Clinical skills day: preparing third year medical students for their rural rotation

In order to prepare third year medical students in the Rural Physician Associate Program for a nine-month community-based continuity care experience in rural Minnesota, USA, a clinical skills day that featured human patient simulators and standardized patients was developed. Patients presenting with common urgent and routine primary-care problems were developed and presented using the objective structured clinical examination for teaching. The goals of the day were to: (1) distinguish urgent from non-urgent clinical presentation; (2) use clinical guidelines for making decisions; (3) communicate effectively in stressful situations; and (4) uncover a significant clinical issue with a different presenting complaint.

Case scenarios were written for a variety of diagnoses in patients with differing ages. Scenarios were both urgent and non-urgent and typical of what might be encountered in primary care. They included: chest pain with bradycardia and pulseless electrical activity; major trauma from an all-terrain vehicle; labor and delivery; acute abdomen (acute appendicitis in a 20 year old and diverticulitis in a 70 year old); anaphylaxis after an influenza vaccination; pediatric upper respiratory infection in which the mother demanded antibiotics; knee injury in a middle-aged man after a weekend of football; heartburn with an underlying significant depression; and X-ray review. The experience occurred in the Interprofessional Education and Resource Center (IERC), where each room was a fully equipped ambulatory examination room with a computer for accessing data and a video camera for central monitoring. Faculty were recruited from the College of Medicine and received an on-line presentation orienting them to the IERC, the teaching model and the scenario assigned to them with supporting evidence-based guidelines. Students reviewed an on-line audio-visual presentation orienting them to the IERC and outlining the learning expectations for the day. Otherwise, students were not expected to prepare for the day because this was an immersion learning experience. Faculty were present in each room as observers, facilitators and educators. Their roles were active or passive, depending on the case scenario and the presence of a simulator or standardized patient. Each station, except the radiology station, involved a debriefing at the end for final questions, and distribution of educational resources or summary teaching points. Standardized patients also gave the students feedback. Students were randomly assigned to small groups of three to four students and rotated through the stations as a unit.

To date two classes of students (n = 77) have participated. Evaluations were completed by both students and faculty and included both qualitative and quantitative data immediately after the event and 9 months later (n = 59). Evaluations were overwhelmingly positive with means well above four on a five-point Likert scale. Feedback from both immediate and delayed evaluations were and continue to be used to improve the session for the following year.

Both students and faculty were enthusiastic about this 'hands on' team learning format, which provided students with opportunities to begin to understand the complex skills that they will need before they learn them step-by-step.