Michael A Barone, MD - Johns Hopkins University School of Medicine; Robert A Dudas, MD - Johns Hopkins University School of Medicine
Background: The AAMC recommends a longitudinal and developmental clinical skills curriculum. All medical schools have clinical skills instruction early in the curriculum but many lack explicit clinical skills instruction during the clerkship years. We developed the simulation-based PRECEDE (PRE-Clerkship EDucational Exercises) curriculum to address this need.
Objectives: Learner objectives included performing the key elements of: taking a pediatric history, establishing rapport with patients/families, gathering sensitive information from adolescents, interpreting pediatric vital signs, performing physical examinations of neonates and children, interpreting cardiac murmurs, providing initial resuscitation during respiratory distress, performing lumbar puncture, urethral catheterization, phlebotomy and IV placement. Program objectives were to deliver standardized clinical skills instruction at set times in the clerkship thus allowing students to further develop skills in their experiential learning on the wards and clinics.
Program Methods: Fundamental skills were taught during 3 days preceding the clerkship and advanced skills were taught during 2 days at the mid-point. Eight workshops were created; neonatal examination, well child care interviewing, HEADSS assessment, ear examination, evaluation of febrile neonates, cardiac murmurs, respiratory distress, physical examination of school-aged children and clinical reasoning. Workshops used multiple modalities; standardized patients, volunteer pediatric outpatients, partial task trainers, and high fidelity simulation.
Results: This series of workshops was delivered to 123 medical students. For each of the workshops, >97% of medical students agreed their skills increased and the session improved their ability to function on the wards/clinics. Summative student evaluations demonstrated that >98% of students agreed the workshops made them more confident, taught them useful clinical skills, and increased their ability to function in the clinics/ward. The overwhelming majority of students (>98%) stated the tradeoff of less clinical time on the wards/clinics was worthwhile.
Conclusions: We successfully incorporated a 5-day series of simulation-based skills workshops into our clerkship. Students value these workshops as useful in building their confidence and increasing their clinical skills in pediatrics. We are currently evaluating the impact of this curriculum on performance on national standardized test results as well as performance on our institutional comprehensive clinical skills examination.