AAMC Conference

Nov, 2011

Pre-Clerkship Clinical Skills Courses

Review of the Literature

• What has been written regarding PCCS courses in general?

• What has been studied about PCCS courses?– What kinds of studies have been conducted?

• What, if anything, has been agreed upon in terms of curriculum and “best practices”?

Questions to be answered..

• Primarily U.S. Schools • 2000-present• Included Europe and Australia if PCCS were

addressed in the article• Included within the PCCS course lit review

– Professionalism – Communication– Clinical Reasoning– OSCEs– Particular PE – MSK, gynecological, abdominal

exam

Guidelines for literature search..

• Clinical skills in clerkships

• Physical Exam training in clerkships

• Professionalism as primary topic

• Overall curricular reform

• Curriculum integration not primarily involving PCCS courses

Exclusion Criteria

Challenges in SearchNumerous names of PCCS Courses

– Doctoring– Essentials of

Clinical Medicine– Intro to Clinical

Decision-Making– Introduction to

Clinical Medicine– Intro to Medical

Professions– Patient, Physician

and Society

– Patient-Doctor – Practice of

Medicine– Principles of

Clinical Medicine– Principles of Health

and Disease

• PCCS Course Curriculum Development/ Assessment– Surveys– Skills/Knowledge– Descriptive

• Teaching Professionalism in PCCS Courses• Specific Clinical Skills Acquisition• PCCS Courses/Skills as Primary Topic

– Commentary/position papers– Survey

Major Categories

Topics of focus Integrated and longitudinal communication skills acquisition Teaching students an integrated approach to interviewing Value of early patient contact and clinical experience Value of patient cases as foundational in PCCS education Identification of milestones/framework for teaching and assessing

clinical reasoning Integration of primary care into PCCS curriculum

PCCS Course Curriculum Development/Assessment

• Importance of longitudinal/stage-appropriate professionalism curriculum

Professionalism in PCCS Course

• Musculoskeletal Examination

• Pain Assessment and Management

• Pelvic Exam

Specific Clinical Skills Acquisition

PCCS Courses as Primary Topic

TOP 5

• 1. Establish consensus on what specific clinical competencies a student should have mastered prior clerkships• Prioritize which clinical skills are important at

what level– What are the criteria for a “core” skill?

• Identify milestones for teaching and assessing clinical skills

2. PCCS courses do make a difference in clinical skills – how much?

– Performance– Confidence – Preparation

3. Clinical skills is a “dying art” – redefine and resurrect – Reconcile clinical skills with technology (the

“other” hidden curriculum)– Recognize that clinical skills in ambulatory

settings may require a more refined skill set– Reinstitute bedside rounds

• 4. Institutional support is crucial for the success of clinical skills programs– Adequate support and time for PCCS Course

Directors– Recognition of the role and work of faculty

preceptors– Protected time for faculty preceptors– Faculty Development- Yes, Faculty

Development!

5. Clinical skills curricula should be integrated across the continuum of medical education– Emphasis in pre-clinical years without building

on skills in the 3rd year creates learning void– Creation of longitudinal curricula

• Communication• Physical Examination• Clinical Reasoning

Future Plans..

• Expand literature search to include 1990s

• Incorporate different names for the PCCS courses in literature search

• Time of educational innovations and reform, including for PCCS

• Though numerous names and identities, core goals remain same

• Discussion today can add significantly to the literature

Take home points