November 2021 - SEM Trainers

Clinical Skills Training – Development, Facilities & Training Centres

Clinical Skills Training is specially designed for students to obtain and integrate general and special medical skills at the patient’s bedside. General history taking and examination procedures are being taught and practised through Clinical Skills Training. This occurs among the students first and then to the patients as well from the involved departments and hospitals. The goals of Clinical Skills Training are mentioned as scripts and guidelines.

Medical Simulation is a Disruptive Change in Medicine

It has changed the ancient and age old practice “One Doctor to One Apprentice”, a practice in “Residency Training” which was introduced by Dr Halsted at the turn of the 20th Century. This “Master-Apprentice Model” served well for the exigencies of that age and time. “The time now is to redesign for the requirements of the current era. However It should be noted that “disruptions” are the originators of paradigm shifts in human evolution, social developments and in scientific discoveries. Disruptions lead to paradigm transformational changes. Simulation has for the first time in the history of medicine, made it possible for the Apprentice to acquire, practice, and become proficient on demand, besides meeting the critical requirements of various Clinical Competencies says Dr. Stephen C. Schimpff in his book “The Future of Medicine-Megatrends in Healthcare”.

Why Simulation is becoming “Indispensable”

Simulation is now rapidly becoming an important and integral adjunct to Medical Education and training.

Let us look at the reasons why Simulation is becoming so indispensable for Healthcare Training.

Learning any new skill means making mistakes
Making mistakes is a normal part of the learning process. Learning medical procedures has traditionally meant making mistakes on real patients.
Making mistakes on real patients can put the patients at serious risks sometimes life threatening, but
Hands on “Experiential” learning is indispensable for Healthcare Professionals, be it at a basic nursing level, or undergraduate level or post graduate level or even at the practicing level

Development in Clinical Skills Training

The training of appropriate clinical skills is an essential element of healthcare education. It is seen that students are able to gain all the theoretical knowledge but somewhere lack the skills in practical and physical examination and thus, are unable to take simple and practical procedures. Hence, Clinical Skills Training makes a strong part of the core curriculum and this training programme ensures that all the students have the necessary learning opportunities and the appropriate assessment.

With frequent changes in the healthcare delivery process and pressure on clinical resources, the desired educational targets are not easily achieved with so many number of students. The hospital wards are not always the appropriate settings for the students to be introduced to clinical skills, practise them and master the essential technique. Thus, clinical laboratories were established to provide students the necessary environment in which they can get the training in clinical skills in a systematic manner using effective educational strategies and experiences.

Clinical Skills Competencies

Clinical skills competencies include:

Communication and history-taking skills
Professional attitudes and awareness of the ethical basis of healthcare
Physical examination, procedural and clinical laboratory skills
Diagnostic and therapeutic skills
Resuscitation skills
Critical thinking, reasoning and problem-solving skills
Team-working, organisation and management skills
Information and technology skills

Clinical Skills Facilities

To develop clinical skills competencies using manikins, fellow class members, simulated and real patients, clinical skills facilities have a space set aside for this purpose. The feedback is also provided through television monitoring or directly through simulated trained patients, their instructors or tutors. Because of these reasons, many medical institutions have now set up clinical skills training facilities or are in the process of doing so.

Targets According to Educational Needs

The clinical skills training is planned having one group in mind. It is usually set up in the context of a new undergraduate medical curriculum with the targeted users being medical students. The target users, however, can be broadened to involve other students from a wide variety of healthcare backgrounds and at various stages of their healthcare development.

Clinical Skills Training Centres

There are many financial, management and educational arrangements for clinical skills training where the multipurpose education remains ascertained. But to make students learn together in carefully selected, practically relevant, task-based scenarios, that prepares students from different professional backgrounds for later work practice as the members of the healthcare team, clinical skills training centres are made. They provide an ideal setting for the early development of such relationships.

Use of these clinical skills training centres by students at different phases of their educational spectrum (undergraduate or basic training, post graduate or vocational training, continuing professional development) emphasizes the importance of the continuous sequence of education. Thus, the making clinical skills training centre accessible by different groups of students allows the facilities to be consumed in a much proper way.

Different Approaches Through Studies

There are many approaches that focus on how to engage students in self-directed learning and peer learning activities to improve clinical skills training in undergraduate medical students. In the first study, the clinical skills training provided by student teachers and associate professors is compared. The results have shown the student teachers performing as good as or even better than associate professors when they are giving simple clinical skills training.

The second study examines how complex clinical skills, such as patient management skills, develop with increasing levels of competence. To reflect this change, the Reporter-Interpreter-Manager-Educator framework was used and explored. In the third study the effects of training in pairs (also known as dyad practice) were examined. This study showed that the students practicing in pairs significantly out-performed those training alone using RIME-based assessments and that dyad training significantly improved students’ confidence in managing future patient encounters. The final study examined students’ use of self-directed clinical encounter cards (CECs) based on the RIME framework.

Results from this study showed that self-directed CECs can have positive effects on participatory practice and clinical reasoning when implemented in a supporting environment but the chance of success depends on the context of use.

For Ideal Skills Lab Development Programme, contact us.

Medical Simulation Over The Years: How It Is Revolutionizing Healthcare

Roughly 50,00,000 deaths happen each year due to preventable medical errors during treatment, and this is often caused by limited practical knowledge among the doctors and the nurses. Many times, they just don’t have the knowledge and resources to deal with unexpected adverse events that can affect the outcome of a treatment. Such huge numbers are alarming and simply unacceptable at a place that is largely dedicated to saving lives. Looking at these statistics, it becomes urgent to look at how we approach medical training. Often, a short delay in taking care of breathing can lead to organ dysfunction and poorer outcomes despite excellent treatment. With proper training, the mortality rate from such medical negligence can be brought down to nearly 50% of what it is today, according to experts. If we train our doctors and nurses through comprehensive, realistic hands-on training, we can certainly cut the death toll in half. And simulation has come a long way in helping us with that. Today, we have come a long way in using medical simulation to improve the quality and accessibility of timely healthcare services.

Medical simulation, also known as healthcare simulation, is the act of reproducing realistic clinical settings to provide aspirants a chance for a hands-on experience while avoiding errors on real patients while training. Whether it’s carried out in the classroom or a special space built for simulation, it generally uses artificial manikins or real actors for patients, and various scenarios and situations are reproduced at different fidelities to make the training realistic and informative.

How Simulation Was Used In The Past

Some of the earliest medical simulators we used were human models that we made from clay and stone. When it was still relatively new, simulation was being used to train medical professionals so that it would dramatically reduce the number of errors during surgery, prescription, and crisis interventions, and in general practice all the same. Anesthesia physicians would use it to reduce accidents. Then around 1930, they built trainers for flight and military applications, and many other field experts began adopting it to suit their own needs.

But even though it was proving to be a game-changer, technological and medical knowledge limitations held us back and simulation did not catch on. Then through extensive military use, we realized how cost-effective and powerful it was at training, with the advancing hardware and software, we established certain medical standards and could now afford medical simulation. However, for long, it has remained unstandardized.

Simulation: Where We Are Today

In the last two decades, our use of simulation in healthcare training has increased a great deal. Today, simulation does more than just perfect medical professionals in their practice. Let’s look at a world without simulation. Trainees need to learn, and they will certainly make mistakes along the way. If we assign them to real patients, not only might it make the patients uncomfortable, but we might risk large complications due to minor errors. And with certain intimate and invasive procedures, some patients might refuse to be overseen by a trainee. Even though they might step into the industry after intensive education, without any actual experience, they are but beginners.

Simulation is now being used to provide detailed first-hand (but supervised) training in a safe and controlled environment to medical aspirants in anatomy, physiology, and communication as well. And then, they are debriefed so they can be assessed and given feedback on their performance in real-time. Simulation helps shorten the learning curve by allowing the student to learn by repetition and without being stressed out. And when we simulate realistic scenarios (like designing simulation rooms with bathroom spaces to simulate bathroom falls for the patients), it may make for a more realistic training experience. The simulators we have today are more realistic than ever. Not only do they look lifelike, the skin and various body parts and casualties look and respond just like they would if they were real.

Along with the procedural skills, through the realistic scenarios, the students also learn critical decision-making and interpersonal skills that they can take with themselves to the clinical setting. Many studies have discovered that students trained through medical simulation achieve overall higher scores and retention rates than the ones trained through traditional methods.

As we have begun to embrace medical training through simulation, we have effectively improved the quality of healthcare we receive. And as technology advances further, we will keep refining our competence for years to come.