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Instant education: virtual treatment for clinical practice

First years are getting an early taste of clinical practice thanks to a groundbreaking scheme that allows them to treat ‘virtual patients’

Medical schools across the UK are showing interest in a unique pilot project that has been teaching a batch of first years to hold online consultations with ‘virtual patients’. 

Speech bubblesFor the past two semesters, 176 students at Leicester medical school have taken part in live virtual consultation scenarios using PKB (Patients Know Best) — an online, patient-controlled medical records system.

In this way, they can apply their academic learning to clinical situations and better develop their communication skills for future doctor-patient exchanges.

Working in small groups, students answer a weekly question sent from their assigned virtual patient via a password-protected online space that allows a private online exchange — which is monitored remotely by tutors.

The weekly question is developed by teaching staff and adapted by each ‘patient’, who is a volunteer chosen for their age, gender and background to establish an online character.


Learn from the young

Leicester innovation lead and senior teaching fellow Ron HsuRepresentatives from five UK medical schools, as well as students taking part in the pilot, attended a recent event where Leicester innovation lead and senior teaching fellow Ron Hsu (pictured right) explained why he took on the pilot.

Speaking at the Royal Society of Medicine in London, Dr Hsu said witnessing his own children’s instant messaging conversations had shown him that teaching needed to reflect the changing nature of social interactions.

‘I realised that the generation coming through are not only capable, but they will expect to be interacting in this way,’ he said. 

‘We do not teach our students much other than face-to-face consultation, [nor] a huge amount on phone consultation.’

Dr Hsu wanted to see whether it was possible to get the fundamental sciences modules linked to clinical interaction without the ‘paraphernalia’ and cost of getting real people in for face-to-face consultations.


Bring on the trial

After gaining agreement from colleagues to trial the project — a process Dr Hsu said took around two years — all new medical students were given their own iPad and assigned small groups to work in.

According to Dr Hsu, the students are working together more than he had seen previously, although he acknowledged that tutors had underestimated the social confidence of first years who are fresh from A-level courses.

‘We think because people have literally just left school, [they] may not have developed the social skills and understanding,’ he said, adding that it was not just about answering questions, but asking them too. 

Leicester students Bethany Sloan and Isobel RitchieLeicester first year Bethany Sloan (pictured on the left) admitted using PKB was ‘a little overwhelming’ at first, but said she really enjoyed the experience overall, adding it had paid to be open-minded about the pilot.

‘It has given us a chance to work together as a team in a safe environment to work through answering patients’ questions and work out how to explain complex things in patient-friendly ways,’ she said.

‘You might not always be perfect when you start at medical school, but opportunities like this [have helped] to improve our communication and team-working skills.’


Writing skills

Isobel Ritchie (pictured on the right), another first year, agreed that being launched into clinical work straight away had been nerve-wracking, but that PKB had been a helpful tool to build a team ethic.

‘I have found that some of the questions that patients [asked], I was not expecting, so it is always good to be surprised by that kind of thing,’ she said.

Ms Ritchie said she felt the benefits of using PKB spilled over into communication skills modules when she talked face to face to patients and made her think about phrasing things properly when writing.

‘It is more important how you write and explain things because you do not have the benefit of body language,’ she explained.

‘If it comes into the NHS in the future, it is really good we have been introduced to it so early.’


Joined-up thinking 

PKB founder Mohammed Al-Ubaydli said he had been fascinated to watch students discover a feature that allowed them to confer on the questions — collaborating and building on answers — before sending one response.

He said some then eventually moved on to asking their own questions to elicit more information from the patient.

‘That is a consultation — a dialogue — between the professional and the patient and the sooner they learn that the better,’ Dr Al-Ubaydli said.

In exchange for the use of the PKB software, Leicester’s medical school has agreed to share any teaching materials it develops under an open-access copyright licence for any other medical school to use.

Now, in addition to UK medical schools, international organisations have started to express interest. 


International interest

‘There were people from outside Europe who emailed us in advance, saying: “We want the video [from the event] as soon as possible — we want to start using this in our medical schools’’.’

BMA medical academic staff committee co-chair Peter DangerfieldDr Al-Ubaydli said e-consultation was something patients would come to expect.

‘In 10 years’ time, people will say, “How could you possibly not have taught things in this way?”’ he says.

BMA medical academic staff committee co-chair Peter Dangerfield (pictured right) added that e-consultations enabled a novel approach to be taken towards education — in particular communication skills, which allow a standardised approach to a key element of medical practice.

‘I would predict this will become a component of personal skill development in undergraduate and postgraduate healthcare education,’ he maintained.

 Listen to Leicester students and Dr Hsu talk about retired patients in the medical student podcast 


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