Clinical Skills & Clinical Encounter

Course goals

Objectives and content

The content of the CSCE program focuses on the teaching and training of medical-technical skills (clinical skills) and basic communication skills (clinical encounters). This program consists of two parts. Part 1 includes the period until the Entrance Examination Student Clinics and part 2 the period until the Final Examination CSCE.

Clinical Skills
The objectives of the CS program are:

• To be able to perform a basic physical examination in a clinical setting
• To correctly report the findings of a basic physical examination in the patient's medical history.
• To perform basic resuscitation on medical phantoms according to the NRR (Dutch Resuscitation Council)-protocol
• To develop other medical skills such as injecting pharmaceuticals and wound care.
   

The main requirements for performing a basic physical examination will repeatedly be covered throughout the year. These are:

• Professional conduct: professional attitude of the physician during the consultation with the patient; this is simulated during each teaching session
• Anatomy in vivo: paying attention to live human anatomy 
• Reliability of the findings
• Interpretation of the findings
• Recognition of pathological findings

Clinical Encounter (communication proficiency and interpersonal skills):
The objectives of the CE program are:

• To learn important skills of the clinical encounter: exploring, structuring, and leading of doctor-patient communication.
  • This is thought for all phases of the consult: identification of the patient’s main question, planning diagnostics and the medical plan.
• To professionally structure the doctor-patient (or doctor-colleague) relationship in order to establish trust and to manage conflicts.
• To demonstrate empathy and respect for the opinions and emotions of patients and colleagues.

To strive for a doctor-patient relationship based on equality. Retaining personal responsibility as a physician while allowing the patient to influence decision-making.

Work formats

CS-instruction
The CS program consists of 19 sessions. During each session, we aim to spend the majority of the time to practicing skills. E-modules prior to teaching sessions will provide background information.  In many of these sessions students will practice skills either on each other or on medical phantoms. When practicing on each other is required, every student is expected to be willing to act as a ‘patient’. For this purpose the student may have to partially undress.
A practice examination session is held in preparation for the Entrance Examination Student Clinics (SP) and the Final Examination CSCE.
Most of the sessions have a duration of three hours. These sessions will be attended by a group of 10 or sometimes 20 students, supervised by a physician/clinical skills instructor.

Throughout the academic year, students have the opportunity to independently practice the learned skills (docent onafhankelijk trainen, DOT; [Instructor Independent Training]) in specially equipped KVO (Klinisch Vaardigheids Onderwijs, KVO [Clinical Skills education]) classrooms. Students must make reservations for practice time in these classrooms through a Blackboard-based online registration.

A separate monthly CS-consultation is provided for students who wish to discuss content-related questions or to practice skills with a KVO-teacher. For this, preregistration is required. Preregistration is possible at the KVO desk on the third floor of the Heijmans van den Bergh building. It is also possible to ask fellow students and KVO-teachers a question via the digital discussion forum in Blackboard.

CE-instruction
The CE program consists of 10 three-hour sessions. The course includes the following themes: respectful attitude and confidence-building, posing questions expertly, active listening and understanding, interpreting non-verbal communication, clarifying the symptoms and the main complaint, exploring and managing emotions, and conducting results/ 'bad news' consultations

Clinical skills are developed using several work forms: role-play exercises in subgroups, mandatory sessions with fellow students and simulated patients, recordings of simulated patient contacts. 
Each subgroup consists of 10 students. CE instructors are behavioral scientists. A practice examination session is held in preparation for the CSCE final examination.

Additionally, a separate monthly CE-consultation exists for students who wish to discuss content-related questions with a KVO-teacher. For this, preregistration is required. Preregistration is possible at the KVO desk on the third floor of the Heijmans van den Bergh building.

CSCE Integration sessions
Two CSCE integration sessions are scheduled (in December);  During these sessions, a full medical consultation is simulated in order to practice integrating CS- and CE-skills . This includes identification of plausible diagnoses. The full medical consultation is practiced either with fellow-students or simulation patients; this includes integrating the information obtained from the medical history-taking and the physical examination, in order to summarize the information, and explain plausible diagnosis. During these lessons, both physicians and behavioral scientists are present as instructors.

Place within the curriculum
The clinical skills and clinical encounters sessions begin during week 1 (calendar week 36) of year 1, and comprise part of the educational steam Clinical Practice.


Literature
The course handbook includes check-lists, sample reports, and E-modules for the CS-sessions and is available on Blackboard. The content of the CS-instruction is based on the following sources:

• De Jongh TOH, Buis J (red.). Fysische diagnostiek. 2015 Bohn, Stafleu van Loghum With films (mandatory textbook)
• De Jongh TOH, Jongen-Hermus FJ, Daelmans HEM, Dekker MJ, de Klerk-van der Wiel I, Schouwenberg BJJW. Praktische vaardigheden 2020, Bohn, Stafleu van Loghum  ISBN 987 90 368 2403 3. With films (recommended textbook)
• Additional recommended literature for specific lessons can be found in the course handbook.

 
The course handbook for the CE-instruction is also available on Blackboard. The content of the CE-instruction is based on the following:
Silverman J, Kurtz S en Draper J. Vaardig communiceren in de gezondheidszorg: een evidence-based benadering. Lemma, 2014 ISBN 978‐94‐6236‐359‐5

Assessment CSCE
In order to be allowed to participate in the CS- and CE-assessments the conditions regarding attendance and study requirements (up to the assessment) must have been met.
A practical examination takes place twice during the academic year: The Entrance Examination Student Clinics part 1 of CSCE), and the Final Examination CE/CE (part 2 CSCE). Students demonstrate the acquired abilities and are observed and assessed by instructors. Detailed information pertaining to the structure, content and organization of practical examinations are available on Blackboard (including instructions).  

Contact
Drs. Linda van de Bunt Docent CS/Medisch Technische Vaardigheden afdeling Klinisch Vaardigheidsonderwijs, mail: l.vandebunt@umcutrecht.nl; Drs. Sjoukje van den Broek, Coördinator en docent CE/ Communicatie & Attitude afdeling Klinisch Vaardigheids Onderwijs; W.E.S.vandenBroek@umcutrecht.nl

 

Content

Objectives and content

The content of the CSCE program focuses on the teaching and training of medical-technical skills (clinical skills) and basic communication skills (clinical encounters). This program consists of two parts. Part 1 includes the period until the Entrance Examination Student Clinics and part 2 the period until the Final Examination CSCE.

Clinical Skills
The objectives of the CS program are:

• To be able to perform a basic physical examination in a clinical setting
• To correctly report the findings of a basic physical examination in the patient's medical history.
• To perform basic resuscitation on medical phantoms according to the NRR (Dutch Resuscitation Council)-protocol
• To develop other medical skills such as injecting pharmaceuticals and wound care.
   

The main requirements for performing a basic physical examination will repeatedly be covered throughout the year. These are:

• Professional conduct: professional attitude of the physician during the consultation with the patient; this is simulated during each teaching session
• Anatomy in vivo: paying attention to live human anatomy 
• Reliability of the findings
• Interpretation of the findings
• Recognition of pathological findings

Clinical Encounter (communication proficiency and interpersonal skills):
The objectives of the CE program are:

• To learn important skills of the clinical encounter: exploring, structuring, and leading of doctor-patient communication.
  • This is thought for all phases of the consult: identification of the patient’s main question, planning diagnostics and the medical plan.
• To professionally structure the doctor-patient (or doctor-colleague) relationship in order to establish trust and to manage conflicts.
• To demonstrate empathy and respect for the opinions and emotions of patients and colleagues.
• To strive for a doctor-patient relationship based on equality. Retaining personal responsibility as a physician while allowing the patient to influence decision-making.

                       
Work formats

CS-instruction
The CS program consists of 19 sessions. During each session, we aim to spend the majority of the time to practicing skills. E-modules prior to teaching sessions will provide background information.  In many of these sessions students will practice skills either on each other or on medical phantoms. When practicing on each other is required, every student is expected to be willing to act as a ‘patient’. For this purpose the student may have to partially undress.
A practice examination session is held in preparation for the Entrance Examination Student Clinics (SP) and the Final Examination CSCE.
Most of the sessions have a duration of three hours. These sessions will be attended by a group of 10 or sometimes 20 students, supervised by a physician/clinical skills instructor.

Throughout the academic year, students have the opportunity to independently practice the learned skills (docent onafhankelijk trainen, DOT; [Instructor Independent Training]) in specially equipped KVO (Klinisch Vaardigheids Onderwijs, KVO [Clinical Skills education]) classrooms. Students must make reservations for practice time in these classrooms through a Brightspace-based online registration.

A separate monthly CS-consultation is provided for students who wish to discuss content-related questions or to practice skills with a KVO-teacher. For this, online preregistration is required. It is also possible to ask fellow students and KVO-teachers a question via the digital discussion forum in Brightspace.

CE-instruction
The CE program consists of 10 three-hour sessions and three ‘consulting room’ sessions with simulated patients. The course includes the following themes: respectful attitude and confidence-building, posing questions expertly, active listening and understanding, interpreting non-verbal communication, clarifying the symptoms and the main complaint, exploring and managing emotions, and conducting results/ 'bad news' consultations.

Clinical skills are developed using several work forms: role-play exercises in subgroups, mandatory sessions with fellow students and simulated patients. The ‘consulting room’ sessions with simulated patients are recorded.
Each subgroup consists of 10 students. CE instructors are behavioral scientists. A practice examination session is held in preparation for the CSCE final examination.

Additionally, a separate monthly CE-consultation exists for students who wish to discuss content-related questions with a KVO-teacher. For this, online preregistration is required.

CSCE Integration sessions
Two CSCE integration sessions are scheduled (in December);  During these sessions, a full medical consultation is simulated in order to practice integrating CS- and CE-skills . This includes identification of plausible diagnoses. The full medical consultation is practiced either with fellow-students or simulation patients; this includes integrating the information obtained from the medical history-taking and the physical examination, in order to summarize the information, and explain plausible diagnosis. During these lessons, both physicians and behavioral scientists are present as instructors.

Place within the curriculum
The clinical skills and clinical encounters sessions begin during week 1 (calendar week 36) of year 1, and comprise part of the educational steam Clinical Practice.


Literature
The course handbook includes check-lists, sample reports, and E-modules for the CS-sessions and is available on Brightspace. The content of the CS-instruction is based on the following sources:

• De Jongh TOH, Jongen-Hermus FJ, Damen J, Daelmans HEM, Franssen R, de Klerk-van der Wiel I, Pieterse AD, Schouwenberg BJJW en Schuring F Fysische diagnostiek. 2022 Bohn, Stafleu van Loghum 978 90 368 2786 7. With films (mandatory textbook)

• De Jongh TOH, Jongen-Hermus FJ, Daelmans HEM, Dekker MJ, de Klerk-van der Wiel I, Schouwenberg BJJW. Praktische vaardigheden 2020, Bohn, Stafleu van Loghum  ISBN 987 90 368 2403 3. With films (recommended textbook)
• Additional recommended literature for specific lessons can be found in the course handbook.

 
The course handbook for the CE-instruction is also available on Brightspace. The content of the CE-instruction is based on the following:
Silverman J, Kurtz S, Draper J, Timmerman A. Vaardig communiceren in de gezondheidszorg: een evidence-based benadering. 2022, Boom ISBN 9789024446674

Assessment CSCE
In order to be allowed to participate in the CS- and CE-assessments the conditions regarding attendance and study requirements (up to the assessment) must have been met.
A practical examination takes place twice during the academic year: The Entrance Examination Student Clinics part 1 of CSCE), and the Final Examination CE/CE (part 2 CSCE). Students demonstrate the acquired abilities and are observed and assessed by instructors. Detailed information pertaining to the structure, content and organization of practical examinations are available on Brightspace (including instructions).  

Contact
Drs. Linda van de Bunt Docent CS/Medisch Technische Vaardigheden afdeling Klinisch Vaardigheidsonderwijs, mail: l.vandebunt@umcutrecht.nl; Dr. Sjoukje van den Broek., coordinator and instructor CE/ Communication skills, Department of Clinical Skills training, mail: W.E.S.vandenBroek@umcutrecht.nl