1.Using a case/vignette introduce the reader to "WHAT to do" and "HOW to do" it when performing a clinical skill e.g. You're sent to see a newly admitted 35 years old patient who presented with cough and shortness of breath for 7 days. What will you do and how? i.e. history and physical exam

2.using acronyms to remember what and how to do things e.g. WIPE. Similarly acronyms that can help learn, present, or gain more from being around doctors who have limited time e.g. SNAPPS, RIME, etc

Scenario proposed a "Situation", "What to do?", "How to do it?" and resources to learn more.

e.g. Sarah, Tanya, Adam, and Rajesh (known among their batch as the STAR group) are assigned as one group to the same primary care (PC) placement in their second year of the medical school. Their first week at the PC was very exciting as their supervising doctor asked them to meet a 58-year old patient who attended the clinic for a routine annual health check. They felt that they could apply what they learnt in the clinical skills sessions at school when doing a throrough physical examination. Sarah suggested they take ten minutes before they meet the patient to go through what they would like to do. The first thing that came to their minds was the WIPE acronym which includes Wash your hands, Introduce yourself & ask about patient’s name & identity, Procedure explanation, Permission to examine the patient. Privacy, Position the patient appropriately, Pain: enquire if the patient is in pain, Exposure to be limited to the part being examined as you proceed, Equipment-check. They then reminded each other of the need to start with a general inspection, then doing the examination by starting with the hands and arms, moving to the head and neck down to the chest and abdomen then down to the lower limbs whilst doing inspection, palpation, percussion and auscultation as they moved to a different part of the body as relevant. (see figure ? checklist for this exam)

• A preamble about learning in health professions, introducing the concept of authentic learning and how to optimise one's learning experience (Ayad)

• Introduce simulation as means for authentic learning

• Define what "simulation-based learning" means

• Forms of simulation in health professions education: part-task, whole-task, low, medium and high fidelity, patients (virtual, simulated, standardised, or volunteer)

• How to optimise learning through simulation

• Overview on assessment of learning following simulation or clinical learning

• What is OSCE?

• How does simulation-based learning prepare students to OSCE

• Strategies for effectively preparing for OSCE, time management, structured clinical examination, and reflection or feedback,

• How to develop confidence in clinical abilities and improve performance in simulated contexts 

• How does simulation-based learning prepare students to real-world practice

• How to develop confidence in clinical abilities and improve performance in patient-care environments (survival tips for clinical placement)

e.g.

John Driscoll's reflective framework

What? Describe the experience, including the facts and feelings (description)

So what? Analyse the experience and make sense of what it means (analysis of significance)

Now what? Use the learning from the previous stages to create an action plan for the future (action plan to inform future practice)

5Fs: Facts, Feelings, Findings, Future

How can AI help me learn better? discuss approaches, principles of use, and examples of platforms currently used by medical and health professions students globally e.g. GIZMO, etc

Can AI help improve or support my patient care?

What if you were a student in your first clinical year e.g. year3, what content in this chapter would attract you to reading it happily and thoroughly?

What if you were a student preparing for an upcoming high fidelity simulation session on trauma management, what content in this chapter will make you want to read it thoroughly?

What if you were a student preparing for an OSCE, what content, tips, advice in this chapter would you be looking for?

What if you were a student who received your first OSCE feedback in writing (example,1,2,3), how will you deal with such feedback?

What if you were asked to write a reflective piece for your portfolio, how will you do that?

What if you were asked to be prepared to demonstrate a physical examination in a clinial round in front some of your classmates and other doctors in training, how would you prepare for that and what will you do on the day?

What if you were assigned to a clinic with a very busy clinician who barely finds time to greet you when you arrive or leave, how will you ensure to maximise your learning experience during such placement?

Preparing for an OSCE

• Identify a partner/group that you feel you can work well with - have similar goals

• Practice early and regularly - do not focus solely on examinations - communication skills are key!

• Make your own checklists (using appropriate teaching and trusted sources) - your checklist will be different from other peoples. - follow the same style for each possible OSCE scenario - the repetition makes it easier to remember in exams

• Practice with family or friends that have little to no medical knowledge - this will ensure that you can correctly explain and understand

• Learn when out on placement - practice on people with real life pathology and signs - this helps to understand WHY examination signs are relevant and can help with differentials in an OSCE

  
  

How to approach any physical examination

• WIPER

• Look, Feel, Move, Listen (+special tests)

• IPPA - Inspection, palpation, purcussion, auscultation

Quick, and easy to remember acronyms that can help in any clinical examination - especially in high stress situations such as exams

How to approach any communication station

• ICE-BAR - Introduce yourself and gather patient identity, Check concern/agenda, Explore ideas, concerns, expectations, Be clear and empathetic, Address the problem, Recap, reassure, and safety net

How to interpret and approach constructive feedback

• Consideration that first time feedback can be difficult for any student - and to not take this as a personal attack - it is an opportunity!

• You can let your tutor know in the next session that you are working on (X...) and ask them to give you specific feedback on this to monitor improvement

• SMART action plans - this is a useful tool for breaking down each point and being productive to make changes

• Try new things - different methods work better for different people. Give it a go and see in real time if it works for you

How to effectively manage time in an OSCE

• Break each station into 3 parts - introduction and explanations (2-3mins), main task (3-6mins), summarise, safety net, and questions (2mins)

• Practice these OSCE scenarios in real time with a partner - do not skip or rush over points during practice. This will allow you to get realistic timings

• Prioritise - if time is short, know what the station was asking from you so you can choose which parts are more important

• Listen for the timers - with 2 minutes remaining start thinking about closing the OSCE

-it might be nice to follow a group of students during this section who all encounter different challenges (intense supervisors, lack of confidence, independent learning etc.)

• Could include a top tips section (or survival guide) - how to impress/ how to get the most out of a placement

• How to approach challenges on placement - i.e. being interrogated on ward rounds.

• Communicate with other members of the team - learn about their roles - their experience can also be useful to you

• Know who to contact if you need support - some days can be stressful

Clinical examinations/patient interactions

• Be prepared - the OSCE techniques learned already are useful here - know the basics

• Have a structure (ABCDE, SOCRATES, WIPER) - real patients can often divert the conversation away from relevant topics

• Real patients can often present differently to simulated ones - it is ok if it takes more time in this setting

• Be keen - examining/talking to patients (if appropriate) is the best way to gain confidence in your ability

• Be observed - this can be scary, but the feedback from this will be valuable

• Work as a team - gain the confidence as a part of a team, until you are ready to try alone

• The patient will not know if you have made a mistake during your examination - so do not feel embarrassed by this - confidently correct the error

How to make the most out of a busy placement

• Sometimes a supervisor simply does not have time to teach you or supervise your placement day, it is important to have a plan in place if this happens

• Establish what tasks you can perform independently (history/exams)

• Inform someone about what you will be doing before hand

• Speak to as many patients as possible

• Find a patient and learn everything about their case - use their records too

• Shadow a member of staff - does not have to be someone from your profession

• Achieve what you can - and then it is OK to consider doing independent learning/study time

• Myocardiac infarction

• Jaundice

• Tuberculosis

• Hypertension

• Rheumatic fever

• Epilepsy

• Asthma

• Diabetes

• Stroke

• Cancer (and treatment if so)

BOXES for considering investigations:

• Bloods

• Orifices

• X-rays

• ECG

• Special tests

  
  

DRUGS for medical history taking

• Doctor (prescribed)

• Recreational (Alcohol, Smoking, illicit drugs)

• User (OTC/Pharmacy medicines including creams/lotion/gels, inhalers, sprays, patches, drops, suppositories/pessaries, herbal remedies)

• Gynaecological (contraceptives / HRT)

• Sensitivities

• Inspection (environmental, general, regional)

• Palpation

• Percussion

• Auscultation

MSK exam:

• Look

• Feel

• Move

An example checklist made by integrating university teaching materials and other learning resources (importance of active learning, making associations to pre-existing knowledge from other disciplines e.g. anatomy and developing clinical reasoning)