The use of simulated clinics as a response to reduced placement length
Creators: name: Kendall, Cameron
name: Manley, Liam
name: Sumaiyah Al-Aidarous
name: Fahmida Miah
name: Bomphrey, Lucy
Publisher: name: F1000 Research Limited
Year: 2024

description: <b>Background</b><br>
The Medical Licencing Assessment will be introduced for all UK medical students in the 2024/25 academic year. Due to a historical variation in the timings of final exams between medical schools, several have condensed their curricula in the early clinical years in response. This has resulted in shorter clinical placements, covering similar amounts of content to previously, with reduced time available for formal teaching.<br>
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In addition to shorter placements, the number of both medical students and medical schools have increased in the UK. An increase in both the number of student cohorts and group size have resulted on additional strain on teaching resources, with teaching having to be spread across all student groups.<br>
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In response to this, we developed a series of simulated clinics for fourth-year medical students on five-week specialty medicine and surgery placements at Walsall Healthcare NHS Trust.<br>
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<b>Summary of Work</b><br>
To maximise content delivery, we designed simulated clinics with three to five individual clinical encounters. Each clinic focused on a specific medical specialty within the students’ curriculum including ranging from dermatology to ENT. Students were asked to undertake pre-reading. Simulated encounters lasted 15-20 minutes and varied from first presentations to counselling patients, covering key topics from the specialty focus. Each encounter was facilitated by a Clinical Teaching Fellow (CTF), who assisted if students were struggling.<br>
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Patients were roleplayed, with modern moulage techniques employed for recreating visible signs. Students rotated through the encounters in pairs to enable social learning and reduce the pressure on individuals. Following each encounter the facilitating CTF would discuss the case further with participating students, evaluating their understanding of the topic areas.<br>
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At the end of each clinic a structured group debrief was facilitated by CTFs, addressing gaps in understanding identified. This was student centred and student led, with the discussion focusing deeper on extra content depending on student need. Where significant gaps existed, additional, targeted small group teaching could be arranged.<br>
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Each simulated clinic was designed to supplement students' clinical encounters and run alongside complementary, traditional, small group teaching sessions.<br>
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<b>Summary of Results</b><br>
Feedback was collected over a six month period with 58 responses. Student feedback for all sessions was overwhelmingly positive. Students particularly appreciated the range of content covered and high yield nature of the session. The interactive nature of the sessions was praised by students, with them commenting that this teaching modality was more engaging than traditional teaching methods. Students also commented on the utility of the simulations in identifying gaps in their knowledge without feeling as though they were being assessed. <br>
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<b>Discussion </b><br>
Simulated clinics are an effective and efficient method of teaching a breadth of topics. Their simulated nature allows for non-technical skills to be developed as well as covering core medical curriculum content. The use of simulation and inclusion of focused debriefs with the structure of the session requires experienced clinical staff with educational training. Though individual sessions appear resource intensive, over an extended period they are an effective and method of teaching a breadth of topics.<br>
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Through identifying deficient areas in student understanding they allow for the efficient planning of future teaching and learning. They are a useful tool in responding to the constraints on placement timings resulting from regulatory changes.<br>
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<b>Take-Home Message</b><br>
Simulated clinics enable students to consolidate learning from clinical experiences and self-directed study. They allow for evaluation of students’ learning needs, enabling educators to directly address these.