OSCE Finest Practice Guidelines—Pertinency for Nursing Simulations

New York University School of Medicine

IntroductionThe ability to utilize the electronic health record (EHR) without compromising the doctor-patient relationship (DPR) is an essential skill of all physicians and trainees, yet little time is spent on educating or assessing learners on needed techniques. To address this gap, we developed a conventional OSCE station coupled with a simulated patient chart within the Epic program in order to assess our students' skills utilizing the EHR during a patient encounter.MethodsOf third-year medical students, 119 were given full access to the patient's simulated chart 24 hours in advance of their OSCE to review clinical data. During an in-person OSCE with a standardized patient (SP), students performed a focused history and physical, using the EHR to verify allergies and medications. Students completed an electronic patient note graded by faculty. SPs evaluated the students on communication and interpersonal skills with specific rubric elements. Faculty graded the students' notes to evaluate their expression of clinical reasoning in the assessment and plan.ResultsTraining SPs and faculty to assess students on EHR skills was feasible. After implementation of a comprehensive curriculum focused on EHR and DPR, there was a significant difference on EHR-related communication skills (M = 76.4, SD = 17.6) versus (M = 37, SD = 28.9) before curriculum enhancement t (117.9) = −12.4, p <.001.DiscussionThe EHR OSCE station provided a standardized method of assessing students' EHR skills during a patient encounter. Challenges still exist in the technological requirements to develop and deliver cases in today's EHR platform.

As the COVID-19 pandemic affected the ability to conduct in-person sessions to teach clinical skills, our medical school developed a curriculum to introduce first-year medical students to telemedicine visits, while also reinforcing their history-taking and clinical reasoning skills. All first-year medical students at Florida Atlantic University went through three sessions on telemedicine that began with a lecture, followed by a standardized patient interaction, then a small group meeting with clinical faculty. We assessed the sessions using survey questions on a 5-point Likert scale and additional narrative feedback. We also assessed students on a telemedicine objective structured clinical examination (OSCE) at the end of the semester and compared results to the previous year's same case done in person. Students overall found the sessions helpful for refining their history-taking skills and that the knowledge gained would be helpful in their future practices. They felt the online platform was a useful way to interact with patients, but had frustrations with technical difficulties. They also expressed a greater appreciation for the ability to perform an in-person physical examination. Students performed similarly on the OSCE station in person compared to virtual visits (mean score 93% vs 93.75%). Introducing telemedicine during a first-year medical school clinical skills course provides students with opportunities to refine their clinical skills while introducing a skill that will be commonplace in the postpandemic environment. This curriculum could be adopted not only during a time of necessary distance learning, but also continued as in-person education resumes.

AimsTo compare examiner and parental ratings of students undertaking a summative clinical assessment of history-taking and examination skills in a ward based setting.MethodsParents of patients participating in the 4th year...

Background Remote consulting has become part of the medical student clinical experience in primary care, but little research exists regarding the impact on learning. Aim To describe the experiences of General Practitioner (GP) educators and medical students in using student-led remote consultations as an educational tool. Method A qualitative, explorative study conducted at four UK medical schools. GP educators and medical students were purposively sampled and interviewed. Results Nine themes arose: practical application, autonomy, heuristics, safety, triage of undifferentiated patients, clinical reasoning, patient inclusion in student education, student–patient interaction, and student–doctor interaction. Discussion Remote consulting has become part of the clinical placement experience. This has been found to expose students to a wider variety of clinical presentations. Verbal communication, history-taking, triage, and clinical reasoning skills were practised through remote consulting, but examination skills development was lacking. Students found building rapport more challenging, although this was mitigated by having more time with patients. Greater clinical risk was perceived in remote consulting, which had potential to negatively impact students’ psychological safety. Frequent debriefs could ameliorate this risk and positively impact student–doctor relationships. Student autonomy and independence increased due to greater participation and responsibility. Pre-selection of patients could be helpful but had potential to expose students to lower complexity patients. Practice points Remote consulting confers unique educational benefits. Remote consulting can help develop history-taking and communication skills, as well as clinical reasoning skills. The psychological safety of the student and the supervisory risk of the tutor can be impacted by remote consulting, but frequent debriefs between the student and tutor can help mitigate this risk. Learning how to conduct remote, and face-to-face consultations is important in medical education.

Background: Good communication skills are essential components of physician-training. Effective communication between the doctor and the patient leads to better compliance, better health outcomes, decreased litigation, and higher satisfaction both for doctors and patients. The acquisition of communication and interpersonal skills is recognized and documented as a core competency for physician training in many countries. In the absence of proper training, Indian medical graduates often have less than adequate communication skills and the demand for formal training in this area has often been echoed. Aim and objectives were to know the attitude and ascertain the change in attitude, assess basic communication skills, ascertain the change in basic clinical communication skills (before and after training) and to impart training regarding communication skills by using different teaching learning methods to undergraduate medical students (third year).Methods: An interventional study was conducted using convenience sampling method. Assessment of attitude, communication skills and self-competence of communication skills was done using standardized questionnaires. Data analysis was done by using appropriate statistical tests.Results: Total 60 students participated in the study. The change in the mean scores of pre-training and post-training attitude, SEGUE (set the stage, elicit information, give information, understand patient’s perspective, end the encounter) framework score and self-assessment of communication competence scores were statistically significant before and after training.Conclusions: After training undergraduate medical students by using variety of effective training methods; their attitude towards learning communication skills changed positively and their basic clinical communication skills improved significantly.

Overview of the Geriatrics Curriculum In recent years, we have developed and strengthened the geriatrics curriculum through a deliberate process of specifying learning outcomes, identifying existing geriatrics content, designing and implementing new learning activities and resources, and assessing students’ geriatrics-related knowledge, skills, and attitudes. Further, recent changes in the curriculum governance structure ensure ongoing assessment and improvement of the geriatrics curriculum. The geriatrics curriculum now is fully integrated in required courses across all four years of the curriculum, providing a coherent and comprehensive program that prepares students to care effectively and compassionately for older adults. A unique feature of our curriculum is its focus on preparing students to improve the health of the state’s population, which includes a growing number of citizens over the age of 65. Approximately 40% of clinical teaching takes place in communities throughout the state, where students learn about caring for diverse populations in a variety of communities and health care settings. Curriculum Management and Governance Structure (see Figure 1)FIGURE 1. Governance StructureIn January 2002, the Curriculum Management and Policy Committee (CMPC) was established as the central body responsible for curriculum management and governance. The CMPC is chaired by the executive associate dean for medical education, who reports to the dean, and its members are the co-chairs of the three course directors’ committees and the associate deans for admission, student affairs, and educational development. The following committees report to and advise the CMPC and are the avenue by which the geriatrics curriculum has been integrated in the overall curriculum: Three course directors’ committees, one each for the first and second year, and one for the third and fourth years combined, are responsible for overseeing, coordinating, and improving the individual courses and overall curriculum for each year. The co-chairs of these committees are appointed by the executive associate dean for medical education. Each committee is composed of all of the course directors for the respective year(s). Ex-officio members include staff from the Office of Medical Education and student representatives. The director of the Program on Aging, as a second-year course director, is a member of that committee and also attends the first-, third- and fourth-year committee meetings. The Curriculum Advisory Board convenes quarterly to serve as a forum for all constituencies and stakeholders involved with the educational program for the MD degree, to share ideas about the curriculum, and discuss current practice, concerns, and plans. The director of the Program on Aging is a member of this committee. Two additional committees report to the CMPC and have supported the development of the geriatrics curriculum: The Faculty Advisory Committee on Educational Technology advises the executive associate dean for medical education on matters regarding effective selection and use of educational technology and information systems. Much of the computer-assisted geriatrics instruction has been facilitated by this group. The Whitehead Curriculum Committee, an arm of the Whitehead Medical Society (the student government), works to improve individual courses and the overall curriculum and serves as the liaison among students, student government, and the Curriculum Management and Policy Committee. Each year the two second-year students who are elected co-vice presidents for curriculum of the Whitehead Medical Society serve as co-chairs of the committee, which is composed of student representatives from each class, the co-chairs of the course directors’ committees, the executive associate dean for medical education, and the associate deans for student affairs and educational development. Whitehead representatives attend meetings of the course directors’ committees and Curriculum Advisory Board. The new governance structure has permitted organizational and administrative flexibility to manage and coordinate the curriculum and to react to a rapidly changing academic medical center environment to facilitate change if and when it is deemed necessary. The strengthening of the geriatrics curriculum has been and continues to be a critical focus. In addition to the overall curriculum governance structure of the medical school, the Geriatrics Curriculum Committee (GCC), centered in the Program on Aging, serves as a major force in the development of the geriatrics curriculum. The seven-member interdisciplinary GCC, chaired by the director of the Program on Aging, was created to remedy gaps in the geriatrics curriculum. The group’s accomplishments include: development of a comprehensive syllabus outlining geriatrics learning objectives and content that all medical students should master prior to graduation; thiswas done through surveying practicing physicians to determine the skills needed to work effectively with elders in the community and following guidelines from the American Geriatrics Society (“Areas of Basic Competency for the Care of Older Patients for Medical and Osteopathic Schools,” 1998); evaluation of existing geriatrics content and learning activities to assess where and how well these topics are taught in the curriculum; and implementation of educationally sound methods to address geriatrics components that may not be fully incorporated into the medical curriculum. Plans developed by the GCC are shared with the three course directors’ committees and the Curriculum Advisory Board via the Program on Aging representative. THE AAMC/HARTFORD GERIATRICS CURRICULUM PROGRAM Institutional Involvement in Curricular Change The John A. Hartford Foundation grant received through the AAMC in June 2000 provided the resources that allowed us to strengthen and build the geriatrics curriculum across all four years, expand our outreach to students interested in geriatrics medicine, and document those areas in the curriculum where geriatrics knowledge and skills were inadequate or lacking. Specifically, our goals were to increase (1) the exposure of all students to core geriatrics content to help ensure a sound knowledge base for practice, (2) the number of opportunities for student exposure to older adults to support empathic practice, based upon an appreciation of normal and successful aging as well as its challenges, and (3) educational experiences to engage students in applying their knowledge and skills to solve complex problems in geriatrics medicine. These efforts were well received by faculty and students and resulted in increased visibility throughout the School of Medicine and increased awareness of the importance of geriatric medicine as an inherent component of core competencies. Both before and midway through the grant period, institutional involvement in curriculum change permitted even greater achievements in enhancing the geriatrics program. Prior to this, the Program on Aging had limited opportunities to make formal recommendations regarding medical school curriculum design and content, with virtually no active, authoritative role in the decision-making process. In 1999, the large and unwieldy First- and Second-Year Course Directors’ Committee was divided in two, so that each committee could focus exclusively on a single year’s curriculum. This promoted more intense and focused work on analyzing the curriculum and determining ways to strengthen it. In 2001, the dean appointed the Leadership Task Force on the Outcomes of the Medical School Curriculum, composed of nine department chairs representing both basic and clinical sciences. This committee was charged with describing the core competencies (learning objectives) to be achieved by graduating medical students and with revising the curriculum governance structure to promote efficient and effective decision making. The subsequent establishment of a set of core competencies and the reconfiguration of the governance structure (described above) resulted in major curriculum changes, with significant implications for expanding the depth and breath of geriatrics content throughout the four-year curriculum. The Second-Year Course Directors’ Committee transformed the second-year curriculum from separate courses generated by each department into integrated block courses focusing on organ systems. The committee also established both an introductory and a capstone block to begin and end the year, with each of these blocks using case-based learning with a strong geriatrics focus. Theme for the Geriatrics Curriculum The teaching mission of the Division of Geriatric Medicine and the Program on Aging is to build the capacity of UNC to prepare health care providers at all levels for evidence-based, outcomes-oriented health care for older adults and ultimately, to improve or preserve their level of function and quality of life. The major theme for the geriatrics dimension of the UNC medical school curriculum is twofold, to ensure (1) that the geriatrics curriculum is a recognizable and integral component throughout all four years of the medical curriculum; and (2) that students, faculty, and administrators recognize that the mastery of geriatrics competencies is most effectively achieved within an interdisciplinary system of care delivery that recognizes the interdependence of education; research; primary, subspecialty, and ancillary care; and public policy and regulation. The questions that must be addressed for each curricular activity are “How does this intervention affect the student’s acquisition of identifiable geriatric core competencies?” and “How does this intervention increase the student’s understanding and implementation of interdisciplinary team skills?” An additional theme is the commitment to recognize and encourage those students who have a particular interest in geriatrics and the potential to be leaders in the field, regardless of their subspecialty interest. Learning Outcomes for the Geriatrics Curriculum After completion of the enhanced four-year geriatrics curriculum, students will be able to describe age-related physiological changes, differentiate between normal aging and disease processes, demonstrate the problem-solving ability necessary to provide care to older persons, exhibit the professional qualities of integrity, compassion, thoroughness, responsibility, and commitment to caring for older persons, identify political, financial, and social factors that affect delivery of care, and recognize their own potential and that of their patients for subscribing to aging stereotypes. Special Programs Community partnerships Community partnerships play an essential role in fulfilling the university’s commitment to prepare professionals to meet the health care needs of North Carolina’s citizens. The Program on Aging facilitates student involvement in two partnerships that offer a variety of opportunities for work with older adults across the spectrum of geriatrics issues: The Program on Aging enjoys a strong and longstanding relationship with the North Carolina Area Health Education Centers (AHEC) program, a nationally recognized model for interdisciplinary education and training of health care providers. Several regional AHECs collaborate with us on innovative projects to ensure that there are community clinical training sites with well-qualified preceptors available to teach geriatrics knowledge and clinical skills. The Education for Lifelong Service (ELS) Program provides students with community service opportunities, complemented by a curriculum designed to foster leadership skills in service delivery. ELS has responsibility for the newly established Office of Community Service and sponsors courses on the care of underserved and vulnerable populations, including activities that emphasize services to older adults. Program on Aging representatives participate on the ELS leadership team. Standardized geriatric patients The UNC School of Medicine Standardized Patient (SP) Program, administered by the Office of Educational Development, gives students opportunities to practice communication and diagnostic and examination skills before they encounter patients in the actual clinical setting. In addition, the program provides a mechanism to assess these same skills in a standardized format. The program maintains an active database of SPs, including those who are suitable for presentation of geriatric illnesses and situations. Simulated case presentations using geriatric standardized patients are frequently requested for classroom learning, most notably in the first- and second-year Introduction to Clinical Medicine course, in second- year integrated cases, and as part of the fourth-year Clinical Performance Examination, which students must pass in order to graduate. Faculty development The Office of Educational Development provides several faculty development programs and activities in which geriatrics faculty participate and that help to strengthen the geriatrics curriculum. The Expert Preceptor Program, designed for practitioners in community-based clinical settings, is available in an online, interactive format known as the Expert Preceptor Interactive Curriculum. This is a self-paced program comprising modules that can be used individually as information resources or collectively as a complete curriculum. Each module focuses on a skill related to clinical teaching in the community practice setting or on strategies for teaching contemporary health issues. The Teaching Scholars Program is a year-long series of monthly seminars designed to promote expertise and scholarship in medical education for fellows and faculty. In addition, participants choose a specific area of educational interest to pursue in depth and present their results to colleagues at a symposium at the conclusion of the program. Completion of the program confers recognition as a scholar in medical education, and graduates are targeted for positions of leadership in the curriculum. Each year, ten teaching scholars are chosen from faculty nominated by their department chairs, with at least one participant from the Program on Aging. The Excellence in Teaching Series consists of monthly seminars and workshops focused on innovative approaches that enhance learning and instruction in medical education. These sessions provide a forum for participants to discuss practical approaches that facilitate and maximize student learning. The series is designed for faculty and residents who have responsibility for teaching in the classroom, lab, and/or clinical setting. Consultations on teaching and curriculum development issues are provided for individuals or groups of faculty as needed. Faculty and staff from the Office of Educational Development work closely with the Program on Aging to provide ongoing support for efforts to enhance the geriatrics curriculum. Student interest group The UNC Student Chapter of the American Geriatrics Society is a student-led organization for physicians-in-training who have an interest in geriatrics medicine regardless of intended area of specialty. The group focuses on ways to enhance the visibility of geriatrics issues at the UNC School of Medicine and to provide educational programs on geriatric medicine. For those students specifically interested in careers in geriatrics, the chapter seeks to develop leadership skills in geriatrics medicine by sponsoring interdisciplinary educational programs, encouraging research participation, and creating geriatrics-related community service opportunities. The leaders of this student group have initiated a one-hour orientation to geriatric patient care for first year students prior to their community week experience. (See the discussion of “Students’ Clinical Experiences” below.) Palliative care and end-of-life issues In the first year, the required Medicine and Society course provides multiple opportunities for exploration of the social aspects of aging in our society and in politics, as well as the economic factors affecting geriatrics health care. Students discuss various medical-ethical issues found most often among the elderly, e.g., palliative care and end-of-life decisions. In the second year, up to 20 students may select the seminar entitled The Good Death or the Good Fight: Ethnical, Legal, and Policy Issues in Medical Choices as their required humanities and social sciences seminar. A fourth-year elective course sponsored by the Department of Medicine specifically addresses palliative care and end-of-life issues. Palliative Medicine is a six semester-hour, interdisciplinary course taught by faculty from the Departments of Medicine (including a certified geriatrician) and Psychiatry; the Schools of Social Work, Pharmacy, and Nursing; and the Hospital Chaplaincy Office. Resulting Pedagogical Changes Program on Aging faculty promote the importance of teaching methods that encourage students’ active engagement in learning processes that are both self-directed and collaborative. One approach that has proven particularly effective is a merger of evidence-based and problem-based methods. Students are given a clinical vignette in which a patient presents with symptoms and complaints (a problem-based case). Students work in teams to define the problem and set priorities for self-directed (evidence-based) study. This approach is especially appropriate where students must understand the unique and complex presentation of common illnesses among older adults. Specific curricular enhancements include: The Introduction to Clinical Medicine course for first-year students (ICM-1), which devotes time for more in-depth presentations of topics that traditionally have not been an inherent component of the medical curriculum. When these “special topics” were introduced into the curriculum in 1998, geriatrics medicine was included as a three-hour roundtable discussion. Today, the day-long seminar on aging is a firmly established component of ICM-1. Through the AAMC-Hartford program, we further developed this activity to include a lecture and exercise on ageism and aging stereotypes. Strengthened geriatrics content in the following targeted first- and second-year courses: Psychiatry, Gross Anatomy, Immunology, Cardiovascular System, and Respiratory System. The success of this collaborative effort with individual course directors led to an invitation to participate in the design and implementation of the new second-year integrated curriculum. Other regularly scheduled, geriatrics-specific teaching opportunities for required first- and second-year courses. These include geriatrics assessment interviews with standardized patients, a polypharmacy component for the pharmacy course, a geriatrics problem-based case that addresses end-of-life issues, and geriatrics case exercises; they were developed for use in the new introductory and capstone block courses in the second-year curriculum. An interactive, Web-based geriatrics case exercise for the first-year Introduction to Clinical Medicine (ICM) course, which was developed, integrated, and titled “Meet Mrs. Jefferson.” A problem-based case, “Robert Waters,” was developed for the second-year ICM course. A “patient bank” of geriatric subjects for student interviews for the required first-year Medicine and Society course. Students are assigned two patients to interview in teams (two to three students per team). The assignment required recruitment of a significant number of patient-volunteers. Geriatricians from the Program on Aging assisted with recruitment, providing an additional opportunity to ensure a geriatrics component in course content. Additions of geriatrics content to the third-year family medicine, internal medicine, psychiatry, and obstetrics - gynecology (See “Students’ Clinical in below.) of the required fourth-year care to include two additional care geriatrics These two sites are in communities with the growing populations in the In addition to the required courses and activities the Program on Aging sponsors the following elective For years, the Program on Aging has sponsored a elective course, known as designed to provide first- and second-year students with clinical care of older patients in and care and opportunities for The Program the by groups of students to an geriatrics to make to older patients and to patients over an Geriatric Education Consultations provide a forum for students to with a master geriatrics clinical team to community-based sites for interdisciplinary with practitioners regarding complex geriatric patient issues. Students who are based in the community are often in with patients or family members and responsibility for case presentations and on geriatrics are through the Departments of Medicine and including in in Geriatric Health and and An to of Technology The School of Medicine that all first-year medical students a and that are specifically to ensure that all students have and to all resources needed for the medical school curriculum. Each student has a at or assigned and each lecture has as resources are and begin with the course that serve as the for course The first-year course students how to and research and build The Educational Technology provides faculty and staff with and to for curricular course directors with and provide expertise necessary to teaching resources to the classroom, the lab, and the clinical setting. This strong learning environment our commitment to evidence-based practice and learning, as in Pedagogical of the ways in which technology the geriatrics curriculum include use of an geriatrics case-based exercise in the Introduction to Clinical Medicine course, and providing students with the appropriate information resources needed to complete the case-based in the introductory and capstone block courses in the second year. Clinical in Geriatrics One and Two the first two years of the medical curriculum focus on students a in the basic the Introduction to Clinical Medicine course provides clinical experiences as Students are introduced to basic clinical skills on in sessions with faculty In addition, they in community-based care Students learn the complete and in the of a approach to care. Both in the classroom and their clinical in the students are to the spectrum of care, from to The Student Chapter of the American Geriatrics Society has initiated a one-hour week seminar for first-year students focusing on basic care issues common to older the internal medicine at least one of the required patient must focus on a patient or the obstetrics and gynecology each student is required to complete two of and two of and attend of and two of which address issues often in geriatric patients, e.g., and Students are responsible for case one of which must be of a patient age or The Geriatric and Management on the service is one of six students can choose to meet the This geriatrics clinical is available for six the academic year and can six students per Through the students learn clinical skills in the of among geriatric geriatrics content the family medicine among overall at least of patients by students are age or and on geriatrics issues are throughout the The required care has two newly established geriatrics-specific sites where students have clinical preceptors who are certified In the academic year students received geriatrics clinical training at these provide additional opportunities for fourth-year students to complete clinical geriatric One is a where the student is assigned to a variety of clinical to work with certified The second is a where the student works with a certified geriatrics to provide comprehensive and for specifically assigned In both the students are to focus on a specific area of interest. The and An clinical examination is used to assess students in the Introduction to Clinical Medicine course, faculty to and how well students specific clinical skills and Students through a series of patient For each the student is to a and a faculty the student’s using a assessment Standardized geriatrics patients are included in this of geriatrics content that is in the courses and is by including appropriate on the various and In with the and Course Directors’ Committee, the Office of Educational Development the Clinical Performance a assessment required of all fourth-year to patient in North the a patient that and medical problems most frequently in care in this geriatrics one to one third of the The is designed to ensure that relationship and communication skills, examination skills, skills, and management and assessment skills are across to Students a that provides a of each case, for each case, overall and skill In with the students are given a case-based geriatrics developed by the Program on Aging. For both the and the the Program on Aging works with the Office of Educational Development to ensure that core geriatrics competencies are included in the to the Program a of the success we have in geriatrics needs to the we are now with the for ongoing faculty teaching time and significant staff and expand our educational programs in all we must engage new faculty as well as who can a geriatrics component to the training they offer in their respective The success of the John A. grant has the for a comprehensive approach to geriatrics education. must to new ways to address the needs of at to assess the of new and to rapidly new information and methods to our Outcomes The recent of the second-year curriculum from courses to integrated blocks us an opportunity to more fully develop the geriatrics curriculum. The provides an for case-based learning the AAMC-Hartford had given new to geriatrics content, we were able to for additional case-based geriatrics The introductory block with a evidence-based case using a geriatric The case provided an opportunity to demonstrate how diagnostic information is used in patient care, to emphasize the of geriatrics care, and to students’ awareness regarding the of health care issues by this rapidly growing of the The capstone block focuses on two patient cases, one of which an Both are designed to multiple aspects of medical care that were addressed in Students work in groups to the including and and The of the curriculum governance system allowed for more Program on Aging involvement in curriculum Through committee the Program on Aging continues to new and from faculty to in and implementing geriatrics teaching resources and of The Program on Aging has achieved an level of visibility and within the School of Medicine and throughout all the and programs in the UNC Division of Health is a relationship with the Office of Medical Education and with individual course a commitment to ensure that geriatrics content and an integral component of required courses. available between 2000 and the staff time needed to collaborate with course directors and offer geriatrics-specific classroom and learning the two years, these course have and the Program on Aging has on all course directors’ committees and in curriculum design and The by the AAMC-Hartford allowed us to for additional from the is us both further expand the medical student curriculum and also build educational programs for and faculty, including community-based For further at

In summary it is essential that we improve our interpersonal and communication skills. We can learn and be taught better skills. We will be evaluated on these skills in the future, and it is important for us to establish ourselves as good role models for the future surgeons who will be entering our profession. It is of benefit to our patients and will give them a better understanding of their disease and elevate their level of healthcare. It is also important to us to help reduce our stress and to eliminate burnout. We can improve our interpersonal and communication skills in many ways. First we must be aware that there is a problem and recognize this as a problem that can be solved and that we do need to improve our current skills. This can be done through multiple educational tools such as lectures, videos, and self-assessments. The responsibility for this culture change ranges from top to bottom, but really begins at the bottom. It is important for all of us especially individuals such as myself, who is not only a practicing surgeon but also a surgeon in a leadership position, a surgeon who teaches medical students and residents, and a chairman who develops the careers of young faculty members. It is important for organizations such as the Southeastern Surgical Congress to recognize this need of our members and to conduct seminars, luncheons, and courses in helping us acquire better skills and also giving us some assessment of the current status of our skills. The American College of Surgeons has already addressed this issue by forming the Task Force on Communication and Educational Skills. Various examining boards have already incorporated this into requirements and expectations of future physicians and surgeons. We must establish ourselves as good role models. Being a good role model cannot be overemphasized. We are very fortunate in being good role models in medical knowledge and mastering phenomenal technical feats; however, this is not enough. It is also important that we also improve our interpersonal and communication skills. We must establish goals and outcomes for ourselves and work on ways of assessing these to ensure that we are effective in improving our skills. We must incorporate interpersonal and communication skills into our training programs, postgraduate courses, and all aspects of lifelong continuing education. Addressing the improvement of our interpersonal and communication skills will have many beneficial effects including improved patient outcomes, a better healthcare status for our patients, and a high level of confidence that patients have in us as physicians and surgeons. We do at times have a less than ideal collegial relationship with other disciplines in medicine. This faulty relationship needs to be rectified. We need to restore and maintain a high collegial relationship with everyone in medicine not only other physicians, but also nurses, paramedical personnel, and others. These changes will require a great deal of effort and will take some considerable time. Initially laparoscopic cholecystectomy and laparoscopic skills were not adequately learned but with recognition of its importance, education, and time, we became master surgeons. We are very fortunate to have residents and practitioners with superb laparoscopic skills that they acquired during their training and in structured postgraduate courses. Likewise it is important to incorporate interpersonal and communication skills into our training programs and our continuing medical educational programs. Finally, this is not just a touchy-feely issue, but it is one of surgical professionalism. It is critical for us to address this as an important issue since it will enhance the good qualities that we already possess. Let's start today. I have enjoyed this year being your President, and wish to thank you for the opportunity of addressing you this morning.

Background: Good communication skill is as crucial for the medical practitioner as medical knowledge for better patient outcome. Incorporating simulated patients for teaching communication skills and assessment can be beneficial for the learners as it gives them learning opportunities under a controlled environment. Objectives: 1. To assess the improvement in communication skills with the use of simulated patients after communication skills training. 2. To obtain feedback from simulated patients about patient satisfaction. 3. To obtain feedback from students and faculties about communication skills training intervention and simulated patients for assessment. Methods: After a thorough introduction and explanation of the study, out of total of 139 students from the fifth-semester bachelor of medicine and bachelor of surgery (MBBS), 44 students gave the willingness to participate. Students were divided into two groups of 22 students; one group acted as doctors, and the other group acted as a standardized patient group. Each simulated patient was randomly assigned to one doctor to make a pair; thus, 22 random pairs of doctor and patients were formed. Before and after giving communication skills training, each doctor-patient pair's consultation was analyzed for clinical communication skills using the Kalamazoo scale adapted version by trained observers. After each consultation, each patient was given a patient satisfaction questionnaire to fill. Results: In this study, students were improved significantly in each competency of the Kalamazoo scale after communication skills training. Before giving this training, the total mean communication skills score of students was 49.86 (SD=10.73), and after training, it significantly improved to 75.45 (SD=15.78) (P &lt; 0.05). Before the training, the mean patient's satisfaction score was 48.95 (SD=12.18), which significantly improved after training to 60.36 (SD=3.99) (P &lt; 0.05). Students as well as observers, found the Kalamazoo scale very useful for communication skills training and assessment. In feedback, they mentioned that the simulated patient approach for the assessment of communication skills was useful. Conclusions: This study showed that the clinical communication skills training with a structured scale was helpful for medical students. Students were found interested in learning such new skills; thus, clinical communication skills training should be an integral part of medical education. Simulated patients were found useful and can be used for the assessment of other clinical skills in medical education.

Accreditation of residency programs and certification of physicians requires assessment of competence in communication and interpersonal skills. Residency and continuing medical education program directors seek ways to teach and evaluate these competencies. This report summarizes the methods and tools used by educators, evaluators, and researchers in the field of physician-patient communication as determined by the participants in the "Kalamazoo II" conference held in April 2002. Communication and interpersonal skills form an integrated competence with two distinct parts. Communication skills are the performance of specific tasks and behaviors such as obtaining a medical history, explaining a diagnosis and prognosis, giving therapeutic instructions, and counseling. Interpersonal skills are inherently relational and process oriented; they are the effect communication has on another person such as relieving anxiety or establishing a trusting relationship. This report reviews three methods for assessment of communication and interpersonal skills: (1) checklists of observed behaviors during interactions with real or simulated patients; (2) surveys of patients' experience in clinical interactions; and (3) examinations using oral, essay, or multiple-choice response questions. These methods are incorporated into educational programs to assess learning needs, create learning opportunities, or guide feedback for learning. The same assessment tools, when administered in a standardized way, rated by an evaluator other than the teacher, and using a predetermined passing score, become a summative evaluation. The report summarizes the experience of using these methods in a variety of educational and evaluation programs and presents an extensive bibliography of literature on the topic. Professional conversation between patients and doctors shapes diagnosis, initiates therapy, and establishes a caring relationship. The degree to which these activities are successful depends, in large part, on the communication and interpersonal skills of the physician. This report focuses on how the physician's competence in professional conversation with patients might be measured. Valid, reliable, and practical measures can guide professional formation, determine readiness for independent practice, and deepen understanding of the communication itself.

Patient-centered interviewing and student performance in a comprehensive clinical skills examination: Is there an association?

The study endeavored to determine the frequency of the the fourth year high school students participation in role-play activities and the extent of the interpersonal skills in terms of risk-taking, team work, sense of responsibility, open-mindedness, confidence, and communication skills. It aimed to test the relationship between the use of role-play activities and the development of the student’s aforementioned skills. The study used the descriptive correlational design in research were a total of one-hundred and twenty fourth year students were chosen. The study identified that majority of the respondents participated in role-play activities three times or less in a week, and that, mostly done during the languages class and Values Education. Furthermore, open-mindedness was revealed to be highly developed in those students who participated in the role-play activities. Moreover, students’ communication skills are potentially enhanced through active involvement in these activities. The five other interpersonal skills appeared to be less developed. Then, debate was identified as the most enjoyable and group discussions and reporting was the least. In conclusion, it could be noted that the students’ participation in role-play activities in the classroom had helped them develop open-mindedness because they were open with their group mates and more willing to listen and accept varied inputs from one another. Keywords: Role play, Interpersonal and Communication skills

Purpose: Communication skills are considered as one of the essential requirements in medical education, and the training often involves exercising medical interviews with standardized patients(SP) or role play. This study investigated the helpfulness of the communication skills training programs for students’ performance on the clinical performance examination (CPX). Methods: Fourth-year students who have taken one of two communication skills programs(exercising communication skills with SP or elective communication skill course with role play) completed a questionnaire on their evaluation of the helpfulness of communication skills programs immediately after finishing the CPX. Then, the programs were objectively assessed by comparing all fourth-year students’ CPX scores between program participants and non-participants. Results: About 70% of participants answered that the programs were helpful to perform clinical clerkship and CPX. However, there was no difference in either the total CPX score or 2 categorical scores(integrated clinical encounter, communication and interpersonal skill) between program participants and non-participants. Conclusion: Although the students felt that the communication skills programs were helpful to their clinical activities, this study failed to find objective evidence of any effect of the programs on the CPX results. Communication skills training should be continued during clinical clerkship to maintain or enhance the skills, and it is necessary to introduce more effective methods for precise evaluation of students’ communication skills.

Background: The coronavirus disease 2019 (COVID-19) pandemic significantly impacted medical education. This study aimed to determine how COVID-19 affected students' opportunity to practice core clinical skills across specialty rotations and their self-perceived proficiency at performing these. Methods: Routinely administered surveys of fifth year medical student' experiences and perceptions of medical training from 2016 to 2021 were analysed. Number of times core clinical skills were performed and self-perceived proficiency of each skill were compared pre- (years 2016-2019) and during-COVID (years 2020-2021). Results: Data from 219 surveys showed a reduction in the opportunity to perform "a cervical screen test" (p<0.001), "a mental health assessment" (p=0.006), "assess the risk of suicide" (p=0.004) and "bladder catheterisation" (p=0.007) during-COVID. Self-reported skill proficiency was also less during-COVID for performance of: "a mental health assessment" (p=0.026) and "an ECG" (p=0.035). Conclusions: The impact of COVID-19 on mental health skills was greatest, potentially due to a shift toward telehealth services and consequent reduced ability for students to engage in consultations. In a time of potential long-term change in the healthcare landscape, it is imperative to ensure adequate opportunity to practice all core clinical skills during medical training. Inclusion of telehealth earlier into the curriculum may benefit student confidence.

The urgent need to enhance medical students’ clinical problem-solving skills even in the pre-clerkship phase ushered in several initiatives in the medical school curriculum. One of such initiative is the introduction of clinical presentation activities combined with patient encounter experience and community-based activities in the first year of medical school. The study described the design, implementation, and evaluation of a medical school curriculum that integrates clinical presentation activities with patient encounter experience and a community-based educational program. For the clinical presentation, a two-tailed, Student’s t-test showed a significant and higher performance in the summative assessments when compared with the formative assessment (P < 0.01). The KR-20 value for the reliability was between 0.69 and 0.92. For the patient interaction experience and community-based stroke education program, medical students demonstrated a significant (P < 0.05) higher perception of their experience in all assessment categories in the post-test evaluation. An integrated curriculum that allows students to directly interact with patients, families, and community members may add a positive context and engagement experience to make a difference in the education of future physicians.