Frederick M. Schiavone, M.D., Associate Dean for Medical Education at Stony Brook University School of Medicine, shows second year medical students Farshid Hajimirzaee, center, and Daniel Lee, how to properly intubate a patient by demonstrating the procedure on one of the computerized manikins used to train students at the new Clinical Skills Center (CSC). Built in the design of an actual clinic, the 6,000 square foot facility uses a variety of real time, interactive clinical experiences to facilitate the development and measurement of clinical skills and professional competencies for students and practitioners of the healing arts.
STONY BROOK, N.Y., DECEMBER 12, 2006 – A 55-year old woman, fatigued, sullen and complaining of sleep loss walks into a clinic exam room and suddenly breaks into tears. This is great cause for concern for the clinician who is caring for her – if her symptoms are real.
The reality is she is feeling fine. She’s an actor, playing a role in which the spotlight is not even on her; it’s on the medical student assigned to correctly assess her condition. How that student cares for the woman is a crucial test of clinical skills and one of the many student-patient encounters played out at a new $4 million Clinical Skills Center (CSC) constructed at Stony Brook University Medical Center.
Built in the design of an actual clinic, the CSC uses a variety of real time, interactive clinical experiences to facilitate the development and measurement of clinical skills and professional competencies for students and practitioners of the healing arts. The 6,000 square foot facility runs on the most sophisticated technology and houses 10 patient exam rooms, each equipped with a computer station which the patient uses to critique a student’s performance and an audio/visual monitoring system for post exam review and analysis. Outside each exam room is a computer station for students to document the patient diagnosis and care plan. A separate simulated operating room and a simulated emergency room are equipped with computerized patient manikins and one-way glass for viewing student-patient encounters.
The CSC is located on level two of the Health Sciences Center within rooms 180 to 192. An opening ceremony of the facility will be held on Friday, December 15.
“The Clinical Skills Center provides students with an opportunity to start competency-based training early on,” says Richard N. Fine, M.D., Dean, Stony Brook University School of Medicine. “This is the best way for our medical students to gain valuable insight to the importance of patient-centered care during their four years of training at Stony Brook.”
“At the Clinical Skills Center, students are learning in a technically advanced, yet-patient oriented setting how to complete histories and physical exams, properly diagnose specific conditions communicate with patients, and deliver compassionate care,” adds Peter Williams, J.D., Ph.D., Vice Dean of Academic Affairs.
“Our review team toured several facilities at some of the top medical schools in the country, including Georgetown University and George Washington University, which gave us the insight needed to develop this state-of-the-art center,” says Elza Mylona, Ph.D., Assistant Dean of Academic Affairs and Director, Office of Curriculum.
According to the Association of American Medical Colleges (AAMC), which represents 125 accredited medical schools nationwide, training health care practitioners using simulated patients – whether actors or manikins – is part of a national trend that is at the frontier of modern medical education.
“More appropriate facilities for clinical skills education will continue to be in higher demand as medical education shifts more to a competency-based paradigm,” says Eugene C. Corbett, Jr., M.D., FACP, Professor of Medicine at the University of Virginia and head of an AAMC Task Force on Clinical Skills Education.
In June 2005, the United States Medical Licensure Examination (USMLE) began requiring students to pass a new hands-on clinical exam as one step in the licensure process. Thus, dedicated training facilities that accelerate students’ hands-on experience is an approach that the AAMC supports, notes Dr. Corbett.
The staff at Stony Brook’s CSC trains actors (also known as standardized patients) to present with specific symptoms to represent a diagnosis. They act out the pre-determined symptoms, and following their “appointment,” evaluate students’ physician skills, such as bedside manner and examination techniques. Actors receive an average of seven hours of training and are paid $20 per hour for time spent in training and in each performance. In OR and ER simulations, computerized manikins are programmed to display symptoms of conditions that actors cannot, such as a diabetic coma or heart attack.
The main component for training medical students is the Objective Structured Clinical Exam (OSCE, pronounced OSKEE). Each OSCE is a theatrical performance, in which actor patients stay in character and students rotate from case to case between exam rooms and to cases presented with manikins in the simulated OR and ER.
“Students often receive immediate feedback from actors after an OSCE,” says Pat Bley, Coordinator of the Standardized Patient Program. “The actors tell them how they did as doctors and evaluate them on things that patients look for in their doctor, such as good eye contact, empathy, care taken during physical examination, and the ability to answer questions.”
As part of the evaluation, School of Medicine faculty view student-patient encounters during an OSCE, live from an undetected observation booth, or via video tape. During one-on-one student evaluations, instructors discuss the student’s strengths and weaknesses as a clinician.
For more information on the CSC, or how to become a standardized patient (acting in the role of the patient), call Pat Bley at (631) 444-2098.
