Pre-Clerkship Clinical Skills Courses Review of the Literature

1. Pre-Clerkship Clinical Skills Courses Review of the Literature AAMC Conference Nov, 2011

2. Questions to be answered.. • 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”?

3. Guidelines for literature search.. • 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

4. Exclusion Criteria • Clinical skills in clerkships • Physical Exam training in clerkships • Professionalism as primary topic • Overall curricular reform • Curriculum integration not primarily involving PCCS courses

5. Challenges in Search Numerous names of PCCS Courses Patient-Doctor Practice of Medicine Principles of Clinical Medicine Principles of Health and Disease • Doctoring • Essentials of Clinical Medicine • Intro to Clinical Decision-Making • Introduction to Clinical Medicine • Intro to Medical Professions • Patient, Physician and Society

6. Major Categories • 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

7. PCCS Course Curriculum Development/Assessment • 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

8. Professionalism in PCCS Course • Importance of longitudinal/stage-appropriate professionalism curriculum

9. Specific Clinical Skills Acquisition • Musculoskeletal Examination • Pain Assessment and Management • Pelvic Exam

10. PCCS Courses as Primary Topic TOP 5

11. 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

12. 2. PCCS courses do make a difference in clinical skills – how much? • Performance • Confidence • Preparation

13. 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

14. 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!

15. 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

16. Future Plans.. • Expand literature search to include 1990s • Incorporate different names for the PCCS courses in literature search

17. Take home points • 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