Last Monday, January 27, David Tvildiani Medical University (Tbilisi, Georgia) launched the pilot project of clinical reasoning training for senior medical students known as Practicum Universities. This multicenter pilot study, jointly coordinated by the Practicum Institute and the European Board of Medical Assessors, aims to investigate the effectiveness of Practicum Script as a standardized educational resource to enhance problem-solving skills among students in clinical rotations. The experiment will consist of the simulation of 20 real clinical Internal Medicine cases during the academic year and the participation includes more than 2000 senior medical students from 25 top medical schools. 

During the hyphotheses step an artificial intelligence system patented by Practicum automatically matches the coincidence of the user’s response with those formulated by experts

According to the vice dean in Medical Education at DTMU, Paata Tsagareishvili, “Practicum Script has a unique design to enhance clinical reasoning and problem-solving skills and it is important that it is supported by respected international experts in medical education”. In his opinion, “there is a need to implement effective approaches for the development of clinical reasoning skills and Practicum Universities makes possible to teach and assess the process of decision-making in a controlled environment”. The simulator presents challenges in dilemmatic contexts and after a successful career as a CPD tool for more than 10 years, it starts a new cycle in undergraduate assessment with the collaboration of our medical school.

Practicum Universities is a leading world-wide pilot study based on decision-making in 20 real internal medicine cases in which there may be more than one solution. For each clinical scenario, final year medical students will be asked to generate hypotheses and justify them by identifying pertinent findings. During this step, an artificial intelligence system patented by Practicum (Ocmale©) automatically matches the coincidence of the user’s response with those formulated by experts. Next, the platform presents new data, and the user must decide on the impact of the new information on the proposed hypothesis. Finally, the simulator offers performance indicators to help users reflect on their results and on the possibility of the opinions presented.

The project, targeted at final year students, is ongoing and the plan is to obtain psychometric results by the end of 2020. During this time, the platform will be tested in more than 20 top medical schools from Europe, the US and Latin America. In retrospect, clinical cases were created by an editorial team from Imperial College London, and then reviewed by an international reference panel consisting of internal medicine specialists from fifteen medical schools who provided rationales for their decisions in the different clinical scenarios. In short, through an interactive tutoring system, the students will make decisions regarding diagnoses, therapies, or complementary tests, which will help them become more autonomous. Two new cases per week will be released every Monday and Thursday.

Cognitive training

Medicine is a probabilistic science, but students sometimes seem to take certain things as if they were truths of faith so making correct clinical decisions is often challenging. According to Dr. Eduardo Hornos, the president of the Practicum Institute, “Practicum Script shortens experiential learning through a longitudinal exposure to real-life cases”. For Prof. Tsagareishvili, this training will prepare future doctors for ambiguous contexts: “the key concept is the management of uncertainty, including the option to crosscheck your approach with external evidences and prominent experts’ opinions”. Practicum Script will allow the youngsters to self-assess their thinking abilities, boosting their clinical confidence.

Experts agree that medical education will face a deep transformation in the future and will need allies and tools to do so. These are times of disruptive technologies and behaviours that demand active learning initiatives like this one, so “David Tvildiani Medical University is proud to participate in this experience”, remarks Prof. Tsagareishvili. At the institutional level, Profs. Liza Goderdishvili and Ketevan Kapanadze, who participated both in the panel of experts for the validation of the pool of cases, will handle the platform and they’ve been very enthusiastic about the fundamentals of the project.

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