Medicine
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This repository contains the published and unpublished research of the Faculty of Medicine by the staff members of the faculty
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Item Medical student’s experiences of training on simulated and real patients in education: A qualitative exploration(Penerbit Universiti Sains Malaysia, 2023) Kodikara, K.; Senaviratne, T.; Premaratna, R.Patient interaction is a key learning experience in undergraduate medical education. An actual or simulated/standardised patient (SP) can be used for this purpose. Although both real patients and SPs have inherent advantages and disadvantages, the value of SPs, as opposed to real patients, is recognised as an important area warranting research. The objective of this study was to explore the students’ perception of using real patients and SPs in their education. Six focus group interviews were conducted using medical undergraduates in the third, fourth, and fifth (final) year batches of the Faculty of Medicine, University of Kelaniya, Sri Lanka, from July to October 2020. The interviews were thematically analysed. All the participants considered real patient encounters more authentic than SP encounters. The students identified many strengths of SP interactions. SP encounters enabled them to prepare for real patient encounters. In particular, the participants appreciated the opportunity to practice communication skills with SPs. Students valued the feedback provided by SPs. The students identified real patient encounters enabled learning physical examination skills and procedural skills. Interestingly, most identified real patient encounters as more instructive, and some students identified that “the nervousness and anxiety” associated with real patient encounters helps improve selfconfidence. Students identified specific strengths and weaknesses in both real patient encounters and SP encounters. Participants appreciated SP encounters explicitly for learning communication skills and preparing for real patient encounters. Real patient encounters were valued for learning and improving clinical skills. The findings of the study support harnessing these specific strengths of each encounter and, thus, incorporating both in undergraduate medical education.Item Pre-clerkship procedural training in venipuncture: a prospective cohort study on skills acquisition and durability(BioMed Central, 2023) Kodikara, K.; Seneviratne, T.; Premaratna, R.BACKGROUND: The effectiveness of simulation-based training for skill acquisition is widely recognized. However, the impact of simulation-based procedural training (SBPT) on pre-clerkship medical students and the retention of procedural skills learned through this modality are rarely investigated. METHODS: A prospective cohort study was conducted among pre-clerkship medical students. Learners underwent SBPT in venipuncture in the skills laboratory. Assessments were conducted at two main points: 1) immediate assessment following the training and 2) delayed assessment one year after training. Learner self-assessments, independent assessor assessments for procedural competency, and communication skills assessments were conducted in both instances. The students were assessed for their competency in performing venipuncture by an independent assessor immediately following the training in the simulated setting and one-year post-training in the clinical setting, using the Integrated Procedural Protocol Instrument (IPPI). The student's communication skills were assessed by standardized patients (SP) and actual patients in the simulated and clinical settings, respectively, using the Communication Assessment Tool (CAT). RESULTS: Fifty-five pre-clerkship medical students were recruited for the study. A significant increase was observed in self-confidence [mean: 2.89 SD (Standard Deviation) (0.69)] and self-perceived competency [mean: 2.42 SD (0.57)] in performing venipuncture, which further improved at the delayed assessment conducted in the clinical setting (p < 0.001). Similarly, the IPPI ratings showed an improvement [immediate assessment: mean: 2.25 SD (1.62); delayed assessment: mean: 2.78 SD (0.53); p < 0.01] in venipuncture skills when assessed by an independent assessor blinded to the study design. A significant difference (p < 0.01) was also observed in doctor-patient communication when evaluated by SPs [mean: 2.49 SD (0.57)] and patients [mean: 3.76 SD (0.74)]. CONCLUSION: Simulation-based venipuncture training enabled students to perform the procedure with confidence and technical accuracy. Improved rating scores received at a one-year interval denote the impact of clinical training on skills acquisition. The durability of skills learned via SBPT needs to be further investigated.Item Challenges in learning procedural skills: Student perspectives and lessons learned for curricular design(Routledge, 2024) Kodikara, K.; Seneviratne, T.; Godamunne, P.; Premaratna, R.PHENOMENON: Developing foundational clinical procedural skills is essential to becoming a competent physician. Prior work has shown that medical students and interns lack confidence and competence in these skills. Thus, understanding the student's perspective on why these skills are more difficult to acquire is vital for developing and reforming medical curricula. APPROACH: This study explored procedural skills learning experiences of medical students with qualitative methods. Through purposive sampling, 52 medical students from the third, fourth, and final years were selected for inclusion. Data were collected using six audio-recorded, semi-structured focus group discussions. Transcripts were manually coded and analyzed using inductive content analysis. FINDINGS: Students provided rich and insightful perspectives regarding their experiences in learning procedural skills that fell into three broad categories: 1) barriers to procedural learning, 2) reasons for learning, and 3) suggestions for better learning outcomes. Students described a range of barriers that stemmed from both patient and clinician interactions. Students were reluctant to make demands for their own benefit during clerkships. The most commonly expressed reason for wanting to learn procedural skills was the desire to be a competent and independent intern. The motivators suggested that students felt empathetic toward interns and visualized a successful internship as a learning goal. Participants suggested peer learning, improved teaching of procedural skills, assessments, and feedback to improve their learning. INSIGHTS: This study generated valuable information to promote critical reflection on the existing curriculum and pedagogical approaches to procedural skills development. Medical educators need to sensitize the clinical teachers to student perspectives and what students are really learning to make impactful changes to teaching and learning procedural skills. Students' self-advocacy skills and self-directed learning skills need to be developed for them to seek out learning opportunities and to promote life-long learning. Lessons from this study may also apply to curriculum design in general, especially in teaching clinical skills. Empowering the learner and embracing a learner-centered approach to teaching and learning procedural skills will benefit future clinicians and their patients.