Student comments on Advanced Clinical Skills Course

Proficiency in clinical examination skills upon graduation from medical school is a core competency. Over the last few decades, the ability and confidence in this fundamental and crucial skill set have declined. The motivation and interest in meticulous physical examination by recently graduated residents have also eroded. In this case study, we describe a comprehensive, innovative, and immersive advanced clinical skills elective taken during the second half of the final year of medical school for students at the David Geffen School of Medicine. The course utilizes novel approaches to inspire, refresh and consolidate essential bedside observation skills and examination techniques. This approach gives senior students the confidence and fundamental understanding of how dedication to the patient exam can improve the doctor-patient relationship, core clinical reasoning and the practice of cost-effective and evidence-based care through their careers. We describe how the integration of fine a..., Methods All students rotate through all of these sessions and field trips over the 15 days of the course. Visual Diagnosis This key component of the course occurs each morning from 9:00am to 10:30am. In our medical school, we have a large classroom equipped with 24 benches, each of which has two flat-screen monitors. The 50 students are randomly assigned to small groups of 4–5 students, who share a bench. At the control screen, the three course chairs reveal up to ten high-resolution clinical images on each group monitor per session.  These clinical images were obtained and curated by the course chairs over their combined 70 years of inpatient and outpatient clinical practice in academic teaching hospital departments: general internal medicine, neurology, ophthalmology, emergency medicine, pulmonary and critical care settings. All images were obtained with patient permission or were de-identified. Most are of actual clinical signs but where appropriate, images are augmented with radiolo..., PDF医学院毕业时熟练掌握临床检查技能是核心胜任力之一。近数十年来，医学生在这项基础且关键的技能组合上的能力与信心均有所下滑，新晋住院医师对细致体格检查的积极性与兴趣也逐渐消退。 本案例研究针对大卫·格芬医学院（David Geffen School of Medicine）的学生，介绍了一门开设于医学院毕业学年下半学期的综合性、创新性沉浸式高级临床技能选修课。该课程采用创新教学方法，旨在激发、重温并巩固学生必备的床边观察技能与检查操作技术。通过本课程，高年级医学生能够建立专业信心，并深刻理解：专注于患者查体如何在其执业生涯中改善医患关系、强化核心临床思维，以及践行高性价比且循证的医疗实践。 本研究阐述了如何对精细[原文内容未完整呈现]进行整合，具体方法详见下文。 方法 本课程为期15天，所有学生需参与全部课程环节与实地考察。 视觉诊断（Visual Diagnosis）作为本课程的核心模块，于每日上午9:00至10:30开展。我校配备一间大型教学教室，内设24组操作台，每组操作台均配有两台平面显示器。50名学生被随机划分为4~5人一组的学习小组，共享一组操作台。每节课上，课程负责人会在主控屏幕上为每个小组的显示器展示至多10张高分辨率临床影像。这些临床影像由课程负责人凭借其合计70年的学术教学医院临床实践经验采集并整理，涉及科室涵盖普通内科、神经内科、眼科、急诊科、肺科与重症监护室。所有影像均已获得患者知情同意，或已完成去标识化处理。大部分影像为真实临床体征实拍图，在合适的情况下，影像会辅以放射学[原文此处内容未完整呈现]相关内容。PDF