Rehman Medical College (RMC) was founded with the mission of producing excellent doctors who are equipped with the most contemporary knowledge in the field of medicine, both in theory and in practice. The clinical skill center (CSC) was developed keeping the same notion in mind. The CSC at RMC is equipped with all the facilities that can help students learn and master the skills needed to interact effectively with patients. These include instruments used on a daily basis in wards to state of the art manikins that help students understand complex processes like auscultation for normal heart sounds and murmurs, doing CPR and different obstetric and gynecological procedures.
What makes our CSC stand apart from others are the ingeniously designed models that are crafted in our own workshop. Students practice processes like suturing wounds, giving injections, giving episiotomy and many more on these models.
Over the years a bank of videos and checklists of various clinical skills has been developed to help students prepare for the OSCEs. Relevant videos are selected from online resources and can be made in the studio present in the CSC as well. To help students use the CSC to its maximum, there is a dedicated faculty of highly trained and motivated doctors who are always present in the department to deliver teaching sessions and guide the students if they decide to use the facility in their spare time.
Furthermore a Cardiac First Response (CFR) course is arranged yearly for third year MBBS students. The course is delivered by an expert team led by Dr Noman from Ayub Medical College. This year three students scored 100% marks and majority scored above 90% marks in the assessment conducted at the completion of course. According to Dr Noman, this was the best performance by students of any medical college that he has trained till date.
The CSC was established and fully operational at RMC when there was no concept of such a facility at any other medical college in Pakistan. This shows the adherence of RMC to its vision of producing theoretically sound and practically safe and expert doctors.
The CSC has a crucial role in medical education and it is to support the acquisition of skills through hands-on training, in a non-threatening environment. The training here ensures that all the students have equal learning opportunities to gain sufficient practice. As they know that any mistakes committed here will not cause harm to patients, makes them confident and competent. Many studies1,2have linked better patient outcomes to simulation-based medical education.
Today, the medical students, are 'technology-enabled' and computer literate and their response towards training in skill laboratory is very encouraging and this drives us to further improve the teaching resources in the CSC. Students start going to the skill laboratory right from first year to learn the application of theoretical knowledge of basic sciences, which they are taught in lectures. So, CSC can be seen as a bridge that links cognitive knowledge and psychomotor skills.
The Department of Medical Education and the faculty of CSC is always striving to keep the curriculum and facilities updated and at par with the international standards. Many RMC graduates who want to take PLAB and USMLE also utilize our resources to prepare for the exams. So, it only makes sense that we start preparing our students right from their induction in MBBS not only for the internal and final exams but to compete with international students as well. Keeping this rationale in mind, the CSC curriculum undergoes periodic up gradation. Recently, a “Spiral” approach was adopted. A spiral curriculum indicates integration of curriculum in its most “Ideal” form indicating both horizontal and vertical integration across time and discipline1.
New topics are added as students advance in their academics and specialties are added in their MBBS curriculum but certain procedural skills like history taking and doing general physical examination are repeated with the addition of more knowledge and complexity. The advantages of this model are stated to be heightened reinforcement of topics through a natural progression of information from simple to complex and prevention of procedural decay that occurs if content is not revised for a certain period of time. The General Medical Council (GMC) of UK, the Australian Medical Council (AMC)and the Liaison Committee on Medical Education (LCME) support the effectiveness of spiral curriculum2.
In addition to teaching clinical skills, the CSC has also included advanced communication skills like breaking bad news and counseling of patients with chronic diseases in its curriculum. This has been included in medical curricula all over the world. Establishing effective communication between a doctor and patient is the key to compliance with treatment and patient safety3.
A flipped classroom approach has recently been adopted whereby learning resources like a video, article, accepted protocols for a certain procedure or a chapter from manual of clinical skills is e-mailed beforehand to the students with the help of the IT department. It is expected that students come prepared with the theory behind the skill and have gone through the resource material so that maximum time is spent on performing the skill by each student.
The CSC works under the supervision of the DME and has a well-defined organogram. It is made sure that a constant number of teaching and non-teaching faculties is always maintained for the smooth and effective working of the department. Since teaching sessions are conducted in small group formats, at least two facilitators are engaged in one session for close interaction with the students. Properly trained simulators are part of the staff and they help students understand and learn the communication strategies in accordance with the provided checklists for the topic of the day.
Empathy is an important attribute of a good doctor. A cross-sectional study was conducted by
Dr Nazish Bilal in charge of the CSC involving students from second and final year MBBS students to see if they lose or gain empathy as they are exposed to the clinical rotations. Another aim was to see if students of both the years have the same perception of empathy. Student’s version of Jefferson Empathy Scale was used. The results were analyzed using the SPSS software.
The results of the study showed that although, students from both the years showed the same levels of empathy but their definition of it were different from each other. Students from pre-clinical year defined empathy as doctor-patient relationship however final year MBBS students defined it as having just the right concern. There were no significant differences in the overall scores of male and female students but they scored differently on various questions of the questionnaire.
The administration of RMC is very keen on keeping the CSC updated and equipped with all the latest equipment so that the students can gain maximum benefits from it. The facilities available in the CSC can be divided into human and non-human resources.