Teaching Clinical Skills

picture of hand holding syringe The patient is not breathing. The medical student struggles to intubate the airway. He elevates the patient’s head and extends the atlanto-occipital joint. He uses the scissor technique to further open the patient’s mouth. He still can’t get the tube in. Precious time is ticking away.

If the patient were a live human being, each second without oxygen could compromise brain function. But since the “patient” is a sophisticated medical mannequin, the student is able to practice the skill until he gets it right, practice without fear of leaving his patient brain damaged—or worse—while learning the skills necessary to practice his chosen profession.

Down the hall, another student examines a patient (an actor) who complains of abdominal pain. The student takes the patient’s history and carefully probes her abdomen. In an adjoining room, the student’s instructor watches the exam via video monitor. Later, the instructor and student watch the videotape and discuss ways the student can improve communication with her patient.

While clinical-skills training has always been an important part of medical education, it is now front and center, spurring curricular reform at medical schools across the nation. Numerous studies have shown that poor communication, interpersonal, and general clinical skills are related to a higher incidence of malpractice suits, reduced treatment compliance by patients, and decreased patient satisfaction. In answer, a clinical skills examination was added to USMLE Step 2 in 2004 that tests medical students on their ability to gather information from patients, perform a physical examination, and communicate their findings to patients and
colleagues.

model of clinical skills teaching rooms
The Clinical Skills Teaching Center with 22 exam rooms, closed-circuit monitoring, and state-of-the-art equipment occupies the lower level of the Setnor Academic Building.

Perhaps the greatest value of using standardized patients is in evaluating student performance. “We can train a group of standardized patients to play the same role, so that each student sees the same type of presenting patient. It’s a way to objectify an evaluation experience. And the new facility will provide better acoustics, privacy and logistics of scheduling,” says Steve Harris, who directs Upstate’s Standardized Patient Program.