This academic year, Imperial College London (ICL) will start its 4th year implementing the clinical reasoning training programme Practicum Script. It all gained momentum by the end of 2018, when a delegation of the Practicum Foundation met Prof Amir H. Sam in Braga (Portugal) and invited him to join the multicentre pilot study Practicum Universities. At that moment, the current Head of the School of Medicine at ICL teamed up to promote students’ independent functioning in the clinical setting, and, since then, ICL has been an outstanding ally, not only validating the methodology but also in the creation of clinical cases.
ICL School of Medicine, ranked 3rd in the world and 2nd in the United Kingdom by The Times Higher Education World University Rankings 2022, has applied Practicum Script for three consecutive years. Since 2019, more than 500 final-year medical students have benefited from the clinical reasoning training programme. Also, the academic authorities of the Faculty, with Prof Sam and Dr Laksha Bala at the front, are behind the creation of a vast pool of internal medicine cases, increasing every year, and they have defended this unique methodology, which, helps them foster work-ready graduates for the clinical setting, in a number of medical conferences.
Known in the UK for promoting best practices, ICL’s courses open doors to the latest thinking in medicine and technology. Students are provided with the skills and knowledge to work as junior doctors in various healthcare settings and be qualified for provisional registration with the General Medical Council (GMC). In this sense, Practicum Script targets the need of specific methods to train and assess the clinical reasoning competence of medical trainees expressed by the new Good Medical Practices outcomes. And that’s because, according to the GMC, clinicians’ ability to provide quality care depends upon their ability to reason, think, and judge.
Thinking clinically implies that one has a knowledge base from which to reason and the acquired ability to evaluate evidence and balance the uniqueness of the patient . Clinical simulation may positively affect this, while improving new doctors’ confidence and competence. When used prior to and alongside clinical experience, Practicum Script may reinforce decision-making. In fact, experiential learning has been shown to enhance students’ abilities to make quick and better decisions, leading to fewer medical errors. The key is that this simulation model does not include academic exercises to test knowledge, but cases based on real patients designed to measure know-how to solve uncertain situations in daily practice.
Far beyond statistics, clinical situations are open ended, which means modus operandi thinking should keep track of the individual, the way the illness unfolds, and the meanings of the patient’s responses as they occur. Practicum Script thinking process requires facing reasoning-in-transition, noticing pros and cons in the problem approach, and this is precisely what makes it so different from other platforms. Practicum Script stimulates reflection on actions. For each clinical case, students must generate hypotheses, then they have to report how new data might affect their likelihood, and finally they can contrast their responses with those of a panel of experts, as well as checking clinical evidence.
ICL prides itself on training the next generation of leaders in clinical healthcare, and they do so through innovating their curricula for an increasingly digital and globalised future. This means transferring knowledge and expertise, and this also means their partner in Singapore, the Lee Kong Chian School of Medicine (LKCMedicine), will soon start their third academic year benefiting from Practicum Script. Using Imperial’s globally renowned undergraduate curriculum as a template, LKCMedicine provides world class and award-winning medical training in the sovereign island country. Both institutions put patients at the centre of care and use cutting edge solutions to transform the arena of medical education.