For new medical students at De La Salle Medical and Health Sciences Institute (DLSMHI), clinical effectiveness is a concept that is inculcated from day one.
“Clinical effectiveness is the application of knowledge that you acquire from research, from your regular patient encounters, or maybe from the things that you learned inside a classroom – so it should be from day one in the College of Medicine that students learn where their basic knowledge will be applied to, and how it will help improve patient outcomes,” said Dr Madeleine Grace M. Sosa, Dean of the College of Medicine at DLSMHI.
Dr Sosa pointed to a shift to outcome-based education in the Philippines’ medical schools as one development that has emphasised the importance of clinical effectiveness in medical students. Issued by the country’s Commission of Higher Education in 2016, the shift in focus saw a restructuring of medical programmes to revolve around the outcomes and core competencies expected of graduates.
“The traditional way probably 30 or 40 years ago entails reading the textbooks, from basic anatomy, biochemistry to pathology, and then during the final years you start the clinical clerkship, which is the only time you are given the chance to integrate all of this in actual practice.”
“But now it is more integrated. For example, we focus on the cardiovascular system, where over several weeks we integrate physiology, biochemistry and anatomy aspects of it. At the end, we present a patient with certain symptoms, and ask – “How does the physiologic process go? How do you explain the anatomy of this? What is the biochemical mechanism that will happen if you have this symptom?” said Dr Sosa.
This allows students to experience first-hand how the textbook knowledge translates to better clinical effectiveness – in terms of diagnosis and treatment recommendations.
Impact of digital in medical education
While DLSMHI already had a digital learning platform before the pandemic, which allowed classes to continue, the bigger impact was on third year and fourth year students, who were supposed to have a stint in a hospital setting, working and interacting with patients.
With those cancelled, the faculty has turned to digital video conferencing tools to conduct virtual conferences between students and consultants, virtual rounds with patients, and also surgical walk-throughs, where the surgeon is in the operating room and the students are watching from home.
Other examples of digital tools adopted by the school include a virtual patient programme, which “is like examining an actual patient digitally”, explained Dr Sosa. Students are presented with patient cases, each with a set of symptoms and data, and are prompted on the type of questions to ask and steps to be taken. This has served as an alternative to physical patient encounters in the wards.
Evaluation of most appropriate tools
The adoption of such digital tools are assessed carefully by the school, to ensure that the investments made do reap benefits for the students.
One criteria for DLSMHI is the accessibility of the tool. “Our faculty range from the most senior to the younger ones, so it’s a very diverse group,” Dr Sosa noted. “If we use a certain tool, it has to be accessible to all ages at all times. They should be able to know how to use it through self-tutorials.”
Another consideration would be the estimated utilisation rate. With information now readily available over the internet, and existing resources on hand, the school has to deliberate if the new tool will indeed add value to the students.
“We don’t want to buy and get a digital tool which the students will not be using at all, or may not be their preference,” Dr Sosa explained. “A lot of information is already available on the Internet – they can easily search on Youtube or Google to learn about a topic. How credible or useful is this tool going to be, in terms of the students’ acquisition of knowledge? That will be our consideration.”
UpToDate as a teaching tool
With these criteria in mind, DLSMHI had subscribed to UpToDate, an evidence-based resource of the latest medical information and best practices.
“I think UpToDate is a very important tool for us to use, because there’s really a disconnect between what you teach in medical school and what you actually see in the workplace, if you are not going to be updating yourself on the current treatment and diagnostic plans, or management tools,” noted Dr Sosa.
Over the past few years, she has noticed increasing utilisation of UpToDate amongst faculty. She attributes that to the speed of updates that the tool provides, which faculty can quickly incorporate into their lessons.
“There are always updates on certain diseases or conditions, clinical practice guidelines or clinical pathways,” said Dr Sosa. “When the faculty members do up their syllabus and instructional design, the questions in their teaching guide will always include – What’s the update in the management of patients? What’s the latest update on the diagnostics? What’s the best evidence that you will see or use to make the correct diagnosis and treatment plan?”
“The guide will always include application of research evidence in diagnosis and management, and I think that is where UpToDate will play a very vital role,” said Dr Sosa.
Accessibility is key
With digital tools being used extensively at the school over the past year, Dr Sosa noted that both faculty and students have adapted to the utilisation of them. “Though our faculty members are of various ages and come with different levels of digital knowledge, we are glad that eventually with the accessibility of the tools and usage tutorials, they have learnt how to really apply these in their regular teachings.”
“For our students, though they are already technologically savvy, the important thing is to explain why we need to use it, and then how you’re going to use it and what will be the advantage of using all of these tools. Once they understand these points, I think it’s going to be easy for them to really adopt, use and make the most out of the tools.”
The value and usage of such digital tools look set to increase, as the rise in Delta variant cases in the Philippines mean that classes at DLSHMI will continue virtually. However, not all digital tools are created equal, and medical schools will need to clearly assess the ones that would bring the most value – such as how UpToDate helps provide DLSHMI faculty and students with trusted medical updates.
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