Search term

Didactical Approach / Skillslab

The didactical approach used at the Skillslab can be described by the following principles:

 

Gradual increase in complexity of skills

Didactically, a skill can best be acquired when the smallest constituting elements are identified.

Students can develop their ability by mastering these elements step by step. When the skills are practised in a variety of circumstances and contexts, the students will eventually master the whole action in a flexible way. The training of skills in the Skillslab increases in complexity throughout the course years.

For example: first students learn to handle the sterile syringe and learn from which angle and with which force to inject this sterile syringe into the vein. Both of these actions are learnt with the use of an artificial arm. Only when these steps are mastered, and that can very well be in the same training, they will proceed to the next step: performing a venepuncture on each other. In this step they learn how to deal with the emotional aspects of this skill: how to interact with a patient/fellow-student who may not be at ease.

Gradual increase in complexity of practicing situations

The skills are acquired in different practicing situations. Analogous to the increase in complexity of skills, these practicing situations increase in complexity. This order should be regarded as a starting point. If at any stage a student considers his level of mastery of the particular skill insufficient, they can go back to a less complex practicing situation, and practice until they are secure enough to re-enter the stage in which they encountered a problem. Moreover, there are ethical, emotional, psychological, cultural and practical reasons why certain skills cannot be trained in a specific practising situation (for example genital examination).

Gradual increase in integration of different skills and knowledge

The skills are acquired in an increasingly complex situation. Moreover, during the curriculum the students also get many opportunities to use their skills and their knowledge in doctor-patient encounters. With the use of simulated patients, twice every block every student can practise an entire doctor-patient encounter. In these simulated patient encounters students integrate their knowledge and physical examination and communication skills. In this way they learn to deal with the complex multidisciplinary problems that patients present, at an early stage in their study.

The roles that simulated patients play represent one complaint (for example: “my elbow hurts”). However, different simulated patients play a number of different actual reasons for visiting the doctor. (“I promised I would type my daughter’s thesis”, or: “I work as a cashier and cannot take a rest with my arm”, or: “I am a retired carpenter and still make myself useful by doing small carpentry jobs. I would break down if I had to abandon this”)

All students meet with these patients. By comparing what information they have heard, they realize that their way of phrasing questions matter and that the advice must be tailor-made to the patient’s individual situation and background. In years 1, 2 and 3 simulated patient encounters take place parallel with the entire curriculum. The simulated patients’ roles are relevant to the block students follow. Physical examination is gradually introduced into the encounter during the first year. The simulated patient encounters, that take place without the presence of a teacher, are digitally recorded. Soon after the encounter the simulated patient provides feedback to the student, about the empathy, congruence and trust that the patient experienced.

A group of ten students, individually, watch the recordings of the simulated patient encounters. They write down remarks and comments of the recording.

One week after the encounters these remarks, comments and questions are discussed by the group of students, together with a teacher.

In the third year students meet with real patients in the students’ outpatient clinics. To prepare for these encounters, the scenarios of the simulated patients in the third year represent more complex pathology and more demands for health education.

In the fourth and fifth years the students take part in clinical rotations. They see patients in the health care settings of different clinical wards, family practices and mental health care institutions. During these clinical rotations they further increase their experience and their clinical competence, by dealing with patients with more complex (and less standardized) pathology. In specific cases introductory training is given in the Skillslab, as a preparation for these clinical contacts.

In the sixth year the students specialize further in patient care and research, both 18 weeks. The Skillslab plays a very small part in these periods.

Teaching formats

In order to apply the principles described above, skills training in the Skillslab takes place in four stages: with models, with each other or patient instructors, with simulated patients and with patients.

Models
Many models are reasonable abstractions of reality. Most useful are those models or manikins that provide feedback to the student. In the case of the artificial arms mentioned above, the students know when they have punctured the vein because they are able to draw (artificial) blood. This way the model provides feedback about the quality of the action. In gynaecological examination the student can concentrate on how to place his hands or how to insert the speculum before having to deal with the interactive aspects of this examination. The students can practice at their own pace, in their own time, and as often as necessary before they move on to the next stage in practicing.

Each other
Practicing among peers has several advantages. Firstly, students experience what certain examinations may bring about. In this way they learn to picture themselves in the patient’s place, which will have positive effects on the way in which they will prepare patients for these examinations in the future. Secondly, students find out that there is a wide variety of findings that are still considered normal.

Patient instructors
Some aspects of the physical examination, like genital and internal examination are very intimate. The transition from models, via fellow students to patients is too extreme for these types of examinations. We therefore make use of patient instructors for the training of these examinations. Carefully selected men and women have been trained to be expert teachers in these fields. In the presence of a teacher, one patient instructor meets with one student during one hour. After a brief preparatory interview, in which the examination is described and the student’s knowledge about this area is refreshed and tested, the student examines the patient instructor. The patient instructor and the teacher guide him. Afterwards the patient instructor gives feedback on the technical and interaction qualities of the student’s performance.

Simulated patients
With the use of simulated patients students integrate the different skills and the knowledge they initially have acquired separately. They learn to apply the knowledge and the relevant skills to diagnose the patient’s problem, and to advise the patient. In this practising stage the training of skills gradually changes into the training of clinical competence.

Patients
Finally, in the most complex practicing stage in the Skillslab, the students train their diagnostic skills with the help of people with relatively stable dysfunctions. For example, at the end of a series of trainings concerning the examination of the thorax, students can thus experience the ‘success’ of being able to actually diagnose impaired lung functions with a patient.