Structured Clinical Insights Modules (SCIMs): High fidelity simulated scenarios for learning clinical skills and clinical reasoning

Abstract

Introduction Scarcity of clinical placements and heightened concern for patient safety have led to an increased focus on simulation methodologies for the early acquisition of clinical technical, human engagement and reasoning skills, in parallel with clinically-based learning opportunities in undergraduate medical education. Background Feedback from senior medical students and their supervising clinicians identified the need to supplement the skills learning from clinical placements with structured learning opportunities. Methods A learning methodology was developed that combines the reasoning-development approach of Problem Based Learning with high fidelity clinical simulation. Students were divided into teams of five (designated as a 'registrar' and four 'interns') who managed a simulated patient through an evolving story over the period of a week. Innovative elements included extensive use of trained simulated patients and relatives, technological simulations, after hours 'on call' experiences and a simulated court case involving cross examination of learners by an experienced barrister. 150 Year 3 medical students undertook the program in 2009. Evaluation was undertaken using standardised questionnaires, as well as Interpretative Phenomenological Analysis of learners' reflective journals to identify evidence of learning in the affective domain (values, attitudes and human engagement). Results The program was very positively received by learners (mean subjective effectiveness score of 6.38 on a 7-point Likert scale). Analysis of journals revealed numerous examples of deep reflection and affective learning in association with the program. Conclusion The SCIMs methodology shows promise for promoting the initial acquisition of essential clinical skills in a safe environment, as an adjunct to clinical attachments. References Okuda Y, Bryson EO, DeMaria S, et al. The utility of simulation in medical education: What is the evidence? Mt Sinai Journal of Medicine 76(4):330-43, 2009. Spalding WB. The undergraduate medical curriculum (1969 model): McMaster University. Canadian Medical Association Journal 100(14):659-664, 1969. Flanagan B, Nestel D, Joseph M. Making patient safety the focus: Crisis Resource Management in the undergraduate curriculum. Medical Education 38:56-66, 2004. Smith JA. Beyond the divide between cognition and discourse: Using Interpretative Phenomenological Analysis in health psychology. Psychology and Health 11:261-71, 1996. Rogers GD, McConnell H, Milligan E, Lombard M, Jones de Rooy N. Desperately seeking evidence of learning in the affective domain: Interpretative Phenomenological Analysis of clinical learners' reflective journals. Paper at this conference, 2010.