MCG-GHSU Clinical Skills Program Shaping Future Doctors

Medical students are improving clinical skills by using simulated patients and extensive practice

By: Katie Sykes

The Medical College of Georgia and the Georgia Health Sciences Institute Partnership has developed unique curriculum techniques intended to reinforce clinical skills.  While all medical schools are required to cover uniform material, the partnership has decided to move emphasis on these skills to the next level by using volunteer actors and extensive time working on clinical skills.

Barbara Schuster, Dean of MCG-GHSU, says clinical skills can include history taking, physical exam skills, laboratory skills and investigational skills, all of which a doctor needs relating to patient care.

“I was taught 90 percent of diagnoses are made through the history,” Dean Schuster said.  “For five percent you need a physical exam, and you only need a laboratory for the last five percent. Of 100 percent of your diagnoses, the majority will be made by asking and listening.  So, those are really important skills.”

On Tuesday or Thursday, partnership students break into clinical skills groups, composed of four students and one professional.  Typically, the professional is a doctor from the community.  Each week, a topic is presented to help students practice their clinical skills in the group.

“I think the very first one we talked about was getting to know the patient – just getting them to open up to you and having that conversation in a normal, facilitated fashion,” said Bijal Vashi, second-year student.

Vashi explained that the group facilitator would demonstrate the kind of conversation a student should be having.  The students would then practice with one another.  After practicing, students are tested on applying the clinical skills with a simulated patient.  Simulated patients are volunteers from Athens community who act out a particular kind of patient.

“We have been fortunate to have about 45 or 50 volunteers from the community who come in and act as our patients,” Dean Schuster said.  “They are coached by the Theatre School presently.  Some of the theatre students now can take a course about simulation in medical education.”

As volunteers work with medical students, the clinical skills professor is able to watch this interaction through cameras in the room.  The students are graded on how well they demonstrate the expected clinical skills.

Andrew Miller, first-year student, explained that clinical skills are more complicated than one might assume.  

“It’s one thing to ask questions to somebody,” Miller said. “It can be a little more difficult to ask questions in a way to organize a diagnosis, with your questions ruling things in and ruling things out.”

Miller and Vashi said they have really benefited from the clinical skills program.  While they enjoy the results now, the students had to adjust to the pressure of being on camera.

“We really did have to ignore the fact that there’s a camera watching you from two different angles and a microphone right above your head,” Vashi said. “I think we had to get over the fear of making a mistake.  That’s the whole point of the situation, learning to adapt to every patient as an individual and every patient being different.”

Students initially focus on body language and approach when interacting with patients their first year.  Towards the end of their first year, students practice taking notes while interacting as well.  During their second year, students work in hospitals and are able to begin applying their skills.

“In the second year, we progress and they begin to practice that history taking along with their communication skills and physical exam skills,” Dean Schuster said. “They do it in other areas, a few times here with our volunteers. More often, they go two weeks out of four to local hospitals.”

First year students interact with simulated patients who act out varying traits, such as those of an angry patient, and students are expected to respond accordingly.  Vashi said she has found practicing these skills helpful now that she is actually in a hospital.

“I’ve run into patients that are upset and start crying during my interview with them in the hospital,” Vashi said. “Having dealt with the simulated patients with extreme emotions here (at MCG-GHSU), helped me do so in the hospital as well.”

Dean Schuster said that the clinical skills curriculum ideas came from all over. She explained that she and many of her colleagues believe clinical skills are core to being a physician and are thus passionate about seeing the program succeed.

“I think many schools are beginning early, but I think we are spending more time and offering more extensive feedback,” Dean Schuster said. “We are really hoping to move those skills along and tell people that these are important.”

Dean Schuster hopes to continue to emphasize these skills throughout students’ time at MCG-GHSU as opposed to stopping after the second year.

“We really need to find a way to do it in the clinical year when they know more and they’ve experienced more,” Dean Schuster said.

Miller and Vashi believe the clinical skills program has improved their ability to interact with patients thus far.  Vashi hopes to see other medical schools place equal emphasis on clinical skills in the future.

“I really hope they do,” Vashi said. “It’s kind of a loss to the students to not act like this. If the first time you are actually interacting with a patient without any guidance along the way is during your third year, that’s really sad.”

Miller said he’s never heard of anybody doing clinical skills as MCG-GHSU students do.  Miller’s peers who attend other medical schools spend less time on clinical skills and generally practice on one another only.  He said ultimately, he thinks the partnership’s focus on clinical skills will pay off, as their practice will be apparent during their residencies and in their careers.

“They will tell you again and again, the best doctors are the ones that do the best histories and physicals,” Miller said. “I think as people start coming out of schools like this, that emphasize clinical skills a lot more, it will start to catch on.”

Magazines Aren’t Just for Reading

Rwandan women use scraps of newspapers and magazines to make unique jewelry.

By Kaitlyn Frizzell

A group of women sit around a table placed on a dirt floor in the city of Kigali. Newspapers and magazines cover the table top along with bowls of sealant, beads, and wire. Each woman uses her hands as her tool. They carefully place each plastic bead in a creative order and prepare pieces of paper to make their jewelry. She holds a bead in one hand and wraps the colorful paper around the bead. The angular shape makes the paper increase in thickness towards the middle and thin out towards the ends. This makes a unique shape that is popular among the jewelry makers. Then, she takes the sealant and layers it on the paper. The sealant holds the shape of the bead. She continues to do this until dozens of beads are made and can be put together to form a necklace.

The women that make this unique jewelry come from Rwanda, a country in Central Eastern Africa. They try to make do with what they have since their country had a genocide in 1994. The people are slowly healing, but still look for work and a way to provide for their families. The women have found a way to do just that.

Alicia Davis, a member of Hopewell Baptist Church in Gainesville, Ga., has been to Rwanda nine times since 2002. However, she did not realize the success of these necklaces until a few years ago while on a mission trip to the country.

“This way of making beads has been going on for generations in their families,” Davis says. “It is their livelihood… how they make their money.”

The beads themselves can be traded in the markets for other items the women might need, but also can be made into several jewelry items. The women are able to make more profit if the beads are available in different types of jewelry.

“I’ve seen these beads on earrings, bracelets and rings,” Davis says.

Davis says there is actually another way the women make the beads. Instead of wrapping paper around a plastic bead, the women use a wire.

“The women wrap the paper around the wire and chose to increase or decrease the thickness of the shape,” Davis says. “Then, when the shape they want is made, they use the sealant on the paper to hold it in place and remove the wire from the middle which creates a hole for the thread to go through.”

Not only is this giving the women money, they are recycling as well. The women use scraps of newspapers and magazines for the shape of the bead.

“They mostly use the magazines for the colorful beads,” Davis says. “It is an easy source for them to find and use.”

Instead of littering old newspapers or throwing away magazines in dumps, the women have found an abundance of material to use.The Rwandan women may not see this as recycling, but in the process of helping their families, they are also helping the environment.

Most of the Rwanda women make the beads and sell to local markets within their community, but recently some stores and organizations from the United States have taken notice of these interesting pieces.

Lifeway Christian Store and Rahab’s Rope set up sections in their stores to display the necklaces. When a customer buys the necklaces, the proceeds go directly to the women in Africa.

Other organizations buy the necklaces directly from the women in Rwanda then sell them here in the United States.

Katie Early, a student at Lanier Technical College, says the beads are something different than the other jewelry seen in the United States.

“I think they are a great visual representation of what part of Africa they come from,” Early says. “You can tell that whoever made them has a great love for their country.”

Davis believes their popularity has grown in the United States due to our cultural interests and styles. She has seen the beads at trade shows in Atlanta and local stores.

“People love the colorful and eclectic look to the necklaces,” Davis says. “Right now, the Bohemian look is big and people like that it’s made by hand.”

The ability to make jewelry out of something as simple as paper has caught the attention of many people. The Rwandan women use their skills to provide for their families and, little do they know, start a trend around the world.