First, it was internal medicine with Imperial College London, then paediatrics with Birmingham Children's Hospital, and now gynaecology and obstetrics has landed in the undergraduate setting of the Practicum Script clinical reasoning training and assessment programme, with cases resulting from the collaboration of renowned specialists from four US schools and the leadership of Dr Sarah Dotters-Katz. We spoke with the editor-in-chief of the new subject, senior lecturer in obstetrics and gynaecology and director of undergraduate medical education at Duke University (North Carolina), about the new content, which is currently being validated by an international panel of experts.
Madrid, 7 February 2024. Under the direction of the Practicum Foundation, a committee of specialists in gynaecology and obstetrics from the US universities of Duke, Tennessee, North Carolina and Weill Cornell Medicine New York has developed ten new clinical cases for Practicum Script Universities with a focus on women's health and pregnancy care. As usual, the blueprint covers relevant topics within the specialty and the cases are based on real patient records (presented in their natural language) and incorporate multimedia content to make the students' experience a high-fidelity authentic simulation.
Obstetrician-gynecologist Sarah Dotters-Katz, who teaches at Duke University, is the editor-in-chief of this new batch production, focusing on the practical integration of knowledge, reasoning skills in contexts of uncertainty, clinical experience and scientific evidence in line with the educational objectives of the curriculum of the clinical cycle of the medical degree. The new subject recreates realistic scenarios from the field of the speciality, with cases of vaginal bleeding in early and late pregnancy, dysmenorrhoea, heavy menstrual bleeding, amenorrhoea, hypertensive disorders during pregnancy, vaginitis, chronic abdominopelvic pain, acute lower abdominal pain and hirsutism.
The cases are currently being validated by fifteen specialists from Europe, the United States and Latin America with at least 10 years of professional experience who divide their time between clinical activity and teaching at distinguished universities such as Birmingham and California - San Francisco. The members of the reference panel are asked to answer the cases and justify each decision. The responses are then pooled and literature is sought to support agreement and disagreement, and finally, a Delphi methodology is run for scenarios with significant variability in expert approaches as a crucial part of the feedback received by the trainees.
Practicum Script's clinical simulation model, focused on know-how for problem-solving and decision-making, allows students to be trained and assessed in an environment that mimics healthcare practice (the highest rung of Miller's Pyramid). The feedback combines clinical experience with evidence-based medicine and is powered by a robust artificial intelligence component that judges the plausibility of students' free-text hypotheses against those of the expert panel.
Individual student learning is complemented by debriefing sessions, led by mentor-facilitators, designed to encourage critical thinking through maieutic methods.
Four core subjects
The speciality of gynaecology and obstetrics comes as a response to the need to cover the four core subjects of the medical degree. Many of the universities currently implementing Practicum Script have been open to including these cases in their use of the platform during the final years of the degree. For them, Practicum Script represents a validated standardised approach to the formative assessment (and optionally as a continuum for summative purposes) of clinical reasoning skills. Since the excellent psychometric properties of this methodology were demonstrated, Practicum Script has continued to grow and consolidate international support.
In 2024, the Practicum Foundation is expected to start working in surgery.
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