Image médecins généticiensOne of the greatest difficulties inherent to clinical genetics is the challenge of dealing with complex clinical situations. This complexity owes much to the low prevalence of rare illnesses, the severity of their symptoms and the fact that many of them currently have no effective alternative treatments.
In order to rise to these challenges, the use of simulated consultations with trained actors is the perfect way to prepare junior doctors to handle complex situations.
This innovative teaching method will help future genetics specialists to provide better care to patients suffering from genetic conditions.
This scheme has been developed in response to the reform of graduate studies, due to come into force at the start of the 2017-2018 academic year.
These teaching days will form part of the junior doctors' training programme, complementing the theory sessions already organised at national level. As with more traditional lectures, we aim to provide this training to all junior doctors enrolled on the Specialised Diploma in Medical Genetics programme (DES 48), with a view to harmonising the clinical genetic teaching available to all French students.

An innovative project


The aim of this educational project is to improve the training and evaluation of junior doctors specialising in genetics (DES 48) by means of simulated consultations.

The objectives are as follows:
  • to evaluate students' capacities when faced with concrete situations, in terms of theoretical knowledge, know-how and manner
  • to train students: identifying difficulties and working to overcome them, providing targeted support throughout the cursus

Implementation of the project


We propose to organise four teaching days per year, with two sessions of two days each for junior doctors enrolled on DES 48, a total of around 60 students nationally (years 2 to 4). The first session will take place in February, with a second session in June.
The first day will adopt a "flipped classroom" approach. We propose to put eight clinical situations online via the Theia digital platform, made available to the students two weeks before the scheduled sessions.
Examples of clinical situations:
  • "A 35-year-old male patient has been referred to you by his cardiologist for a dilation in the ascending aorta;"
  • "A 4-year-old child is showing signs of psychomotor retardation..."
The students will be asked to list the different steps of their consultation, specifying the information they would need to obtain in each clinical situation regarding the patients' family history, personal medical history, clinical examinations and, where relevant, which additional examinations (particularly genetic analyses) would be advisable.
The students' answers will be gathered by the course tutors via the online platform and discussed in seminars on the first day of training, giving students and teachers a chance to discuss and debate the questions raised.
This theoretical preparation will act as a warm-up for the second day, which will be devoted to simulated consultation sessions with actors. There different scenarios will be presented to each junior doctor. They will be asked to hold 25-minute consultations, followed by 5 minutes of "debriefing" time with the actors, followed by a more comprehensive debrief with the tutors and other students. The scenarios are designed by the tutors, and become progressively more difficult as the junior doctors advance through their cursus (an example of a genetic clinical case which might be used early on in the course is given in Appendix 1; we would then move on to more complex cases later in the programme, including announcing diagnoses).

Students will be assessed on their:

Knowledge
  • ability to gather information on the patients' medical history which will be useful when forming a diagnosis in these clinical situations;
  • ability to formulate pertinent diagnostic hypotheses on the clinical situations at hand;
  • capacity to prescribe pertinent further examinations based on the results of the consultations;
  • ability to provide relevant genetic analysis and advise the patients accordingly.
Know-how
  • ability to examine patients and detect clinical symptoms which will inform the diagnosis or prognosis;
  • ability to provide patients with suitable explanations and advice based on genetic science, allowing them to better understand their diagnoses.

Manner
  • capacity to tailor verbal and non-verbal communication to the patients' needs, in response to their psychological circumstances;
  • capacity to listen and empathise;
  • ability to create an atmosphere of trust.
With regard to the development of knowledge and know-how, an assessment table will be drawn up by the tutors: each factor will be rated from 1 to 7 in terms of pertinence, as shown in the example given in Appendix 1. Factors considered to be irrelevant will not be retained in the final table. The actors (trained in assessments of this nature) and tutors will complete the finalised assessment table for each student.

As for the evaluation of students' manner, i.e. their communication and doctor-patient relationships, a CARE questionnaire will be completed by the actor and tutor after each consultation.
 

Resources provided


The Medical faculty at Nantes University has 8 rooms dedicated to simulated consultations.
They are all fully-equipped for student doctors to question and examine patients. A video recording system is available. The project will have access to all of these facilities.
The university's theatre department is responsible for managing a troupe of actors who have already been trained in simulated medical consultations.