Background:The COVID-19 pandemic has affected the delivery of face-to-face teaching especially bedside teaching for medical students in the hospitals. Rheumatology outpatient clinics have mostly become virtual or telephone consultation clinics which prevent medical students from seeing patients in person. Students are deprived of the opportunities to take rheumatology history, examining patients and seeing signs of rheumatologic diseases. New adaptations have to be made to ensure equitability and that students still receive the relevant teaching in line with their learning curriculum and to help them prepare for their examinations.Objectives:Our aims are:1)To adapt bedside teaching in the wards to simulated teaching in the classroom using trained simulated ‘patients’; and2)To create simulation teaching of patient journeys in Objective Structured Clinical Examination (OSCE) format known as Clinically Observed Medical Education Tutorials (COMET) (Nair et al., 2001).Methods:1)For simulated teaching in the classroom, we have trained our teaching colleagues as simulated or standardized patients (SPs). We write up fictitious patient histories which simulate common presentations at rheumatology clinics. We train the SPs to give as accurate a history as possible and to simulate pains in different joints (e.g. pain at the metacarpophalangeal joints and proximal interphalangeal joints in rheumatoid arthritis) on clinical examinations. For clinical presentations that are not easily simulated, we use photographs of the relevant signs. This method is used not only as formative assessments but also as end-of-placement summative assessments.2)COMET comprises 3 OSCE-style stations with a tutor each where the students perform different tasks based on a patient’s clinical problem (e.g. acute hot swollen joint). The first station is initial A-to-E assessment of the patient (using a simulator), followed by investigations and interpretations of lab results and imaging (station 2) and lastly, management (including prescribing medications) and communication skills (e.g. explain arthrocentesis to the patient).Results:The overall feedback from students is very positive. We use Likert scale to assess confidence level before and after the teaching session, and pre-session and post-session multiple choice questions to assess learning and knowledge gained.Conclusion:While simulated teaching cannot replace encounters with real patients, students do enjoy these sessions as they get to ‘experience’ a large variety of rheumatologic cases and practice their clinical skills which at times are limited with real patients due to reluctance and pain of the patients.References:[1]Nair, R., Morrissey, J., Carasco, D., Desilva, S. & Patel, V. (2001) COMET: Clinically Observed Medical Education Tutorial - a novel educational method in clinical skills. International Journal of Clinical Skills[2]Van der Vleuten, C.P.M. & Swanson, D.B. (1990) Assessment of clinical skills with standardized patients: state of the art. Teach Learn Med, 2: 58-76.Disclosure of Interests:None declared
Students’ Views on the Use of Real Patients and Simulated Patients in Undergraduate Medical Education