WORKSHOP How to integrate basic clinical skills and simulation adjuncts in an undergraduate pre-clerkship medical curriculum? Dr. Muhammad Zafar MBBS, MPhil, PhD Associate Professor of Anatomy/Skill Lab Director of Clinical Skills Program Email: mzafar@alfaisal.edu Dr. Nasir Ali Afsar MBBS, MPhil, PhD, MERC Senior Lecturer of Pharmacology Email: nafsar@alfaisal.edu

What is simulation? Artificial representation of a real-world process to achieve educational goals via experiential learning. A training and feedback method in which learners practice tasks and processes in life-like circumstances using models or virtual reality, with feedback from observers, peers, actor-patients, or video cameras to assist improvement in skills. 24-Feb-2016 CSC 2016 Dubai

Definitions Simulation Lab. Is a laboratory that contains simulators and is used for simulation for teaching, training, evaluation and feedback purposes Simulation area: An area in a simulation lab that simulates certain medical setups like OT, ER etc. 24-Feb-2016 CSC 2016 Dubai

Definitions Standardized Patient (SP): Real people portray patients with scripted or outlined responses to the healthcare provider’s questions or physical examination. Mannequin or a manikin: A model of the body, usually with moveable or removable members or parts. Partial task simulator: Simple & low fidelity simulators. 24-Feb-2016 CSC 2016 Dubai

Definitions Feedback: The return of some of the out put of a system as input so as to exert some control in the process. Facilitator: A person who facilitates the conduction of a process of teaching or training for learning purpose. 24-Feb-2016 CSC 2016 Dubai

Basic Clinical Skills Any purposely selected and integrated set of individually skillful acts that are pertinent to each patient encounter. Examples: Communication skills Clinical history Mental and physical examination Initiating clinical tests Undertaking diagnostic procedures and therapeutic interventions. 24-Feb-2016 CSC 2016 Dubai

Simulation Adjuncts Standardized patients (SPs) 3D or static Anatomy Models Written Scenarios Human Cadavers Animal Models Computer based simulations Audio-simulations Video-based simulations Virtual reality simulation 24-Feb-2016 CSC 2016 Dubai

Why use Simulators? The reasons behind the increased use for patient simulation are many and include: Standardization and replication of the skills Limited availability of patients Patient safety Improved realism of simulation devices The growth of medical knowledge Changes in medical education New demands on student availability 24-Feb-2016 CSC 2016 Dubai

Simulator’s Fidelity Means: how true to life the teaching/evaluating experience must be to accomplish its objectives. Low-fidelity simulators: focused on single skills to practice in isolation. Medium-fidelity simulators: more realistic representation but lack sufficient cues for the learner to be fully immersed in the situation. High-fidelity simulators: allow full immersion in the experience and respond to treatment interventions. Yaeger et al. (2004) 24-Feb-2016 CSC 2016 Dubai

Limitations of Simulation Many areas of human anatomy and physiology are yet to be realized for simulation. Such as, the feel of the skin, skin color, and skin temperature The simulation is constrained by the degree it can mimic reality. Such as, the fast-paced, high- stress environment of a critical care unit is difficult to simulate. As a result, there is no assurance that the learner will make a smooth transition of knowledge from the simulated situation to the actual clinical environment. High cost to establish and maintain a simulation facility. 24-Feb-2016 CSC 2016 Dubai

Our Experience at Alfaisal University Medical Curriculum: hybrid, 5-year curriculum for both genders Our strength: Clinical Skills Courses as an important strategy to train medical students from Year-1. Year 1-2 Basic Year 2-3 Preclinical Year 4-5 Clinical Medicine, Pediatrics, Surgery, Eye, ENT, OBGYN, Electives, Focused History taking and Physical Examination Pathology, Microbiology, Pharmacology, Family and Community Medicine, History taking, Physical Exam, selected procedures Anatomy, Physiology, Biochemistry, Community Medicine, Communication Skills 24-Feb-2016 CSC 2016 Dubai

Typical Week 24-Feb-2016 CSC 2016 Dubai

Typical Organization of a CS Session 24-Feb-2016 CSC 2016 Dubai

Students’ Feedback Theme Percentage Sample quote Hands-on practice in the course 30% (90) “The course gave us the chance to practice and by the hospital visits, we got the chance to break our fear of practicing on real patients” The organization of the course 26% (76) “The subjects we are taking are similar to what we're learning in the blocks which thus makes it easier for us to grasp the concepts” Clinical Skills acquired from the course 13% (40) “It improved our clinical skills required in the clinical sessions.” A table from a publication in press (Medical Teacher). A Combined Approach of Clinical Skills Training utilizing Near-Peers, In-Campus Faculty and Clinicians: An Innovative Integrated Model. 24-Feb-2016 CSC 2016 Dubai

WORKSHOP: How to integrate basic clinical skills and simulation adjuncts in an undergraduate pre-clerkship medical curriculum? Thank You Dr. Muhammad Zafar MBBS, MPhil, PhD Associate Professor of Anatomy/Skill Lab Director of Clinical Skills Program Email: mzafar@alfaisal.edu Dr. Nasir Ali Afsar MBBS, MPhil, PhD, MERC Senior Lecturer of Pharmacology Email: nafsar@alfaisal.edu

Weekly Time table Template Days Sunday 14/9/2014 Monday 15/9/2014 Tuesday 16/9/2014 Wednesday 17/9/2014 Thursday 18/9/2014 Time Male Female 8 - 8.50 am   9 - 9.50 am 10 - 11.50 am 12- 1.00 pm 1 - 2.50 pm 3 – 3.50 pm 4 - 4.50 pm 24-Feb-2016 CSC 2016 Dubai

Integrated Schedule Example 24-Feb-2016 CSC 2016 Dubai