First-year of study: The Clinical Skills Center is immersed into the first year of the curriculum by using trained standardized patients for the introduction of history taking skills, interpersonal communication skills including sensitive topics, physical exam skills, and overall patient assessment. Learned skills are then assessed during graded OSCEs and remediation sessions are incorporated as needed.
The Introduction to Clinical Skills (IDC, Spanish abbreviation) course provides students with the first simulated history and physical exam practices using standardized patients and real patients.
Among the activities using standardized patients are the following:
- The adult and geriatric interview
- The pediatric and adolescent interview
- System based physical exam practices: Mental status, Musculoskeletal, Cardiovascular, Thorax and lungs, Abdomen, Head, Eyes, Ears, Nose, Throat and Neck, Neurologic exams
Other activities using the high-fidelity simulators and anatomic models are:
- Cardiovascular system workshops- heart sounds
- Respiratory system workshops- lung sounds
- Genitalia, pelvic, breast and rectal exams workshops
This course has summative OSCEs for history, communication skills and physical exam techniques assessment.
Second year of study: During the second year of medical school training, students advance their clinical skills in preparation for clerkship year through activities at the CSC. Students engage in formative sessions in focused history taking and focused physical exam skills based on a chief complaint and are stimulated to develop a differential diagnosis. They also continue to advance their communication skills as well.
Among the activities using standardized patients are the following:
- Patient centered interview focusing on communications skills
- Focused history practices on common chief complaints
- Physical exam practices
- Formative OSCEs on common chief complaints for adult and pediatric populations
Other activities using the high-fidelity simulators and anatomic models are:
- Cardiovascular system workshops- pediatric and adult heart sounds
- Genitalia, pelvic, breast and rectal exams workshops
This course has summative OSCEs for focused history, communication skills, focused physical exam techniques and clinical reasoning assessment.
What is the purpose of the Clinical Skills Assessment?
The Clinical Skills Assessment (CSA) is an objective assessment of clinical skills. It
uses standardized patient (SP) encounters to assess student performance in:
- Focused history taking
- Focused physical examination
- Interpersonal communication skills
- Clinical Reasoning
The exam has an OSCE format of four patient encounters (20 minutes each) encompassing across the spectrum of ages from pediatric patient, adolescent, young or middle-aged adult and the elderly patient. Students conduct the patient encounters as if they were the physicians responsible for these patients. They must gather data from history and physical exam basing their data gathering on a chief complaint and communicate a differential diagnosis to the patient or family member.
In the evaluation process each SP scores student performance using a checklist of key items for each case. These include essential aspects of history, physical examination, diagnosis and aspects of communication skills. Each SP is trained to score specific key components for each case. In all cases, the SP also scores on aspects of communication skills such as introduction, use of jargon, attention to patient comfort, and use of both open and closed-ended questioning among other.
The students are required to pass the test with a passing grade of 70% per each skill mentioned above to be promoted to the third year (clinical year).
Students who do not meet passing criteria may be given an opportunity to pass a retake exam after the mandatory remediation. Students who, in their exam performance, show that they need to reinforce some of their clinical skills may also be required to perform remedial activities to reinforce these deficiencies which helped them in the longitudinal goal of meeting the Educational Objectives of our school.
Third and four years of study: Instruction at the CSC during the third and fourth years focuses on providing structured opportunities to advance their clinical skills and clinical reasoning and receive specific feedback with the goal to achieve competence within the framework of the 6 core competencies Patient Care, Medical Knowledge, System Based Practice, Practice Based Learning, Interpersonal and Interprofessional Communication and Professionalism before graduation.
The third-year clerkships: Internal Medicine, Pediatrics, Surgery, Obstetrics and Gynecology, Psychiatry and Neurology use the CSC to provide formative and/or summative OSCEs, Interprofessional Education Activities, and Procedure workshops.
Among examples of activities in addition to the OSCEs are:
- Procedure workshops: intubation, lumbar puncture, intramuscular injections, among others.
- Trauma patient management using high-fidelity simulator.
- Telemedicine technology in the evaluation of ENT and Ophthalmology patient.
- Interprofessional education activity in the management of a medical error.
During their fourth-year students are required before graduation to take the Clinical Performance Examination (CPX). This examination is a standardized patient-based clinical skills assessment in an OSCE format.
What is the purpose of the CPX?
- Main purpose is to provide a standardized and objective measure of medical students’ clinical skills in order to determine that they have met the requirements to be competent in the clinical skills of the School of Medicine Educational Objectives:
- History taking,
- Physical exam,
- Clinical reasoning for both diagnosis and management plans,
- Communication skills,
- Medical documentation,
- Interprofessional and teamwork skills
- Provide students with information about their readiness to move on to graduate medical education.
- Provide the School of Medicine with information about clinical skills performance to assist in the refinement of existing curricula and in the development of new teaching strategies and assessments.
During the CPX, the students will be exposed to eight simulated patient encounters with a broad range of problems, which encompass subject material from any core clerkship. The encounters focus on common complaints that a general physician should be able to diagnose and manage for a varied display of patient ages, different medical settings, involving all organ systems and addressing topics like health maintenance and health disparities. In the evaluation process each SP scores student performance using a checklist of key items for each case. These include essential aspects of history, physical examination, diagnostic and management plans, and aspects of communication skills. Each SP is trained to score specific key components for each case.
Students who fail individual skill domains, passing grade of 70% in each of the skills examined, will be required to successfully complete a remediation program that includes individualized feedback, self-reflection, and working with a faculty mentor to develop the skills necessary for improvement. Following this remediation, students will undergo reassessment exam to ensure minimum proficiency with all categories of clinical skills. Successful completion of this reassessment exam will be required for graduation.