Learners (Students, Residents, Fellows)
What to Expect in the Clinical Skills Center
The Clinical Skills Center consists of 16 exam rooms in four suites (308, 310, 320 & 322) located on the 3rd floor of the medical school building. Each suite has a central small group/debrief room and 4 exam rooms equipped as a doctor’s office or clinic exam room might be.
Professional (attire appropriate for seeing patients) and a clean, white coat are required for seeing patients in the Clinical Skills Center. Scrubs are not allowed. Bring your stethoscope with you!
Equipment & Supplies
Each exam room is equipped with an ophthalmoscope/otoscope/BP/thermometer wall unit. Tongue blades, cotton swabs, cotton balls, tuning forks, a reflex hammer and gloves are standard supplies in each room. Unless otherwise instructed all you’ll need to bring with you is your stethoscope.
Standardized Patients (SPs) are frequently used in the Clinical Skills Center. An SP is a person who has been trained to portray a patient with an illness or medical condition and to do so in a standard, reproducible way with each learner. Working with SPs presents a unique opportunity to practice various clinical skills in a safe, controlled environment without having to worry about potential harm to a patient. SPs can also provide you with objective and unbiased feedback.
Standardized Patients have been trained to expect the same treatment from you as if they were an actual patient (with a few exceptions) and they will interact with you accordingly. They are highly realistic and most clinical experiences will be indistinguishable from a real clinical experience.
Interacting with Standardized Patients
The SP will always be in character from the time you meet him/her until the entire interaction is over. Most often they will play a patient you are meeting for the first time. You are yourself – a medical student or PA student or whoever you really are. Your roles will be clearly defined in the instructions you receive about specific events.
Even during feedback the SP will be speaking to you as your patient, albeit a particularly informed and educated patient. When the SP is portraying a patient who is in great pain or distress or who is altered in some way, you can expect their condition to improve sufficiently for them to deliver cogent, relevant feedback appropriate to the interaction.
Encounters with Standardized Patients
A typical encounter with an SP may involve interviewing, counseling, examining and/or treating a patient in the same manner as would occur during a regular clinic encounter. However, unlike many student experiences, there is no team or attending to consult with. You will need to commit to a diagnosis (or differential) and plan without use of any resources, human or otherwise. In these encounters, it is up to the student to decide what questions need to be asked and what body systems need to be examined.
Most encounters in the Clinical Skills Center are recorded and an automated software program called Learning Space runs the recording equipment. Because this software is programmed ahead of time students cannot switch places with peers. Because the software starts every event precisely on time, if you are late, the event cannot be delayed for you – you may start whenever you arrive and you will have whatever time is remaining in the timeslot. Arriving late may also mean that you will miss important information given in the event orientation.
Clinical Skills Exams
The Clinical Skills Exam (CSE) is an objective assessment of clinical skills typically involving multiple cases. CSEs can be found throughout the curriculum. The medical students participate in a CSE at the end of foundations and applications and as a part of certain clerkships (junior medicine, psychiatry, surgery and emergency medicine).
Physician assistant, physical therapy and genetic counseling students have CSE’s at various points throughout their curricula.
Cases and checklists are developed by faculty and clinical staff and are typically based on real cases they’ve been involved with.
Feedback may come from faculty, SPs, both or neither. It may be verbal and/or written depending on the objectives of the event. Not all events will involve feedback.
SP feedback typically focuses on bedside manner, communication skills and how the encounter made the patient feel.
Faculty feedback typically focuses on the medical aspects of the encounter – history taking, physical exam skills, medical knowledge and critical thinking.
Verbal feedback, either from the faculty or SP, will be delivered in the exam room following the encounter. Checklists—written feedback—allow faculty and SPs to score a student's performance in various categories.
Tips for a Successful SP Experience
- Be yourself – you are not being asked to portray anyone other than you!
- The sooner you can forget that you are being observed and the sooner you can immerse yourself in the experience, the better you will do.
- Interact with the SP as you would with any other patient with the following exceptions: refrain from conducting corneal reflexes, breast, pelvic, rectal or male GU exams. You may examine axillary or inguinal nodes, examine the PMI and examine the femoral pulse.
- Let yourself believe your physical exam findings. Don’t make the mistake of thinking that because these are SPs their physical exams will be normal. There are many SPs with abnormal physical findings – some incidental and some related to the problem they are portraying. In addition, many abnormal findings can be simulated. There is even a special stethoscope that allows us to simulate abnormal heart & lung sounds!
- Remember LOCATES!
- Really examine your SPs – don’t just go through the motions. You are being assessed on your physical exam skills so if you are just going through the motions, you probably will not do the maneuvers precisely and correctly.