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Association of Medical Schools in Europe

Practicum Script took part of this year’s AMSE conference with a presentation of the host’s experience

Georgian medical university David Tvildiani (DTMU) presented its experience with the clinical reasoning training programme Practicum Script at the AMSE 2022 conference, which was held in October in Batumi (Georgia). The aim of the study conducted by this year’s host was to evaluate Practicum Script for teaching and assessment purposes in undergraduate medical education. According to DTMU, Practicum Script can improve hypothesis generation skills, and serve as an effective methodology to remediate students’ clinical reasoning gaps and provide valuable inputs in clinical thinking.

Batumi (Georgia) - Dec 1, 2022. Under the motto “The medical school of the future: ensuring quality”, the host of the annual conference of the Association of Medical Schools in Europe (AMSE) shared their experience with Practicum Script. Dr Liza Goderdzishvili, Head of the Emergency and Internal Medicine Department of Tbilisi Central Hospital and Associate Professor at David Tvildiani Medical University, delivered this short communication on the opening day. The specialist, who has collaborated with Practicum Script since its validation at undergraduate level with the Practicum Universities pilot study in 2019, emphasized the fitness of the methodology for a better understanding of clinical uncertainty.

The event, held between October 6th and 8th, was announced as a great opportunity for the leaders of member schools and other key organizations, such as the World Federation for Medical Education, the European University Association – Council for Doctoral Education, the Organization for PhD Education in Biomedicine and Health Sciences in the European System and the International Federation of Medical Students’ Associations, “to come together to reflect on their present situation and how they can actively shape the future of medical education, research and patient care”.  More than 125 participants from 19 countries were invited to contribute to the debate through the lens of quality assurance.

According to the organizers, “the majority of medical schools in Europe, as well as worldwide, have been finding themselves in a period of ongoing major crisis”. The challenges arising from the COVID-19 pandemic and the need for a paradigm shift, moving away from a pedagogy centred on factual knowledge towards one enhancing reflective thinking, are just some of the root causes. On the occasion of the event they were hosting, DTMU exposed their first-hand perspective using Practicum Script. The aim of their approach was to explore and evaluate the clinical reasoning simulator for teaching and assessment purposes.

In this sense, under the direction of the vice dean in medical education at the university Paata Tsagareishvili, DTMU focused on 24 last year medical students included in the course  “Summarizing Training and Assessment in EPAs”. The teaching staff used Practicum Script to enrich training in internal medicine with a formative cycle consisting of ten clinical cases based on real patients, followed by a summative 3 hours OSCE exam (with another 10 cases). Students' answers for each case were structured in 3 steps: (1) formulation of hypotheses (in free text format), (2) argumentation of hypotheses, (3) decision making in different clinical scenarios related to the same patient.

In average, students answered 9.83 cases (out of 10 available) during the formative cycle and they completed the first step of hypothesis formulation in 97.5% of cases. At this step, 71.51% and 75.97% of the answers were matched as valid during the formative and the summative cycle, respectively. Almost 60% (59.5%) of the arguments sustaining the different hypotheses were correct in the formative cycle (vs 48.50% in the summative cycle). In clinical scenarios, corresponding to the decision-making step, 91% of answers were valid (matching with the panel of experts) in the formative cycle (vs 84% in the summative cycle).

During the session, Dr Goderdzishvili concluded that ““Practicum Script is a good tool to assist academics to diagnose clinical reasoning difficulties in students and provide meaningful feedback to students in the context of clinical reasoning processes”. It is especially useful in the first step of hypothesis formulation, while “more efforts are required to train hypothesis argumentation and clinical decision making skills in a context of time limitations and higher degrees of uncertainty”. The DTMU professor also highlighted the potential of Practicum Mentoring and Practicum Analytics, two real-time data solutions meant to offer aggregated stats on the strengths and weaknesses of medical students.

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