The University of Birmingham Medical School, Aston University Medical School, Birmingham Children’s Hospital and Sandwell and West Birmingham Hospitals have recently committed to produce 20 cases in Paediatrics for the clinical reasoning training programme Practicum Script. As per norm, all cases will be drawn from real patients and will be built with strict respect to the Practicum Script methodology, which has recently received a solid psychometric backup. More than another simple simulation tool to facilitate self-assessment and reinforce factual knowledge, Practicum Script addresses the management of uncertainty in clinical practice. 

Practicum Script provides an architecture for the interaction between intuitive and deliberate thinking.

Four respected medical institutions in the UK will collaborate with the Practicum Foundation in releasing Paediatrics in undergraduate education. Six experienced paediatricians from the Birmingham Children’s Hospital, named in Newsweek’s World’s Best Hospitals 2020 list as the leading British paediatric centre, integrate the team. The rest of the authorship committee is composed of paediatricians from Sandwell and West Birmingham Hospitals (4), Birmingham Medical School (1), and Aston University (1). The member of the Department of Child Health at Sandwell and West and Paediatric Curriculum Lead at Birmingham, Prof. Dr Nick Makwana, has been appointed as the editor-in-chief. 

In the first phase of this joint collaboration, 20 cases based on real patients will be built. These cases will cover the main thematic areas of Paediatrics and will present relevant situations in emergencies, clinical wards and outpatient clinics. This means, based on their clinical experience, the 12 specialists will create a pool of cases consistent with the undergraduate level in cardiac, respiratory, digestive, neurologic, endocrinologic, renal, infectious, rheumatic, haematologic, oncologic, dermatologic, and adolescent diseases, as well as growth and development disorders and paediatric emergencies.

Then, an international panel of experts will review and answer all cases, justifying their responses in a validation process. These rationales will make up the feedback students get once they formulate their hypotheses and make decisions in clinical scenarios during their training.  The methodology is a clinical reasoning programme that compares the thought process of learners to that of experts to determine to what extent their cognitive ‘scripts’ align. According to the dual-process theory, Practicum Script provides an architecture for the interaction between intuitive (system 1) and deliberate (system 2) thinking. The end point is to assess the skills inherent in decision making, while acquiring expertise.

The plan is to work on two cycles, from February to May and from May to July, each of which will include the authorship, reviewing process, compilation of rationales and search for scientific clinical evidence supporting different approaches. In this last step, experts are invited to identify, appraise and synthesize all the empirical evidence that meets eligibility criteria to answer a given question. This systematization embraces evidence-based medicine and experience-based medicine. For now, the authors have already been instructed so that they can build the cases according to the Practicum Script pedagogical principles. These new cases should be available for medical schools by next academic year. 

Most faculties currently implementing Practicum Script in Internal Medicine have shown a great interest in adding childhood care, especially after the good psychometric properties  proved by Practicum Script in the pilot study Practicum Universities. The reliability estimates and the evidence of validity based on the simulator’s internal structure have been excellent. 

As for the four institutions, this partnership may result in a collaborative space similar to the one established between the Practicum Foundation and Imperial College London in Internal Medicine (ICL).  As they did in 2019/2020 under the leadership of the Head of the School, Prof. Amir H. Sam, ICL has continued developing new clinical cases on an annual basis. This agreement ensures students have access to different cases all along the clinical cycle. Practicum Script’s standard modality works on a three-year calendar plan, consisting of a progressive training strategy with an adapted proposal for the last three of the medical degree and a summative final exam for last year.

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