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PILOT EXPERIENCE IN BRAZIL

Medical students from the Federal University of Minas Gerais get ready to manage patients with the realistic virtual simulation of Practicum Script

The medical school of the University of Belo Horizonte has signed an agreement to pilot Practicum Script for two years.

In May, the Brazilian Federal University of Minas Gerais (UFMG) started implementing Practicum Script as a formative activity in years 5 and 6 of the medical degree. The public leader institution in education and scientific research has adopted this online clinical reasoning training and assessment platform, using real-life clinical cases, to prepare its medical students for the clinical stage in a safe-to-fail environment. For the coordinator of the simulation laboratory, Prof. Maria do Carmo Barros de Melo, “Practicum Script helps students practice clinical reasoning. Its use in the last three years of the medical course in a longitudinal manner is interesting and relevant, allowing content to be added gradually.”

Belo Horizonte, 17th June 2024. According to a survey published by the Institute of Supplementary Health Studies of UFMG, almost 55,000 people die each year in Brazil due to medical errors (the equivalent of six per hour!). Prof. Barros de Melo is aware that most of these medical errors are not due to inadequate knowledge, but to cognitive failures, mainly in uncertain situations. The point for the university, when they took the decision to apply Practicum Script in the clinical cycle, was to provide students with an opportunity to test their clinical judgment in high-fidelity healthcare settings in internal medicine in order to preserve patient safety and reinforce clinical competence at an early stage. 

For this purpose, UFMG has signed an agreement with the Practicum Foundation (Madrid, Spain) to conduct a two-year pilot experience, in which Practicum Script is expected to foster the students’ cognitive skills and autonomy for clinical decision-making, through repetition, immediate feedback and reflection on actions. The longitudinal standardised approach, applicable to Y4, Y5 and Y6, helps to identify errors and reduce bias, while assimilating relevant knowledge and know-how, in relation to scientific evidence and experience-based medicine. 

In short, Prof. Barros de Melo trusts that this methodology will reinforce clinical maturation among students by offering genuine challenges of daily practice. The medical contents for this experience, which aims to evaluate the educational impact of Practicum Script, as well as the level of satisfaction with the methodology among the teaching staff and the students, have been validated by local experts and recently audited by staff of UFMG to ensure its relevance in Brazil. The results of the study will be published in an international medical education journal.

Furthermore, UFMG has planned a calendar of post-simulation clinical debriefings to complement this self-regulated learning. The main goal of these sessions is to encourage students to think critically and improve their retention by learning through the discussion of events and mentor guidance. To do this, a group of selected teachers is using Practicum Mentoring, a digital solution for the development of clinical debates, using maieutic methods, with special attention to the deconstruction of errors.

Proficiency increases with practice

Virtual patients offer an excellent way to accelerate the learning curve in medical education. By interacting with life-like cases based on real records, where they must order tests, treat and diagnose by formulating their own hypotheses in free text, learners build the skills necessary to care for encounters in the flesh. Novices can exercise problem-solving skills, make mistakes and learn from them in a controlled manner. Also, the exposure to a wide range of clinical conditions and complex scenarios helps students better prepare for the real-world, where statistical patients, book cases and single algorithmic solutions are not that common.

 

Interview with Maria do Carmo Barros de Melo, Full Professor of Paediatrics and Coordinator of the Simulation Laboratory at UFMG   
In recent years, new Brazilian national curricular guidelines for undergraduate medical students have been adopted to improve students' training and assessment. In your opinion, is there anything still to be improved to achieve this goal?
The national curricular guidelines for courses in medicine in Brazil were published in 2014 and require updating. In September 2024, another edition of the Brazilian Congress of Medical Education will be held, with the theme “National Curricular Guidelines for medical training: 10 years of construction!” With the new technologies implemented in recent years, it is necessary to adapt the skills and abilities required for medical training.There has been implementation of simulation laboratories, greater use of telehealth tools and medical equipment with advanced technology. New scientific evidence has emerged regarding teaching in the health area. At the same time, we need to restore communication skills and empathy.
What is your perception about the utility and the educational impact of Practicum Script as a programme to be implemented in the last 3 years of the medical degree?
The Practicum Script program helps students practice clinical reasoning. Its use in the last three years of the medical course in a longitudinal manner is interesting and relevant, allowing content to be added gradually. Students really enjoy participating and report that the experience has been very beneficial.
What feedback are you receiving from medical students throughout the Practicum Script pilot? And what about professors?
Feedback has been very good from students, especially sixth-year students, who have requested that more clinical cases be made available. They consider the system to be easy to use with interesting feedback, allowing them to review mistakes and successes. Furthermore, they report that they help with studying for medical residency exams. Teachers have highlighted the importance of participating in the project for students.
You have been coordinating the pilot experience with Practicum Script at UFMG, so from your insider's perspective: how do Practicum Script cases differ from cases used in other virtual platforms for formative purposes? In what sense?
As coordinator of the pilot project, I consider that there are several advantages. I must emphasise the fact that the Practicum Script platform is easy to access and use. It presents clinical cases with topics relevant to medical teaching and promotes effective and quick feedback. The format was very well structured. I have experience in distance learning and the platform showed me other possibilities. Another important issue is obtaining an international certificate.
How valuable can introducing the management of clinical uncertainty into the clinical cycle be, rather than believing that this competence is gained gradually and naturally over time, to reduce the risk of medical errors?
There are several ways to prevent medical errors, which include the use of clinical case simulation, development of skills and competencies crucial for care qualification. I coordinate the Simulation Laboratory at the UFMG Faculty of Medicine, and we have ways of training with mannequins and simulation equipment. The Practicum Script platform, using response simulation in clinical cases, is a good tool and the feedback provided helps the student to reflect and better understand clinical decision-making. All of this adds knowledge and prepares the student more effectively to practice the medical profession.

 

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