George Washington University Medical School’s Clinical Skills Center control room. Photo courtesy of Professional Products, Inc. Medical students are scrutinized at every phase of their education, right into their residencies and that scrutiny has gone digital as medical schools’ “clinical skills centers” (CSC) have turned to digital video to record their students’ progress.
A company that specializes at installing CSC recording equipment is Professional Products, Inc. (PPI)—of Gaithersburg, Md.—which has overseen the installation of 17 CSCs, including at Cornell University’s Weill Cornell Medical College and George Washington University (GWU) Medical School.
A CSC is a mock examination room in which student doctors practice their clinical skills on “standardized patients” (SP), who are actors trained to feign an illness, said Jim Hatcher, PPI’s chief technology officer. A CSC will have a dozen or more mock examination rooms, each outfitted with two cameras and two microphones to record an examination from two different views, said Hatcher, who added GWU’s Medical School was PPI’s first CSC.
Two cameras are necessary in each examination room to record the activities that occur there, Hatcher said. The school not only wants to record how well medical students do when conducting physical exams, but also if the students are taking patient histories, “each camera is better situated for those,” he said.
Dr. Karen Lewis, George Washington University Medical School’s administrative director of the Office of Interdisciplinary Medical Education, stands behind a full-body simulator. Photo by J.J. Smith Dr. Karen Lewis is GWU Medical School’s administrative director of the Office of Interdisciplinary Medical Education, which means she administers the school’s CSC, which, she said, is not the future of medical education, it is the standard.
CLINICAL SKILLS EXAMS
“Medical schools have these (a CSC),” because in 2004, the National Board of Medical Education (NBME), the medical school licensing body, instituted a “step 2 clinical skills exam, that’s an exam every medical student has to take,” she said. The exam consists of 12 standardized patient sessions, and the students have to pass that exam, so once the clinical skills exam was implemented, “schools that didn’t have these before, got one fast,” she said.
However, the reason for having a CSC is not just to pass the NBME exam, she said. The CSC provides benefits to both the student and the faculty, Lewis said. Faculty members can go into the control center and select which exam room they want to watch. Once they do that, they can take control of the cameras in the room, and pan, tilt and zoom, she said.
Why that is favored is because the faculty member can see everything that occurs in the room, said Lewis, who added, there are times when the students are sent to clinics to shadow real doctors and also conduct interviews and physical exams on real patients. The doctors who participate in that are called “preceptors,” who watch as the student examines a patient. “But, because of the demands of the clinical practice, a preceptor usually cannot watch an entire patient interview or an entire physical exam, or see a student do multiple interviews.”
The advantage a CSC provides, is that a faculty member can watch six or more interactions students might have with standardized patients, and from that can get an idea of how skillful the students are with a patient, Lewis said.
Lewis’ CSC career began in 1998, at which time the recording technology was video tape. “Every time a student would move from one room to another, we’d take out the video tape and walk it to the next machine and put it in,” she said. However, the medical school switched to digital recorders in 2001, making recording and storing the data “a whole lot easier,” she added.
Cornell University’s Weill Cornell Medical College’s Clinical Skills Center. Photo courtesy of Professional Products, Inc. REALISTIC ENVIRONMENT
Dr. Yoon Kang, director of the CSC at Cornell University’s Weill Cornell Medical College, said, construction of the CSC was completed in 2007 and, “We designed the entire space to support a program in simulation as it relates to medical education.”
Most people are familiar with the term simulation as it relates to the aviation industry, where pilots are put in realistic situations to help them practice and test their skills, so CSCs put students in very realistic clinical environments to allow them to practice and receive feedback on their clinical skills, Kang said. The CSC also allows the students to make mistakes in a “low stakes” environment, where no harm would come to a patient, she added.
There are a number of ways we can simulate a clinical “low stakes” environment with the first being the use of standardized patients, who assist in teaching students a wide-range of clinical skills such as providing students with the experience of conducting patient histories, right down to the basic parts of the physical exam, Kang said. The other way the school can simulate clinical encounters is through the use of manikin simulators, she said.
There are a wide range of simulators; said Kang, who added that a simple simulator can be a model of the eye, the purpose of which is to train how to conduct an eye exam. The other end of the technology spectrum is a full-body simulator, which looks like a manikin, but is outfitted with very sophisticated software to imitate the physiology and reactions that a patient would have to different clinical maneuvers, she said. The primary purpose of a simulator is to allow students to practice in a safe setting, fostering the seamless transition for the students from the classroom setting of a simulator to a real clinical setting, she added.
OTHER DATA COLLECTED
While the simulation rooms look like examination rooms, the data collected includes biometric data coming off that robot, including heart rate, blood pressure, respiration, Hatcher said. All the data collected will be played back for the student and faculty.
Manikin simulators are also part of the curriculum at GWU Medical School, which has “a variety of manikins” to provide a range of aliments for students to treat, Lewis said. Some of the manikins are able to bleed, she said. Such realism allows students to learn how to treat patients in more dire need.
The whole concept of observing students as they work with patients, is something that has become very important in medical education, Kang said. “We can take a look at the video database and assess the impact the sessions are having as we watch a student’s progression of clinical skills from the first year to the fourth year,” she added.
There are a lot of different scholarly efforts related to CSC use, Kang said. The medical school can function on a bare bones level without this equipment, but to not record the students’ sessions would defeat the purpose of having simulations, she said.