Medical Students' Perception of Telesimulation Training: A Qualitative Analysis.

OBJECTIVES: Over the past 2 decades, simulation-based learning has become an essential part of medical training. Simulated clinics have proven to be effective for training medical students. Even so, this learning method presents organizational and financial challenges that limit its dissemination to all medical students, especially since the COVID-19 pandemic. Simulated teleconsultation retains the advantages of interactive simulated clinics while offering concrete solutions to the challenges faced. The project aims to explore students' perspectives on simulated teleconsultation training compared to simulated clinics in person. METHODS: Ten pre-clerkship students in the Faculty of Medicine at the University of Ottawa participated in interviews following in-person and teleconsultation simulated clinic sessions. The interview guide was developed based on previous work. The questions asked concerned experience with teleconsultation, interaction with the tutor and patient, practical or logistical obstacles, educational value and feasibility. The authors evaluated the results using a thematic analysis. RESULTS: The interview analysis showed that the tutor feedback received during the simulated teleconsultation was comparable to that received after the in-person simulated clinic. Although most of the students enjoy teleconsultation, they raised the challenge of carrying out physical examinations and creating a personal connection with the tutor/patient. CONCLUSION: Given the circumstances of the pandemic and students' comfort with technology, the new generation of medical students seems prepared to embrace teleconsultation. The themes identified in the analysis will enable the necessary adjustments to be made in order to optimize their teleconsultation training, an inextricable step in promoting the active offer of healthcare services.

Nomenclature of real patients in health professional education by role and engagement: a narrative literature review.

Research problem: Real patients living with a disease and engaged in the education of healthcare professionals are referred to by different terms. To address this, A.Towle proposed a draft taxonomy. Objective: Our objective is to extract from the literature the definitions given for the following terms: (1) patient educator, (2) patient instructor, (3) patient mentor, (4) partner patient, (5) patient teacher, (6) Volunteer Patient in order to clearly identify their roles and level of engagement. Methods: The literature search was carried out in Medline, CINAHL, PsychInfo and Eric by adding medical education or healthcare professional to our previously identified keywords to ensure that it is indeed literature dealing with real patients' involvement in the education of healthcare professionals. Results: Certain terms refer to real and simulated patients. Roles are more or less well described but may refer to multiple terms. The notion of engagement is discussed, but not specifically. Conclusion: Explicitly defining the terms used according to the task descriptions and level of engagement would help contribute to Towle's taxonomy. Real patients would thus feel more legitimately involved in health professional education.

Problème de recherche: Les patients vivant avec une maladie et qui sont impliqués dans l'éducation des professionnels de la santé sont désignés par des termes différents. Pour y remédier, A.Towle a proposé un projet de taxonomie. Objectif: Notre objectif est d'extraire de la littérature les définitions données pour les termes suivants : (1) patient éducateur, (2) patient instructeur, (3) patient mentor, (4) patient partenaire, (5) patient enseignant, (6) patient volontaire afin d'identifier clairement leurs rôles et leur niveau d'implication. Méthodes: La recherche documentaire a été effectuée dans Medline, CINAHL, PsychInfo et Eric en ajoutant l'éducation médicale ou le professionnel de santé à nos mots-clés précédemment identifiés afin de s'assurer qu'il s'agit bien de littérature traitant de l'implication des patients dans l'éducation des professionnels de santé. Résultats: Certains termes font référence à des patients ayant une maladie ou simulés. Les rôles sont plus ou moins bien décrits mais peuvent faire référence à plusieurs termes. La notion d'implication est abordée, mais pas de manière spécifique. Conclusion: Définir explicitement les termes utilisés en fonction de la description des tâches et du niveau d'implication permettrait de contribuer à la taxonomie de Towle. Les patients se sentiraient ainsi plus légitimement impliqués dans la formation des professionnels de santé.

[Clinical reasoning and simulation: facilitating hypothesis prioritization using simulated patients. Data from quantitative research]. / Raisonnement clinique et simulation : faciliter la priorisation d'hypothèses grâce aux patients simulés. Données d'une recherche quantitative.

Background: Prioritizing diagnostic hypotheses can be difficult for novice medical students given their limited clinical exposure. Simulated clinical reasoning (CR) clinics allow students to practice focused histories with a simulated patient (SP). The delivery of clinical data by SPs can influence hypothesis generation. Objective: This pilot study seeks to test whether the transmission of key elements through SP acting influences CR prioritization among medical students. Method: The diagnostic hypotheses of two cohorts of students of the same academic level were compared following a virtual interview with an SP. The SPs in the experimental group were given a targeted script and briefing on key elements while the SPs in the control group were given a traditional script and briefing. The difference between the distributions of frequencies of the hypotheses of the two groups was determined using the chi-square calculation. Results: The students in the experimental group prioritized expert-validated hypotheses more than those in the control group. The control group showed greater variability in their diagnostic choices. Conclusion: Targeting the delivery of key elements by SPs could be a way to help novice medical students prioritize their diagnostic hypotheses. Simulated CR clinics therefore become a space for learning about CR in the absence of clinical exposure. The risk of inducing premature closure of clinical reasoning needs further research.

Comparison of Clerkship Directors' Expectations of Physical Examination Skills with Point-of-care Ultrasound Skills Using the RIME Framework.

Background: The expectations of point-of-care ultrasound (PoCUS) in undergraduate clerkship at the University of Ottawa has not been described. We compared clerkship directors' expectations of physical examination skills with PoCUS skills, before and after completing the clerkship rotation. Methods: A pilot-tested, expert developed, bilingual on-line survey consisting of 15 questions was sent to all clerkship directors (23) in December 2019. The survey included questions regarding the expectations of medical students with respect to physical examination and PoCUS using the RIME Framework: none, reporter, interpreter, manager, educator. Results: The response rate was 60.9% (14/23). With regards to physical exam skills, 82.8% of directors had no expectations or expected students to be reporters when starting clerkship. At graduation, 77.5% of directors expected students to be interpreters, managers, or educators. For PoCUS, 100.0% of directors had no expectations or expected students to be reporters when starting clerkship. At clerkship completion, 33.0% of directors felt that students should be interpreters or managers for PoCUS skills. Conclusions: Clerkship directors have low expectations of PoCUS skills for entering and graduating clerks when compared with their physical examination skills despite formal pre-clerkship PoCUS objectives. Enhanced communication and targeted education of directors could improve the PoCUS curriculum.