Teaching Problem-Based Clinical Evaluation During COVID-19: Clinician as Simulated Patient
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2021
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Australian & New Zealand Association for Health Professional Educators 2021
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Australian & New Zealand Association for Health Professional Educators
Melbourne Authors
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Medical Education
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Barmanray, R., Seymour, C. & Morley, P. (2021). Teaching Problem-Based Clinical Evaluation During COVID-19: Clinician as Simulated Patient. Australian & New Zealand Association for Health Professional Educators 2021, Australian & New Zealand Association for Health Professional Educators.
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Abstract
The COVID-19 pandemic forced the suspension of ward-based medical education worldwide, necessitating novel approaches to medical education.
Video case-based education has been successfully trialled in specialty medicine, however, problem-specific clinical evaluation is difficult to be taught via non-interactive video cases.
In March 2020 the University of Melbourne instituted a virtual problem-based patient evaluation program for second-year Doctor of Medicine students commencing clinical training. This involves students interviewing expert clinicians in a simulated clinician-patient interaction through a real-time videoconferencing platform. The clinician uses a case précis to portray a presenting complaint and patient behaviour in a realistic manner as per their experience. Differential diagnoses are then generated and consideration given to whether elements of the history make each more or less likely. Examination findings are displayed and evaluated with regard to the differential diagnoses, followed by viewing (and discussion) of an expert performing the relevant physical examination.
An experienced clinician acting as the patient allows demonstration of usual patient behaviours. Unlike a student peer-portrayal of a patient, responses can be matched to the phrasing of questions and manner in which they are asked (e.g. when evaluating chest pain a student’s question “Do you have any associated features or symptoms?” might be met with simulated confusion while “Could you tell me, other than the pain were you experiencing anything else unusual, for example…” would be met with a more fruitful response from the clinician). Elements of real-world patient interactions can also be modelled (e.g. inaccurate recollection of medication names/doses, “metmorphine” for “metformin”; or frustration at having to recount their history yet again, “Don’t you have all the information in your computer?!”). Feedback and guided reflection on the simulated encounter allows students to refine their interviewing skills to manage such real-world difficulties. The program has thus far been found engaging and valuable.