Most of the member universities of the European Board of Medical Assessors are taking part in the pilot application of the Practicum Script clinical reasoning simulator to medical students and the last annual conference, held in Lodz (Poland) last weekend, confirmed the positive progress of the project. Ghent, the Imperial College London and Exeter, among other medical schools, showed their full support to the multicentre study which is about to start its implementation phase. In short, EBMA 2019, jointly organized by the Association for Medical Schools in Europe (AMSE), brought new perspectives to the discussion on the development and implementation of assessment strategies in health professions.

Ghent, icl and Exeter, among other medical schools, showed their full support to practicum universities at ebma 2019

The Practicum Institute attended the annual conference on assessment in medical education of EBMA and we took the chance to present results about the pilot experience for medical students that we’re conducting. Drs. Eduardo Pleguezuelos, Academic Secretary of Practicum, and Amir H. Sam, Head of Curriculum and Assessment at the Imperial College London, led a couple of sessions about the benefits of Practicum Script to enhance medical students’ clinical reasoning skills and ability to manage uncertainty. Both agreed “there is a growing demand for better assessment of decision-making processes at the undergraduate level.” 

Practicum Script is an online simulation-based platform which offers an innovative approach to developing medical students’ clinical reasoning skills and aims to introduce critical thinking in training. It poses challenging and dilemmatic real clinical cases in order to measure the way users apply knowledge to resolve complex daily cases. “Single best answer’ questions are widely used in undergraduate and postgraduate assessments, expert opinions vary though; the sooner students assimilate medical uncertainty, the better for their future performance”, argued Dr. Sam. “Patients -he added- are unlikely ever to get to a consulting room and give three or four possible diagnoses for their symptoms!”

According to Dr. Pleguezuelos, “Practicum Script shortens experiential learning time and now we’re ready to test it with medical students”. The assessment material, created by an editorial board at ICL, will consist of 20 internal medicine cases reviewed by an international reference panel from 15 different universities. For each clinical scenario, final year medical students will need to generate free-text hypotheses and provide justifications by identifying positive or negative findings in the case. Also, students will be asked to report how new information affects their original hypotheses. “The feedback for them will be based on experts’ answers along with the literature evidences”, explained Dr. Pleguezuelos.

Assessment for learning

“The point is to embrace the gray scale of clinical decisions and for that purpose the tool allows interaction among learners and provides a reflective portfolio”, remarked Dr. Sam. He and Dr. Pleguezuelos share the opinion of the limited variety of cases and coaching offered to students to date. The objective of this pilot project is to develop an applied research related to the implementation of Practicum Script for senior medical students in order to assess the feasibility of using the simulator for formative longitudinal assessment purposes. Actually, it could be a valuable tool as a formative assessment to monitor clinical reasoning skills’ growth and, at the same time, the results of longitudinal formative tests could be translated into a summative decision.

Transformative assessment standards are crucially important for ensuring that medical education meets the needs of future health care. Concurrent sessions during the congress covered a wide range of topics on programmatic assessment, OSCEs, progress testing and very short answer questions. Our approach focuses on research in the cognitive processes involved in clinical decision-making in congruence with the current concepts of the neurosciences and the cognitive psychology. “It’s time to consider establishing a clinical reasoning competence integrated into medical schools´ curriculum and Practicum Script could contribute meaningfully to this goal.


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