phase 2 Clinical Skills (MED 6760)

Introduction
In Phase 2 students continue to work on communications skills and start begin the system skills sessions. System skills are taught in small group  sessions (five students) and students get introduced to each body system: Musculoskeletal, Head and Neck, Cardiovascular, Respiratory, Gastrointestinal and Neurology. 
Student assessment includes a two station formative OSCE (mid phase) and a complete ten station summative OSCE at the end of Phase 2.


Objectives for Phase 2
Through Phase 1 and the communication part of Phase 2, the objectives are outlined in the Learning Objectives for Phases 1 and 2.
In addition, the objectives for systems skills are listed below:

Respiratory Objectives 
Musculoskeletal Objectives 
Cardiovascular Objectives
Head and Neck Objectives
Neurology Objectives
Gastrointestinal System Objectives

Assessment for Phase 2
Students are assessed using formative and summative assessment throughout the course. The overall assessment process for the Phase 2 Clinical Skills course is outlined in the Phase 2 MED 6760 assessment map.

The following forms are used for assessment in Phase 2:

Formative assessment

  • Formative Evaluation Interview: checklist will be provided at the time of the interview 
  • Formative Objective Structured Clinical Examination (OSCE): checklist will be provided at the time of the formal OSCE for the tutor to review with the student. The student is not given the checklist but is able to review it during the time allotted for verbal feedback. 

Summative assessment
  • To assess the communication part of Phase 2 Clinical Skills: Summative Assessment Report Phase 2* 
  • To assess OSCE performance: Checklist will be provided at the time of the OSCE
  • For more information about OSCE, see above.
*This forms is for information only. All necessary forms are provided to tutors by the Clinical Skills Co-ordinator or completed online using One45.

Phase 3 Clinical Skills (MED 7720)

Introduction

Students integrate the material learned in Phases 1 and 2 to expand their history taking, physical examination and diagnostic skills. The sessions are in small groups consisting of three to four students. Initially students take turns in history taking and completing the physical examination. As students advance their skills, they are expected to individually perform two complete history and physical examinations, develop a problem list and complete a differential diagnosis and should be able to write up their patient assessment and present the results to their tutor and peers by the end of the Phase. Students also complete sessions about Breast Health, Psychiatry, Surgery, Pediatrics, Obstetrics and Gynecology, Death and Dying, and Violence.
Student assessment includes full patient work-ups, a witnessed physical examination and a final ten station OSCE.


Objectives 
As students integrate material from previous phases, the objectives for Phase 3 are covered in the Overall Clinical Skills Objectives document.

Objectives for individual sessions are as follows:
Urogenital Teaching Objectives
Breast Health Objectives
Introduction to Trauma Objectives
Psychiatry Objectives
Pediatrics Objectives

Day in Violence Objectives
Miller Centre Session Objectives


Assessment for Phase 3
Students are assessed using formative and summative assessment throughout the course. The overall assessment process for the Phase 3 Clinical Skills course is outlined in the Phase 3 MED 7720 assessment map. 

The following forms are used for assessment in Phase 3:

Formative assessment

Summative assessment
  • To assess students taking a history, doing a physical exam or write-ups: Summative Assessment Report for Write-ups* (slightly different forms for different disciplines). Written assessments are combined into a cumulative summative assessment report.  
  • To assess the summative witnessed physical examination: Summative Witnessed Physical Examination Checklist*
  • To assess OSCE performance: Checklist will be provided at the time of the OSCE
  • For more information about OSCE, see above.
*This form is for information only. All necessary forms are provided to tutors by the Clinical Skills Co-ordinator or completed online using One45.

Clinical Skills Contacts

Clinical Skills Lead
Dr. Maria Goodridge
Maria.Goodridge@med.mun.ca  
Clinical Skills Co-ordinator
Ms. Marilyn Moss
clinicalskills@med.mun.ca 709 864 6309
Standardized Patient Program Co-ordinator
Mr. Frank MacLean
Frank.Maclean@med.mun.ca 709 864 6287
CLSC Secretary
Ms. Cynthia Skinner
cynthia.skinner@med.mun.ca 709 864 6322


Last Updated 2017-09-07 10:05:50 AM
Disclaimer: This handbook is in review.  Many sections are under development and final implementation is subject to the approval of the Office of Faculty Relations.