Scenario-based student workshops in acute medicine
Emma-Jane T Crawford, Royal Bolton Hospital, 6 Saddlecote, Barton Road, Worsley, Manchester M28 2HB, UK. Tel: 00 44 161 794 0533; Fax: 00 44 1952 676554; E-mail: Emma126285@aol.com
Context and setting
The National Institute of Health and Clinical Excellence has recently published guidelines highlighting the importance of the early identification, assessment and treatment of the hospital in-patient who is acutely unwell. This has necessitated a shift in clinical practice from more traditional reactive strategies to early recognition and effective intervention.
There is also an increasing bank of evidence-based guidelines for the management of common acute medical conditions; examples include the ‘surviving sepsis campaign’ guidelines.
Why the idea was necessary
Despite the shift of focus in clinical practice, the undergraduate curriculum still relies on advanced life support and similar courses to prepare students for these situations. These courses have adapted to include pre-arrest, disease-specific scenarios, but their standardised algorithms remain the central focus. Furthermore, despite changes in the undergraduate curriculum to include training in skills previously learned on the job, such as problem-solving and communication skills, medical students and new doctors still lack confidence in these areas.
What was done
A total of 28 final-year medical students who had completed their final assessments participated in four workshops. The topics piloted were sepsis, chest pain, gastrointestinal bleeding and breathlessness.
Pre-workshop reading material was e-mailed to each student. This covered essential background knowledge for each topic and included references to evidence-based guidelines in that area.
Each 2-hour session started with an introductory group discussion to clarify any issues arising from the pre-reading material or from students’ clinical experience.
The practical session was based around three clinical stations, each manned by a facilitator. Students rotated around each station. One student was selected as the junior doctor. The other students played the roles of supporting staff and gave feedback at the end.
Students were given a scenario and were expected to take a short, focused history and examination. They then worked through what they would do in each situation, starting with initial resuscitation skills, performing appropriate investigations and initiating treatment. The practical application of skills and knowledge learned elsewhere in the medical curriculum was applied in real-time to encourage the students to apply their knowledge appropriately to the situation. It also gave students the opportunity to develop skills that traditionally have been learned on the job, such as effective time management, delegation of appropriate tasks to support staff, the importance of continuous reassessment of the patient and the ability to recognise the limits of one’s experience. One final task each student performed involved a telephone referral to an appropriate senior, such as the on-call medical registrar. The workshops were sufficiently flexible to allow diversion into any individual areas of concern, such as how to prescribe intravenous fluids.
Evaluation of results and impact
Written feedback from each of the participants was universally positive; students reflected on both the perceived need for teaching in this area and the benefit they had obtained from the flexible, scenario-based sessions with a focus on practical aspects of patient management. Following this positive response, we aim to extend the programme to include a wider range of clinical situations and more generic sessions on, for example, the management of stress in the workplace.