Icíar Fernández Crespo is a sixth (last) year medical student at the Francisco de Vitoria University in Madrid (Spain). Since mid-January, she has been participating in the international project of integration of the clinical reasoning training simulator Practicum Script into the medical curriculum. On the day that Emilio Cervera (the institution’s vice dean of practices) spoke about Practicum Universities, Icíar volunteered. Her motivation? Gain clinical experience without the risk of doing any harm. Here, Icíar tells us about her growth outside the four classroom walls: “As a participant in the process, you go beyond just reading data, and the experience leaves an imprint on you.”

You have completed more than 60% of the course, what are the strengths of this online clinical reasoning training?

I think its strongest points are the way it presents the clinical cases and how the information presented leads you to a deductive thinking sequence and a series of clinical diagnostic hypotheses. I also found very useful to compare my hypotheses with those of the experts, and the fact that I’m able to present my hypotheses for evaluation and then decide whether or not it makes sense to add them to the database (i.e., to submit for expert evaluation those hypotheses that may not have been included originally).

Is it better to learn by doing than simply studying from a book?

I believe that learning with this tool is much more efficient in terms of time and results compared with the traditional method of learning from books, since the structure of Practicum Script grabs your attention as a participant in the process. This goes beyond the act of only reading data, and the experience leaves an imprint on you. By that, I mean that the information is not forgotten, as it may happen with clinical cases of patients that we simply see in the hospital.

For the last years of my career and after acquiring basic anatomical, physiological, and clinical knowledge, interactive clinical cases – both in practice in the hospital or with virtual simulators, like this program – are the best way to learn medicine. I believe that medicine is a profession absolutely linked to experience.

You are probably aware that UFV is extending Practicum Script as a compulsory tool for all sixth-year students…

Yes, I am; and I think it is a very useful tool, in my opinion, and I think that the Internal Medicine course is the best academic training to get the most out of Practicum Script. This decision will be very beneficial to improve our clinical reasoning and our future clinical practice. Also, given the current situation of our hospital practices being reduced by the pandemic, Practicum Script is an invaluable tool for those working from home. It helps you practice reasoning, like going to the gym to stay fit.

As medical students, we are right from the start overwhelmed by not knowing enough: there is always something escaping us, always a thousand more things to study. This generates anxiety. Thinking about our patients, we all want to be high-standard professionals, and as we see more and more cases, we realize that we are picking up the thread, a process of thinking and reasoning based on experience that guides you and makes you confident. That is why I believe that simulators like Practicum Script help in adding experience, and do so from the comfort of quietly thinking from your own home, so you learn by making mistakes and make fewer mistakes by exercising.

Of all the available assets, which one in your opinion is the best and why?

All the assets (tutor, forum, bibliography, etc) are interesting to me, although the forum, in particular, seems very useful to compare points of view and evaluate hypotheses raised by others. Medicine is a team effort. I have not personally participated in the forum, but I have read the comments from my colleagues and the feedback from the experts. The global approach of the platform is very useful in presenting the clinical perspective of colleagues from all over the world, considering that our clinical reasoning is often somewhat biased by the most prevalent cases in the area that we live, so I think that the debate at an international level broadens our views. It gives us perspective.

If it were up to you, would you integrate Practicum Script into the medical CV?

The way that medicine is taught has improved substantially over the past few years, in my opinion. As students, we see more practice integrated into the theory that we study, and we participate more in the hospital routine. Also, our professors and preceptors are becoming more focused on teaching everything they know and participating in our own process. I think that this will continue to evolve along this line, which is how we best assimilate everything. In this sense, my opinion is that the clinical simulation tool Practicum Script would be a great guide to integrate knowledge and skills and abbreviate experiential learning.

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