Competency-based learning in an ambulatory care setting: Implementation of simulation training in the Ambulatory Care Rotation during the final year of the MaReCuM model curriculum

What Happened to Simulation-Based Education in Outpatient Setting in The 21st Century: A Scoping Review

Introduction

Simulation-based education (SBE) is an instructional approach that aims to accurately recreate real-life scenarios and engage learners in the practical application of lesson content. By replicating critical elements of clinical situations, SBE facilitates a deeper understanding and better preparation for managing such conditions in actual clinical practice. SBE offers promising prospects for improving medical education and patient care in various settings, such as outpatient clinics. Therefore, this scoping review aims to determine to what extent the most effective components and standards of the simulation have been considered in outpatient education.

Methods

The present scoping review adheres to the guidelines outlined in the "Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) checklist" and the "Joanna Briggs Institute (JBI) Reviewers' Manual". This review focused on articles that specifically focused on the use of simulation in outpatient education. Google Scholar, PubMed, Scopus, Embase, and ERIC were searched for keywords related to simulation, ambulatory care, outpatient clinics, and medical education from January 1, 2001, to August 12, 2023.

Results

The search indicated 513 articles, which were narrowed down by title and abstract relatedness. Twenty-nine articles entered the study's second phase, and after reviewing their full text, nine articles that explicitly reported simulation use in outpatient education remained. Based on the findings of eligible articles, the ten most frequent components of SBE that should be considered and followed discussed. These features were training facilitators, pre-briefing sessions, the type of simulation techniques, the site of simulation participation, the simulation duration, unit of participation, extent of direct participation, Simulation fidelity, feedback, and debriefing and reflection.

Conclusion

SBE is a contemporary method of practical training for medical students that involves realistic modeling or simulation of clinical situations. It enhances learning effectiveness and provides a safe, educational atmosphere for teaching and learning. Designing simulations adhering to established standards and carefully considering essential components improves efficiency and effectiveness.

Restructuring the final year of the model study programme MaReCuM at the Medical Faculty Mannheim: the academic quarter in ambulatory medicine

Introduction: To reflect the ever-growing importance of outpatient care in medical education, MaReCuM - a reformed curriculum, also referred to as a model study programme - was introduced at the Medical Faculty Mannheim in 2006. It divided the final year of medical study into quarters and added a mandatory quarter dedicated to ambulatory medicine. This project report presents our experiences, the costs and the evaluation results connected with making specific changes to the final year of undergraduate medical study. Project description: The final-year quarter in ambulatory medicine, taught at the Medical Faculty's outpatient teaching placements, allows final-year medical students to gather practical experience in one of four elective areas in outpatient care. The parallel coursework encompasses interactive case presentations and practical reviews. Relevant curricular content on ambulatory medicine is then tested in the oral/practical section of the M3 medical examination. Results: Students are very satisfied with the academic quality of the final-year quarter in ambulatory medicine. Restructuring the final year, generating the concept and recruiting teaching placements at outpatient facilities required additional full-time positions in the beginning. Discussion: The processes of reforming MaReCuM have not only contributed to a stronger recognition of ambulatory medicine in the final year and in the clinical phase of study, but have also enabled broader opportunities for focussing individual choices during medical education. A high caliber of academics in the quarter in ambulatory medicine can be achieved with a calculable amount of organisational effort. Conclusion: Anchoring a curriculum on ambulatory medicine in medical education is possible through restructuring the final year and is received positively by students. The success of MaReCuM demonstrates the feasibility of the recommendations made by the German Council of Science and Humanities (Wissenschaftsrat).

Barriers to outpatient education for medical students: a narrative review

OBJECTIVES

This study surveys medical education literature published over the last 25 years (1993-2018) to identify the factors scholars consider deleterious to outpatient teaching for medical students.

METHODS

This study conducts a review of medical education literature published between 1993 and 2018 using Medline, Lilacs, Ibecs, Cochrane Library, and Scielo databases. The following search terms were utilized: "Education, Medical, Undergraduate" AND "Ambulatory Care" AND "Teaching/methods" OR "Clinical Clerkship" OR "Preceptorship." This study focuses on papers describing deleterious factors for outpatient teaching with medical students and analyzes their results, discussions, and conclusions sections.

RESULTS

Of the 363 articles obtained, this study selected 33 for analysis. These papers identify numerous factors as barriers to outpatient education. For didactic purposes, these factors are categorized into four barrier groups: environment-institution, academic staff, students, and patients. Academic staff-related teaching barrier was the most frequently mentioned obstacle. Intense care schedule with little teaching time was considered the most common and relevant barrier to outpatient medical education, followed by inappropriate teaching environment and inadequate supervision model.

CONCLUSIONS

There is a lack of recent literature on studies focusing on barriers to effective outpatient medical education. Factors identified as harmful to outpatient education have been pointed out by course directors, academic staff, and students in the literature. However, many of these factors remain overlooked by educators, who can use these factors to modify their academic activities for more effective results.

Competence-based teaching and learning in the outpatient clinic: development of a clinical elective in ambulatory medicine

Aim: Although physicians have the most contact with patients in the outpatient setting, topics relating to ambulatory medicine have been less present in medical education. To teach professional skills, practical learning opportunities must be created in which students can practice medical skills under authentic working conditions in the outpatient setting. The clinical elective in ambulatory medicine has been developed, evaluated and revised at the Mannheim Medical School as a practical, competency-based learning experience in outpatient clinics (liver clinic, psychiatric outpatient clinic, uro-oncological consultations, etc.). Methods: The elective was designed using the plan-do-check-act (PDCA) cycle in the form of a longitudinal practical course during the fourth year of study. By selecting one of four concentrations in ambulatory care, students have the opportunity to focus on and pursue an individual interest. Students are given assignments during three separate sessions at an outpatient clinic and complete a log book which contains the learning objectives, assignments and grading criteria. Once the elective had been completed, the students (n=165) and mentors (n=7) had the option to participate in a survey to evaluate knowledge gain and satisfaction with the elective. Results: The students rated their personal growth in knowledge about common diseases and patient-centered communication positively, while rating their knowledge gain in ambulatory patient management somewhat lower. The first offering of the elective was evaluated as satisfactory by students and mentors. In 85.8% of the cases, students reported that they would recommend the selected outpatient clinic for this course. Suggestions for improvement, such as those concerning the log book and scheduling system, were considered during the first revision. Conclusion: This elective provides an opportunity to become familiar with ambulatory medicine in a practical and competency-based manner during medical studies. Skills in ambulatory medicine are already taught and applied in the fourth year of study in a practical setting and also deepened further through interconnections with other courses and chosen concentrations. Moreover, this elective format may be used by other medical schools depending on which aspects of ambulatory medicine are focused on.

Physicians' roles in competency-based teaching: Do students recognize them?

Introduction: Imparting the concept of physician's roles with the help of new teaching formats is becoming increasingly important in medical education. The "ambulatory care simulation" was developed at the Medical Faculty Mannheim as a format to teach the roles of "medical expert," "communicator", "health advocate", "manager", "team member" and "professional" in the practical year. During the "ambulatory care simulation", students work through case scenarios with simulated patients focusing on the physician's roles and subsequently discussing and reflecting on their experiences. Several measures are designated to ensure that each role is covered by the new teaching format. The present study investigates whether the physician's roles are actually addressed during the "ambulatory care simulation" and whether the competency-based learning objectives are recognized by the students. Methods: All participants in 12 of the 38 obligatory "ambulatory care simulations" signed informed consents to be filmed during the "ambulatory care simulation". These videos were categorized using previously defined observation criteria. A total of 211 out of 224 students completed and handed in a one-minute paper at the end of the "ambulatory care simulation". The answers to the question, "What have you learned?" have been assigned to competency-based learning objectives. Results: Although instructors and students adhered to the guidelines in the recorded "ambulatory care simulations", the most frequently addressed roles were "medical expert" and "communicator." Two-thirds of the participants indicate learning outcomes that do not correspond to the previously defined learning objectives of the "ambulatory care simulation". Discussion: To ensure a thorough understanding and long-lasting appreciation of the physician's roles, longitudinal integration of teaching interventions into the curriculum is to be favored over single teaching units. Instructors need intensive preparation for the unfamiliar construct of physician's roles. The learning objectives must also be made more transparent. Conclusion: Especially complex teaching formats need to be evaluated for success if they are to achieve their aims. Formative evaluations enable verification of whether the learning objectives are addressed, recognized and, finally, achieved.