Course information (short description of the course, general information, and instructions, where and in which form is the course organized, necessary tools, instructions on class attendance and preparation, student obligation, etc):
Simulation of Clinical Skills is a mandatory course on the sixth year of the Integrated Undergraduate and Graduate University Study of Medicine in English. Comprising 8 hours of lectures and 125 hours of practicals, the course totals 133 hours, accounting for 6 ECTS.
The course is facilitated by an experienced team of medical educators and physicians from different departments, including Anaesthesiology, Resuscitation, Emergency, and Intensive Care Medicine, Internal Medicine, Gynaecology and Obstetrics, and Paediatrics. These educators are based at the Faculty of Medicine, University of Rijeka, and Clinical Hospital Centre Rijeka.
The primary objective of this course is to equip sixth-year medical students with the skills necessary to effectively respond to a variety of emergency medical conditions using simulation techniques. The course endeavours to enhance students’ decision-making skills, hone their clinical judgement, and develop their communication and teamwork abilities. This is achieved through a combination of concise theoretical overviews of specific medical skills and/or emergency medical conditions, and the practical application of this knowledge in simulations of real-world scenarios.
COURSE LEARNING OUTCOMES
After finishing the course, the student should be able to:
A. COGNITIVE DOMAIN – KNOWLEDGE
1. List the most common medical emergencies, including various causes of acute respiratory and circulatory failure, acute coronary syndrome and malignant arrhythmias, sudden neurological deterioration, sepsis and septic shock, fluid and electrolyte imbalances, hypovolemic shock, polytrauma, obstetric and gynaecological emergencies, and paediatric emergencies.
2. Describe typical clinical presentation and diagnostic tools for evaluating common medical emergencies.
3. Identify different causes of cardiorespiratory arrest.
4. Understand the indications for synchronized cardioversion and transcutaneous cardiac pacing.
5. Describe normal and pathological findings in airway assessment, including basic and advanced techniques for maintaining an open airway.
6. Characterize normal and pathological findings in breathing assessment, indications for oxygen therapy and artificial ventilation, and describe necessary equipment and techniques.
7. Explain normal and pathological findings in circulatory assessment and corresponding basic management strategies.
8. Describe neurological assessment, including Glasgow coma scale (GCS).
9. Understand the indications, contraindications, dosage, and complications of different types of intravenous fluids.
B. PSYCHOMOTORIC DOMAIN – SKILLS
1. Recognize and manage cardiorespiratory arrest according to advanced life support guidelines.
2. Conduct a structured assessment (ABCDE, SAMPLE) of simulated patients experiencing medical emergencies, identify pathological findings, and apply this knowledge to create a differential diagnosis and propose diagnostic plan.
3. Analyse results of basic diagnostic tests: laboratory tests (blood count, glucose and electrolyte values, urea, creatinine, cardiac and inflammatory biomarkers, BGA), coagulation tests, microbiology cultures, ECG, and chest x-ray.
4. Manage a simulated patient with a medical emergency, including selecting appropriate treatment and emergency procedures based on clinical findings and diagnostic results.
5. Identify and manage an obstructed airway, respiratory failure, acute coronary syndromes, and signs of increased intracranial pressure in simulated patients, and apply appropriate treatment.
6. Apply synchronized cardioversion and transcutaneous cardiac pacing on a simulation model as indicated.
7. Differentiate between the acute coronary syndromes and apply appropriate therapy.
8. Choose appropriate type and volume of intravenous fluid during fluid resuscitation.
9. Recognize positive qSOFA score in suspected infection and administer therapy according to the “first hour bundle.”
10. Correctly immobilize severely injured simulated patient on a long backboard and apply a cervical collar in suspected cervical injury.
11. Apply and assess the correct position of a pelvic splint.
12. Communicate effectively with team-members during clinical scenarios and other medical personnel during patient hand-over, fusing a structured approach (e.g. SBAR).
C. AFFECTIVE DOMAIN – VALUES AND ATTITUDES
1. Recognize the importance of structured patient assessment in high-stress situations.
2. Acknowledge the importance of early recognition of deteriorating patient and the need for prompt intervention planning.
3. Understand the significance of effective communication among medical personnel during medical emergencies.
4. Appreciate the specific challenges and constraints of providing medical care in out-of-hospital setting.
COURSE CONTENT
With the aim of realisation of learning outcomes, classes are organized in 10 thematic units that utilize simulation medicine to bridge the gap between theoretical knowledge and practical application:
1. STRUCTURED APPROACH TO MEDICAL EMERGENCIES
(How to assess, recognize and manage a deteriorating patient in a daily practice?)
L1 Introduction to the simulation medicine
L2 Cardiopulmonary Resuscitation Algorithm
L3 Initial assessment and hand-over of acutely ill patient (ABCDE, SAMPLE and SBAR)
L4 Essentials for interpretation of 12-lead ECG in medical emergencies
L5 Initial assessment and management of a patient with cardiac arrhythmias
P1 Recognition and management of a deteriorating patient; advanced life support: onsite workshop in conjunction with educational materials provided via Merlin e-learning platform
2. ACUTE RESPIRATORY FAILURE
(How to assess, recognize and manage a patient in acute respiratory failure in a daily practice?)
P2 Acute respiratory failure – background, assessment, recognition, and management: onsite workshop in conjunction with educational materials provided via Merlin e-learning platform
3. SUDDEN NEUROLOGICAL DETERIORATION
(How to assess, recognize and manage a patient with sudden deterioration in neurologic status in a daily practice?)
P3/part I Sudden deterioration in neurologic status: onsite workshop in conjunction with educational materials provided via Merlin e-learning platform
4. SEPSIS AND SEPTIC SHOCK
(How to assess, recognize and manage a patient with suspected sepsis/septic shock in a daily practice?)
P3/part II Sepsis and septic shock: onsite workshop in conjunction with educational materials provided via Merlin e-learning platform
5. FLUID AND ELECTROLYTE DISTURBANCES AND THERAPY
(How to assess, recognize and manage a patient with hypovolemia and/or electrolyte disturbance in a daily practice?)
P4 Fluid and electrolyte disturbances and therapy; hypovolemic shock: onsite workshop in conjunction with educational materials provided via Merlin e-learning platform
6. TRAUMA LIFE SUPPORT
(How to assess and manage injured, burned or poisoned patient in a daily practice?)
L6 Trauma Life Support
P5 Trauma assessment and management: onsite workshop in conjunction with educational materials provided via Merlin e-learning platform
7. CHARACTERISTICS OF MEDICAL EMERGENCIES IN OUT-OF-HOSPITAL SETTING
(How to assess and manage medical emergencies in out-of-hospital setting? What are the limitations regarding diagnostics and management?)
P6 Recognition and management of acutely ill or injured patient in out-of-hospital setting
8. CLINICAL SKILLS IN OBSTETRICS AND GYNAECOLOGY
(How to assess, recognize and manage gynaecological and obstetric emergencies in daily practice?
P7 Clinical emergencies in Obstetrics and Gynaecology
9. CLINICAL SKILLS IN PAEDIATRICS
(How to assess, recognize and manage paediatric emergency in daily practice?
L7 Initial assessment and management of paediatric emergencies
P8 Paediatric Emergencies and Life Support
10. THINKING IN PATERNS OF CLINICAL FEATURES IN WIDE DIFFERENTIAL DIAGNOSIS
(How to properly integrate acquired theoretical and practical knowledge in a wide variety of different medical scenarios and perform an effective communication between medical personnel?)
P9 Integrated simulation of all clinical skills – part 1
P10 Integrated simulation of all clinical skills – part 2
COURSE CONCEPT
The primary objective of the course “Simulation of Clinical Skills,” held at Skills Lab Simulation Centre (Kabinet vještina) and Out-of-hospital Emergency Medical Services (Zavod za hitnu medicine Primorsko-goranske županije), is to equip sixth-year medical students with the essentials skills and knowledge required to respond effectively to diverse emergency medical situations. The course employs advanced simulation techniques to enhance decision-making abilities, refine clinical judgement, and foster effective communication and teamwork.
Innovatively using the flipped classroom model, students independently study theoretical overviews of essential medical skills and specific emergency conditions via Merlin e-learning platform, prior to onsite classes. This independent study is followed by highly interactive in-class sessions, where the theoretical knowledge is tightly interwoven with practical simulation exercises. These theoretical segments aim to equip students with robust skillset necessary to properly recognize, assess, and manage varying medical emergencies.
Upon mastering the theoretical aspects, students are introduced to a range of simulation scenarios that mimic diverse clinical conditions. These scenarios provide an ideal platform for students to implement the theoretical knowledge they have acquired throughout the medical school and summarized during the theoretical parts of the classes. Each simulation is run by a team of students, consisting of one team-leader and 2-3 team members, and is moderated by a teacher. This structure ensures that students receive ample hand-on experience while also promoting effective team communication.
As a conclusion to each simulation scenario, a teaching discussion is held where personalized feedback is provided to each student. This feedback mechanism is integral to the learning process, enabling students to reflect on their performance and make necessary adjustments for future simulations.