J. Hudson1,2, B. Power3,4, B. Kurabi1, S. Ratnatpalan1,5

1. University of Toronto, Toronto, ON; 2. Trillium Health Partners, Mississauga, ON; 3. University of Ottawa, Ottawa, ON; 4. The Ottawa Hospital, Ottawa, ON; 5. Hospital for Sick Children, Toronto, ON.

This study demonstrates the extensive role of patients in the education and assessment of medical students. Interestingly, results indicate that SP methodology is utilized by every medical school across Canada. This highlights the significant role that SPs play in clinical skills teaching and assessment and supports the perception that the use of SPs in the medical school curriculum is increasing (Anderson, 1994). We defined PVs and RPs separately but the two groups appear to have similar characteristics and each are a substantial part of teaching and assessment of history taking and physical exam skills with a lower proportion of involvement (approximately 65%) with communication skills. It appears that PVs and RPs are utilized about 50% less by respondents than SPs for assessment of clinical skills overall. Not surprisingly, VPs are rarely used in history taking and communication skills, but a small number of schools use VP technology for enhancing teaching of physical exam skills.

There is limited literature on Canadian medical school practices regarding the utilization of different types of patients in teaching and assessment in the first two years of medical education. A national survey was designed to assess current practices of the utilization of SPs (Standardized Patients), PVs (Patient Volunteers), RPs (Real Patients) and VPs (Virtual Patients) for teaching and assessment of clinical skills at the pre-clerkship level across Canadian medical schools. Results indicated that across Canada all patient types are utilized for teaching pre-clerkship students. SPs clearly play a significant role in clinical skills teaching and assessment, while PVs and RPs are utilized in much greater proportion to VPs. VPs are currently a small component of clinical skills education. Finding the best choice for the student will likely involve combining all modalities. The results of this survey demonstrate the complexities of decision making for patient resources across Canada.

Abstract

• A cross-sectional survey of all 17 medical schools in Canada was conducted in 2012-2013 after obtaining institutional research ethics approval from the University of Toronto.

• Survey Development was an iterative process involving many steps and stages to arrive at a purposeful sample of 17 respondents. Data collected from the pilot survey was presented in November 2012 at the AFMC Clinical Skills Interest Group Meeting where 13 medical schools attended. Extensive feedback was received at the meeting, and patient type definitions for the survey were agreed upon by consensus by the AFMC clinical skills interest group. The final survey instrument was sent to one representative (point person) from each school. For the purposes of this survey four different patient types were defined: SP, PV, RP and VP. Definitions for terms were provided for each corresponding section in the survey instrument. (See Glossary Terms).

Methods

Across 17 medical schools, SPs are the modality most often used for teaching (75% of respondents) and assessment (85% of respondents) respectively. The table illustrates a summary of all patient types used to teach and assess the different types of clinical skills such as interviewing and history taking, and communication skills in pre-clerkship curriculums.

Results

Discussion

Conclusion

Utilization of patient resources in teaching and assessment of pre-clerkship clinical skills in Canadian medical schools

Across Canada all patient types are utilized for teaching pre-clerkship students. SPs play a significant role in clinical skills teaching and assessment, while PVs and RPs are utilized in much greater proportion to VPs. VPs are currently a small component of clinical skills education, but this may change with the increasing financial pressures on medical schools. Determining the best choice for the student will likely involve combining all modalities. This survey demonstrates the complexities of decision making for patient resources across Canada. No one school is utilizing only one patient resource type for all clinical skills teaching and assessment. These survey results are a national baseline for patient resources in Canadian medical schools in 2013. As curricula change towards earlier clinical exposure the demand on patient resources with more patient experiences will need to be integrated into pre-clerkship. Alongside these challenges will be implications for medical schools in choosing the best possible approach amongst the different patient types. The literature has not demonstrated any clear superiority of one patient type over another (Hudson, in press) so the schools will need to continue to make educational and business based decisions which include accessibility, availability, capacity which include local knowledge, skills and ability and financial impact.

The last twenty years in Canadian Medical Education have yielded significant changes in patient experiences for pre-clerkship medical students. At present and into the future, competition for diminishing resources will result in individual Canadian schools seeking effective and efficient models in their local utilization of patient resources for pre-clerkship medical students’ learning. This poster addresses a broad survey with informative results with significant implications for medical schools in their patient recruitment and utilization in the pre-clerkship years.

1-Recommendations for Clinical Skills Curricula for Undergraduate Medical Education. Task Force on the Clinical Skills Education. Association of American Medical Colleges 2008

2-Barrows, H (1993). "An overview of the uses of standardized patients for teaching and evaluating clinical skills". Academic Medicine 68 (6): 443–453

3-Teaching tips: working with patient resources in clinical skills teaching; accepted for publication Canadian Family Physician, Hudson. J; Ratnapalan S.

4-http://trilliumhealthpartners.ca/volunteers/Pages/Patients-Playing-a-Part.aspx5-Nestel, D., Layat Burn, C., Pritchard, S., Glastonbury, R., Tabak, D. “Viewpoint: The use of

simulated patients in medical education” AMEE Guide 42; 20116-Nestel D, Tabak, D, Tierney, T, Layat Burn, C, Robb, A, Clark, S, Morrison, T, Jones, M, Ellis, R,

Smith, C, McNaughton, N, Knickle, K, Higham, J and Kneebone, R. Key challenges in simulated patient programs: An international comparative case study. BMC Medical Education. 2011;11(69).

7-http://www.arthritis.ca/page.aspx?pid=10008-Anderson (1994). Growing use of standardized patients in teaching and evaluation in

medical education.9-AAMC and HHMI 2009. Scientific Foundations for Future Physicians:

http://www.hhmi.org/grants/pdf/08-209_AAMC-HHMI_report.pdf

References

The authors thank Dr. Jodi Herold for her assistance in designing the survey and supporting the project and the following people who were the point persons for the Canadian Survey: Laurie Mereu, Ari Shali, Donald Boudreau, Bernard Martineau, Maria Goodridge, David Wong, Julie Theriault, Karen Klym, Christine Dipchand, Henry Averns, Jacques Abourbih, Meredith McKague, Mal Kaminiska, Christopher Leighton, Barbara Power, Christian Bourdy, and Matt Petrie. Diana Tabak.

Acknowledgements

Standardized or Simulated Patient (SP): are individuals who are trained to portray a patient with a specific condition in a realistic, standardized and repeatable way (where portrayal/presentation varies based only on learner performance). SPs can be used for teaching and assessment of learners including but not limited to history/consultation, physical examination and other clinical skills in simulated clinical environments. SPs can also be used to give feedback and evaluate student performance. SPs are paid for their time.

Patient Volunteer (PV): is an individual from the community who volunteers to be a patient for medical education purposes. They are not trained or standardized. They may or may not have a medical condition that is specific to the educational session.  These individuals may be reimbursed for expenses or paid a small stipend.

Real Patient (RP): is an individual who is already coming for medical care in the hospital or clinic.  Pre clerkship medical students are not part of the treatment team but may see these patients as part of their medical education.

Virtual Patient (VP): this term is used to describe interactive computer simulations used in health care education.

Glossary Terms

University of AlbertaMcMaster UniversityMcGill UniversityUniversité de SherbrookeMemorial University of NewfoundlandUniversity of TorontoUniversité LavalUniversity of ManitobaDalhousie UniversityQueens UniversityNorthern Ontario School of MedicineUniversity of SaskatchewanUniversity of CalgaryWestern UniversityUniversity of OttawaUniversité de MontréalUniversity of British Columbia

Institutions Involved

Proportionate amount of time patient resources are used for teaching and assessing.

Proportionate amount of time patient resources are usedTEACHING history taking/

interviewing skills

Standardized Patient Patient Volunteer Real Patient Virtual Patient

Proportionate amount of time patient resources are used for

ASSESSING communication skills

Proportionate amount of time patient resources are used for

ASSESSING history taking/ interviewing skills

Proportionate amount of time patient resources are used

TEACHING physical exam skills

Proportionate amount of time patient resources are used

ASSESSING physical exam skills

Patient types used by medical schools (percent of respondents)

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