At the Split University School of Medicine, discussion on clinical training intensified in the summer of 2009 and the Curriculum Reform Committee entered into permanent session. Training of basic and general clinical skills was programmed to start early in six two-week modules in the first two ("preclinical") years (Ref. 1). Teaching of clinical examination skills stays in the third year, and training of special clinical skills (ENT, surgery, gynecology) will continue in the fourth and fifth (clinical) years, where they will take place in appropriate blocks of clinical courses. Radical changes are anticipated for the sixth year of study, which will become “the clinical practical year” when the students will have the opportunity to immerse themselves in the real world of clinical practice.
According to our “Catalogue of clinical skills” there are as many as 550 practical skills to be mastered during the undergraduate study (Ref. 2) and, in our opinion, this is the only possible approach to guarantee the mastering of all important skills in a systematic manner and to the fullest extent.
Is it advisable to structure the curriculum like this, with clinical topics being introduced in the "preclinical part" of curriculum?
References:
1. Simunovic VJ. Basic & General Clinical Skills; Charleston (SC): CreateSpace Independent Publishing Platform: 2013. (http://www.amazon.com/General-Clinical-Skills-Vladimir-Simunovic/dp/1489556648/ref=sr_1_2?s=books&ie=UTF8&qid=1392901355&sr=1-2)
2. Simunovic VJ. Catalogue of Clinical Skills; Charleston (SC): CreateSpace Independent Publishing Platform: 2013. (http://www.amazon.com/Catalogue-Clinical-Skills-Vladimir-Simunovic/dp/1489580212/ref=sr_1_4?s=books&ie=UTF8&qid=1392901355&sr=1-4)
http://www.amazon.com/General-Clinical-Skills-Vladimir-Simunovic/dp/1489556648/ref=sr_1_2?s=books&ie=UTF8&qid=1392901580&sr=1-2
we have started to practice the same at our medical school.When you start exposing students to clinical or hospital environment, that does not mean that you start teaching them all the clinical stuff to which they have not developed any concepts. Rather students get sensitized to the fact that whatever anatomy , physiology and other basic sciences they are studying , all of it gets correlated in the clinics. In addition, they learn about interviewing and communication skills. they develop a sense of empathy for the patient sufferings and find it motivating to excel in their profession.
They can get trained and skilled in the clinical skills of examination, diagnosis and management later on with improved interviewing skills and communication regarding doctor-patient relationship.
Without question is it valuable. At OUHCOM for 40 years our students have had clinical experience as part of curriculum from the first day of medical school. This has proven to develop a more clinically comfortable and facile physician. In addition as an osteopathic medical school are students are taught manual medicine techniques from day one and encouraged to practice them.
This is process develops students who are not afraid to touch patients and develop clinical exam skills very early in their education while simultaneously integrating the knowledge and concepts behind their exam. It is so essential to our process that I am always surprised when I have a clinical student who tells me that they finished an early clinical experience during which a physician did not allow them to touch any patients. I tell them, you are using your stethoscope as an accessory, why don't you actually use it to learn. Once they are freed up to actually listen they start developing their ear for sounds.
Similarly I do the same with ENT exam equipment so that they develop the manual skills to use their otoscope and ophthalmoscope. When we find an otitis media, I point is out to them and they are learning. Expertise comes from the understanding of what normal looks like. Knowing normal comes from lots of exams. Once a physician knows normal, finding disease is easy.
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