Best Practice 1 (2023-2024)
Title: DMIHERs Standardized Patient Program (SPP), infused by Mayo clinic, for teaching clinical skills & reasoning to trainees in Health professions.
The context that led to initiation of practiceTraining in Health Professions necessitate uniform inculcation of clinical skills and competencies that are pertinent for health care and practice. Every learner must get equal opportunity to practice in a safe and controlled learning environment to gain mastery over essential clinical skills and knowledge in real life settings. Hence, the use of simulation has become widespread in health professions and is evidenced to have a significant impact on inculcation of desired clinical and professional skills amongst health professions trainees.
Standardized and Simulated patients (SP) are two such simulation based teaching learning approaches, as described below:
Simulated patients: Simulated patient is a lay person who has received training to portray an amalgam of different clinical scenarios including history taking, physical examination, and communication skills. A simulated patient cannot be recognized and discerned by an expert if appropriately trained. When we use the term simulated patients, we are more implicitly directing the participant towards the role of a patient or an acting role or a kind of role play.
Standardized patients: Standardized patient is a real patient who has been directed to use his/her own history and physical exam findings to participate in the education of medical/health sciences students. The term standardized patient is defined as a person with his/her own medical problems (history and physical exam findings) or a real patient who has been coached to depict a specific medical case or play the role of a patient.
In both cases, simulated/standardized are the persons who are trained to act like a patient with a specific clinical condition in a standardized way (they give a consistent presentation which does not vary from student to student) and can be effectively can be used for teaching and assessment of history taking, clinical/physical examination, consultation, professionalism, vernacular language, in simulated teaching environments or in situ. They can also coached to give feedback and evaluate student performance.
Objectives of the practice:
- To offer ethical ground for practice of clinical skills and multiple opportunities to practice those skills in a safe and controlled environment.
- To foster clinical skills (History taking skills, procedural skills, physical examination, clinical reasoning skills etc.) in an Indian Health Professional Graduate.
Process:
Goal: To ensure equal opportunities for learning of core clinical competencies and combat contextual paucity of clinical material.Aim: The aim of introducing Standardized patient in skill training is to ensure equal learning opportunity of core clinical competencies to every learner in a safe and controlled setting.
In order to offer uniform and multiple opportunities for clinical training, SP based training in history taking, physical examination, clinical reasoning, critical thinking, problem solving , team skills, inter-professional skills and clinical judgment was initiated at DMIHER for trainees in graduate and postgraduate level in faculty of Medicine, Dentistry, Nursing, Ayurveda, Physiotherapy and Nursing. The SPP lab is established under guidance and as per protocols of Mayo Clinic. The instructors are trained by Mayo and and all the learning modules vetted by the team of experts at Mayo clinic.
The practice has been consolidated in all HP faculties and has ensured that every learner practices in a safe and controlled environment for mastery over essential clinical skills. It can also serve as a pre-requisite to obtain training in a real life clinical setting. The given strategy was adopted for training and assessment purposes, as stated below; Teaching learning: Defined curricular hours of SP based training in Simulation lab and during Clinical rotations
Assessment: SP based assessment of Long case, Short case and Objective Structured Clinical examination (OSCE)
The first step of the process is to identify clinical competency which will be taught on SP. The script of SP is designed revolving around the said competency. The script is first written in English and then translated in vernacular language for learners to understand, comprehend and communicate in local language with the patients. Once the script is validated, the chosen SPs are coached by the subject expert to mimic that clinical condition in a standardized way. As per the slots allocated in Time table, the students are posted in SPP lab where they are taught such clinical competencies by the subject expert. Later the student is assessed on the same clinical competency by direct observation of SP learner encounter. During the learning session with SP, the SP presents case history in response to questioning by the student, undergoes a limited physical examination at the student's direction, assists students in developing their communication & clinical skills and assist students in working through difficult emotional situations in a safe environment.
Training through SP is implemented as a part of Structured Self Directed Learning (SSDL) sessions, starting with classroom teaching - training in skills lab on SP – Hospital based training finally culminating in community based training, as depicted in the diagram below :
The number of clinical competencies which are taught on SP, faculty-wise and professional year wise, are as follows;
| Faculty | Year | Total Number of Competency Year Wise |
| Medicine | 2nd year | 2 |
| 3rd year | 1 | |
| MBBS Final Part I (3rd Year) | 6 | |
| MBBS Final Part II | 4 | |
| JR 1 | 2 | |
| JR 1 | 2 | |
| 1 | ||
| 2 | ||
| 4 | ||
| 4 | ||
| 2 | ||
| 2 | ||
| JR II | 5 | |
| 2 | ||
| 2 | ||
| 1 | ||
| 1 | ||
| JR III | 1 | |
| Dentistry | III BDS (UG) | 2 |
| 1st year (PG) | 3 | |
| Ayurveda | Second BAMS (1st Sem) | 1 |
| Final BAMS | 1 | |
| JR 1 | 2 | |
| Physiotherapy | Final year | 4 |
| JR 1 | 6 | |
| Nursing | Sem - I | 1 |
| Sem - V | 4 | |
| MSc Nursing 1st year | 2 | |
| 1st year PBBSc. | 2 | |
| GNM | First year | 1 |
| Second year | 2 | |
| ANM | First year | 1 |
Outcomes and Impact of Practice
- Partnered with prestigious institutions like MAYO Clinic to establish the practice as per global standard.
- A pool of 52 standardized patients have been recruited and coached by subject experts to simulate medical conditions.
- 34 SP based training modules are designed and being utilized for TL purposes.
- The practice has helped in fostering tangible skills (procedural skills, physical examination) and intangible skills (communication skills, professional behavior and interpersonal relationship) in the Learner significantly.
- 100% students of all professional years in faculty of medicine, dentistry, ayurveda, nursing and physiotherapy are taught chosen clinical competencies on SP.
- It has offered an ethical ground for practice of clinical skills and multiple opportunities for practice in a safe and controlled environment.