28 November 2022. On the treatment table lies a baby, wheezing and breathing with significant difficulty. Next to her child sits the mother, who asks: “What are you doing? What happens next?” HSG medical student Yelena Rubli observes the baby’s breathing, asks which medication the child has been given, whether they are vaccinated, and whether they might have swallowed a small object. She continues: “I’d like to keep your child here for observation.” The mother nods and asks more questions.
Rubli is wearing a white doctor’s coat and constantly taking notes. In this case, the baby in front of her is just a video recording and the concerned mother an actor – nevertheless, when she is practising medicine as a qualified physician, she will frequently encounter this and other similar situations. The 25-year-old is studying the Joint Medical Master for Human Medicine from HSG and the University of Zurich (JMM-HSG/UZH). The 24 students currently on the third year of the JMM-HSG/UZH course will treat a total of 12 simulated cases from various medical disciplines (paediatrics, gynaecology, geriatrics, surgery, psychiatry, family medicine, internal medicine and specialist outpatient consultation).
These case-based simulations (CBS) are designed, among other things, to help the students test their ability to work under pressure. “Within a treatment time of 13 minutes, they enquire about the patient’s medical history in a systematic and problem-orientated manner, carry out a focused examination, give a presumptive diagnosis and make a professional decision”, explains Peter Krähenmann. He is Senior Physician for the Cardiology and Intensive Medicine Department at the St.Gallen Cantonal Hospital, in addition to overseeing skills training and simulations for the JMM-HSG/UZH course. “Empathetic interaction and professional communication with patients and relatives is the focal point here”, says Krähenmann. During the CBS, the students are observed by experienced doctors from the respective specialism. After the 13 minute treatment time has elapsed, they give the budding doctors detailed feedback on their communication and technical approach using a standardised check list with clear, predefined objectives.
“Unique chance for students”
The 12 CBS sessions, under the supervision of experienced teaching physicians, offers students the “unique chance to experience the role of the physician by providing initial treatment to patients with a clearly defined condition under time pressure”, says Krähenmann. At the same time, he explains, the CBS act as a dress rehearsal for later professional life. “By receiving feedback after each session, the students are told where they performed well and where there is still room for improvement.”
Students receive several hours of one-to-one instruction as part of the CBS at the HSG School of Medicine. “One-to-one teaching of this scope within a medical school is not yet well established across Switzerland”, says Krähenmann. Krähemann also emphasised that the CBS were a good fit for the competency-based curriculum of the human medicine programme at HSG.
For the 24 HSG medical students, the simulations are also important with regard to future challenges: in summer 2023 they will sit the Swiss Federal exam on human medicine. Over the course of half a day, they will have to deal with 12 such simulated cases, the same as they did during the CBS. “The CBS give both the students and us as developers of the curriculum for the study programme indications of where there are still gaps in training and practical skills”, explains Krähenmann.
HSG medical degree places focus on skills
The JMM-HSG/UZH study programme was first launched at the HSG School of Medicine in the Autumn Semester of 2020. The students enrolling at that time will graduate from the university next summer as the first cohort of doctors trained at HSG. “In addition to the important specialist knowledge, the course is designed to be highly skills-based”, explains Krähenmann. Prior to the CBS the students received various input on patient communication across a variety of course activities. “Ideally, medical graduates should enter hospitals as doctors with proven practical expertise, rather than primarily specialising in theory.” Krähenmann explains that, up until now, the gap between practice and theory in the study of medicine was too large. “Admittedly, the students do complete several medical internships in their fifth year of study. Nevertheless, clinics and hospitals often do not have the time to train students in structured manner and evaluate their acquisition of skills”, says Krähenmann. According to Krähenmann, the primary focus when developing the JMM-HSG/UZH was on practical learning formats.