Winter 05

The Tao of Bedside Manner

Students learn to develop their competency skills in real-life scenarios at the Clinical Skills Education Center.

The medical student spends several moments looking over the chart and then raps on the door of the examination room. Opening the door slowly, he smiles and introduces himself to the man seated on the table, then strikes up a casual conversation that blends in questions about the nature of the problem.

Welcome to the IU School of Medicine’s Clinical Skills Education Center, where IUSM students learn to develop their examination, diagnostic and communication skills with “standardized patients” – actors trained for realistic roles in clinical scenarios.

Gone are the days when medical students studied only scientific subjects; today’s medical graduates are expected to master basic interpersonal skills such as history-taking and physical diagnosis, communication and ethical reasoning. In 1999, IU School of Medicine became one of the first medical schools in the country to establish a competency-defined education, which requires students to progress measurably in these and other areas. These competencies are, in part, evaluated though Objective Structured Clinical Examinations during the third and fourth years of medical school.

“In the past, students only could practice these and other skills in area hospitals, but that’s not always possible to do now because patients frequently are on the move for tests and consultations and are unavailable to students on clinical rotations,” says Susan Ballinger, MD, center director and associate professor of clinical pediatrics. “While OSCE cannot replace real-life clinical situations, it does give students realistic training experiences.”

Before the development of the center, the OSCEs were an exhausting affair, taking up to two full weekends and staged in inconvenient locations. All of that changed in 1999, when Stephen B. Leapman, MD, executive associate dean for medical education affairs, made it his mission to find a more permanent home for the exams.

Working with Clarian Health officials, Dr. Leapman found such a place at Methodist (Hospital) Tower, where the specially designed center is located. The center’s facilities also are used to further train and assess residents and others in health care professions.

The Doctor Will See You Now

OSCEs are as much about process – knowing the right questions to ask and gleaning as much relevant information as possible from each patient – as they are about honing students’ clinical skills. For each case, there is a patient profile, complete with background information, symptoms and medications being taken. To standardize the experience, the patients are trained specifically how to answer questions a student may ask.

Fourth-year student Cami Pfennig says she considers these factors as she prepares for each case scenario. “Based on the chief complaint presented,” she says, “I develop a thought process and think about what the possibilities are and how I will approach the patient and follow through with my exam.”

The most challenging exercises for students are those involving crises, when patients or family members are emotionally charged and unpredictable. Says Pfennig: “You may be discussing a do-not-resuscitate order or telling someone that their loved one didn’t make it through surgery. The patient may react with silence, hysteria or belligerence.”

Each of the fifteen examination rooms in the CSEC is equipped with a pan-and-zoom video camera feeding to a central observation area, where faculty evaluators monitor cases. At the end of the sessions, students often have the opportunity to sit down with evaluators and discuss their performances.

The actors also participate in the evaluation process; following each scenario, they complete a checklist about the physical examination and the questions the student should have asked based on the symptoms. Dempsey Arnold, a professional actor who has played many roles as a patient at the CSEC, notes that he and other actors see marked improvement in the students’ skills and confidence when they return for further exams.

“I enjoy playing the drug and alcohol abuse cases and seeing their reaction to the lifestyle,” muses Arnold. “If I say I work as a bartender in a topless bar, am I going to be treated differently? And how far can you take a common cold?”

Why, you can take it as far as reality allows at the Clinical Skills Education Center.

To view images and information about the Objective Structured Clinical Examinations at the center, go to www.medicine.iu.edu/osce/index.html.

Karen Wiens, a recent Purdue University graduate, is an intern with the Office of Public and Media Relations.