The clinical reasoning simulator Practicum Script will extend to more than 20 medical schools from different countries in the 2019/2020 academic year. In Spain, it will include the Complutense University of Madrid and the Francisco de Vitoria. Both medical schools join the project coordinated by the Practicum Institute, along with the European Board of Medical Assessors (EBMA), and presented at the end of 2018. The agreement, which has also been signed by the Spanish State Council of Medical Students (CEEM), establishes the basis for implementing the tool among the students. The goal is to improve thinking skills for future clinical practice.

Madrid - June 27, 2019. Cognitive training is an ongoing subject, and the Practicum Foundation has designed an action plan for the 2019-2020 course. In Spain, the Complutense and Francisco de Vitoria universities, both located in the country’s capital, have joined the challenge. The project, to be presented entirely in English, consists in the simulation of 20 real clinical Internal Medicine cases available on the Practicum Script online access platform directed to fifth- and sixth-grade students in clinical rotations. The particularity of this approach to learning is the fact that rather than measure factual knowledge, it measures reflective skills.

The authorship of the cases is the responsibility of an editorial team at the Imperial College London (ICL) led by Prof Amir H. Sam, scientific director of EBMA and Head of Curriculum and Evaluation Development at the ICL. The Foundation is currently working on the phase of content validation by experts from Oxford, Charité (Berlin), and Sapienza (Rome), among others. Outside the continent, Harvard has confirmed its participation along with the University of São Paulo. Around 20 schools will test Practicum Script as a standardized methodology for training reasoning according to the level of satisfaction and the analysis of results.

Practicum Script is a platform of cognitive acceleration that increases critical judgment, broadens the mind to differential diagnoses, and reinforces confidence in decision making. It presents challenges in dilemmatic contexts and embraces the gray scale of the clinical environment, thus, debate and dissent dominate the tone. According to its CEO, Dr Eduardo Hornos, Practicum Script “is a collaborative learning network that provides immediate feedback from experts and solid scientific evidence to support agreements and discrepancies, breaking with horizontal memory learning and introducing the concept of uncertainty in the medical curriculum."

The program enjoys a consolidated track record in continuous professional development in Spain and Latin America. It has been available to specialists and residents in Cardiology, Gastroenterology, and Pediatrics, and now prepares to expand to the education at university level with the pilot project signed with EBMA, a leading European medical evaluation organization that includes personalities like the Karolinska Prize recipient Cees van der Vleuten. According to the project director, Dr Pleguezuelos, “the idea is to develop a degree-adapted case bank, apply the pedagogical project during the next course, and obtain psychometric results to be analyzed by the psychologist Carlos Collares by the end of 2020.”

More than one valid answer
Drs Jesús Millán and Emilio Cervera, Vice Dean of Institutional Relations and Teaching Innovation at Complutense and Vice Dean of Practices and Health Centers at Francisco de Vitoria, respectively, agree that medicine is not an absolute science and that Practicum Script introduces to the medical curriculum a transversal competence: clinical reasoning. Specifically, students will be required to solve 20 complex cases on comprehensive care for adult patients. Using an interactive tutoring system, the students will make decisions regarding diagnosis, treatment, or use of complementary tests that will help them become more autonomous and capable.

In an interview with Diario Medico, Dr Millán mentioned that "clinical reasoning is a complex training area" with a small presence in the curriculum. The hallmark of this research lies in the exercise of recognition of patterns and in the possibility to resort to the Delphi method in case of controversy. Along these lines, Dr Cervera also stated in the same report that “although medicine is a probabilistic science, students sometimes seem to take certain things as if they were truths of faith. I observe this with residents: it is difficult for them to handle uncertainty because they believe that advanced technology is sufficient to establish a diagnosis.”

Full list of medical schools participating in the research and application project for students:

• University of Algarve (Portugal) • University Charité Berlin (Germany) • Complutense University of Madrid (Spain) • David Tvildiani University (Georgia) • University of Exeter (Great Britain) • Francisco de Vitoria University (Spain) • University of Ghent ( Belgium) • University of Glasgow (Great Britain) • Harvard University (United States) • University of Lodz, (Poland) • Imperial College London (Great Britain) • University of Maastricht (Netherlands) • University of Minho (Portugal) • Newcastle University (Great Britain) • Oxford University (Great Britain) • Plymouth University (Great Britain) • Pontifical Catholic University Argentina (Argentina) • University of Rome La Sapienza (Italy) • University of Salvador (Argentina) • University of Sao Paulo (Brazil) • Uppsala University (Sweden)