By MINETTE CLAIRE O. ROSARIO, MD, FPCP, DPSMID

THE SIMULATION SPECTRUM RANGES FROM TASK trainers to standardized patients, human-patient simulation, screen-based simulation and hybrid patients.

Because of changes in healthcare delivery and concerns about the lack of objectivity or standardization of clinical exams, the dependence on patient contact in traditional medical training has led to the use of simulated patients for practice, learning, evaluation or to gain an understanding of systems or human action. Simulation has eliminated the opportunistic and random nature of classical bedside teaching and provides a safe and immersive environment that allows no harm to actual patients.

Medical simulation concept follows Kolb's experiential learning cycle, such that the simulation scenario is the experience, debriefing is the reflection on that experience, subsequent teaching and reading is conceptualization, and repeated experiences are the experimentation part of the cycle.

Kolb's Experiential Learning Cycle

Despite the many challenges of initiating and maintaining a simulation program (as to logistics and cost of manpower or equipment), the published articles on simulation in healthcare education are encouraging. The key to a successful simulation program is to choose the appropriate level of simulation that best achieves the objectives or learning outcomes of the medical curriculum.

By Dr. ISAURO Q. GUIANG JR.,
PDR Course Coordinator

THE TASK AT HAND WAS TO LEARN AND ABSORB as much as we can on the topic. My specific assignment was to attend sessions involving medical professionalism. The first session I attended was a workshop that attempted to define professionalism-a task that the group, in the end, found difficult because of the many interpretations and cultural angles that each delegate brought to the meeting.

Prof. Alastair Campbell defined a professional as "an individual trained and skilled in a craft and uses it for the needs of the society". This definition applies to a great many people. However, a "medical professional" is given a special status whether he likes it or not. According to Campbell, medical professionalism is not about academic excellence alone. It encompasses a "set of behaviors, values and relationships that underpins the public's trust on doctors". Not only do we have to continuously enrich ourselves with medical knowledge, we also have the responsibility of being society's guardians of that knowledge. Guardians of medical truths and know-hows who behave and interact in a way that society sees as respectable and worthy of their trust. They should be able to willingly entrust upon us the practice of medicine.

Corollary to this definition, it is therefore inevitable that there is a need to teach professionalism to future guardians-to-be. "Can it be taught?" was the opening question of Prof. Donald Hill, a speaker from the NUS Centre of Biomedical Ethics. He said professionalism can be effectively taught if the material/activity employed is close to real life context as possible. Activities or sessions as lectures followed by discussion of clinical scenarios where students explore the situation, discuss openly their insight, and then spend time to reflect on what was "experienced". Dr. Hill suggests writing an essay, reflection paper or a personal journal, as this paves the way for building a "professional identity" in a student.

Service learning is another scenario, where students "can learn on-the-job". The "Hidden Curricullum" is a set of values and behaviors that cannot be taught inside classrooms or through reading assignments. It is learned "in hospital hallways, corridors, wards and at the patients' bedside". Dr. Ponhamperuma, from the University of Colombo in Sri Lanka, suggests a simple but key strategy. Senior physicians, residents, mentors and consultants-while doing their rounds of patients-should explicitly point out desirable behavioral aspects in their medical practice. Behavioral aspects such as end-of-life decisions, patient-doctor relationships, communications skills, patient safety, etc. are all unnoticed by the novice practitioner or student. However, if specifically mentioned before entering a dying patient's room, then students are bound to absorb every moment of the experience.

Many other essential points were learned in the conference and many have already been incorporated in the UERMMMCI College of Medicine curriculum starting this school year. The Physician-Doctor Relationship (PDR) course is continuously undergoing refinement and this conference provided several new concepts. I appreciate the support of the UERM-College of Medicine Alumni Association Inc., as well as the Office of the Dean, for sending us to this conference.