AAMC Conference Nov, 2011 Pre-Clerkship Clinical Skills Courses Review of the Literature

What has been written regarding PCCS courses in general? What has been studied about PCCS courses? –What kinds of studies have been conducted? What, if anything, has been agreed upon in terms of curriculum and “best practices”? Questions to be answered..

Primarily U.S. Schools 2000-present Included Europe and Australia if PCCS were addressed in the article Included within the PCCS course lit review –Professionalism –Communication –Clinical Reasoning –OSCEs –Particular PE – MSK, gynecological, abdominal exam Guidelines for literature search..

Clinical skills in clerkships Physical Exam training in clerkships Professionalism as primary topic Overall curricular reform Curriculum integration not primarily involving PCCS courses Exclusion Criteria

Challenges in Search Numerous names of PCCS Courses –Doctoring –Essentials of Clinical Medicine –Intro to Clinical Decision-Making –Introduction to Clinical Medicine –Intro to Medical Professions –Patient, Physician and Society –Patient-Doctor –Practice of Medicine –Principles of Clinical Medicine –Principles of Health and Disease

PCCS Course Curriculum Development/ Assessment –Surveys –Skills/Knowledge –Descriptive Teaching Professionalism in PCCS Courses Specific Clinical Skills Acquisition PCCS Courses/Skills as Primary Topic –Commentary/position papers –Survey Major Categories

 Topics of focus  Integrated and longitudinal communication skills acquisition  Teaching students an integrated approach to interviewing  Value of early patient contact and clinical experience  Value of patient cases as foundational in PCCS education  Identification of milestones/framework for teaching and assessing clinical reasoning  Integration of primary care into PCCS curriculum PCCS Course Curriculum Development/Assessment

Importance of longitudinal/stage- appropriate professionalism curriculum Professionalism in PCCS Course

Musculoskeletal Examination Pain Assessment and Management Pelvic Exam Specific Clinical Skills Acquisition

PCCS Courses as Primary Topic TOP 5

1. Establish consensus on what specific clinical competencies a student should have mastered prior clerkships Prioritize which clinical skills are important at what level –What are the criteria for a “core” skill? Identify milestones for teaching and assessing clinical skills

2. PCCS courses do make a difference in clinical skills – how much? –Performance –Confidence –Preparation

3. Clinical skills is a “dying art” – redefine and resurrect –Reconcile clinical skills with technology (the “other” hidden curriculum) –Recognize that clinical skills in ambulatory settings may require a more refined skill set –Reinstitute bedside rounds

4. Institutional support is crucial for the success of clinical skills programs – Adequate support and time for PCCS Course Directors –Recognition of the role and work of faculty preceptors –Protected time for faculty preceptors –Faculty Development- Yes, Faculty Development!

5. Clinical skills curricula should be integrated across the continuum of medical education –Emphasis in pre-clinical years without building on skills in the 3 rd year creates learning void –Creation of longitudinal curricula Communication Physical Examination Clinical Reasoning

Future Plans.. Expand literature search to include 1990s Incorporate different names for the PCCS courses in literature search

Time of educational innovations and reform, including for PCCS Though numerous names and identities, core goals remain same Discussion today can add significantly to the literature Take home points