The Platform facilitates the doctor to have mental algorithms that help the decision making in the day to day

DRA. IOLANDA JORDÁN GARCÍA

Pediatrician in Hospital Sant Joan de Déu's intensive care unit

Dr. Iolanda Jordán is a pediatrician in the intensive care unit at Hospital Sant Joan de Déu in Barcelona, where she belongs to the research team in pediatric infectious diseases. She was the vice-president of the scientific section of the Catalan Society of Pediatrics for four years, and she is an associate professor at the University of Barcelona.

You played an important role in forging the agreement signed between the Catalan Society of Pediatrics and the Practicum Foundation. What does this academic agreement mean to you?

As vice-president of the scientific section (of the Catalan Society of Pediatrics), collaboration with an institution like yours, that has developed at an international level, has without doubt been a great experience, and an important accomplishment for the scientific and educational areas of the Catalan Society of Pediatrics. The truth is that the Practicum Foundation was introduced to us as an institution working for the public good with the mission to promote learning in a totally innovative platform, so that really got us interested. Apart from that, we thoroughly investigated the whole trajectory of the project, and we found that it was incredibly relevant and outstanding, especially regarding teaching. What’s more, the fact that Practicum is endorsed by prestigious and renowned societies, such as the European Union of Medical Specialists or the Ministry of Science and Innovation here in Spain, ensured us of the excellence of this platform for academic training. 

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Thanks to this agreement, 86 pediatric residents in Catalonia are already using Practicum Script. What benefits do you think they can obtain from using this tool as part of their training?

The most important thing in recent years, if there’s something that stands out in training in general, especially when we talk about training adults and healthcare staff in particular, it is that we really need to stress repetition, simulation, and skill building. We are always using elite athletes as an example—they have really got it down, but they keep on training anyway—they keep on repeating and building their skills. Thus, if we extrapolate this idea to the world of medicine, where training has to be ideal because otherwise pediatricians or physicians in general will not work so well, we see that we need a platform like yours. In fact, when residents (and taking into account that there are 86 residents in pediatrics who are using this platform) start out, they face clinical situations that they never would have been able to imagine they would have to face. And right now, the methods used in medical school are very traditional—studying and memorizing specific diseases—and not enough emphasis is placed on training in decision making and the approach to syndromes, and that is where Practicum can really help.

I think that the usefulness of your platform lies, above all, in the way it connects your theoretical knowledge with your clinical practice, so that it clearly helps physicians, and especially those in training, to carry out their work more fluently and especially by facilitating the acquisition of mental algorithms that help in daily decision making.

During the course, the residents have to make decisions in 300 different clinical scenarios, but without the risk of harm to patients, since they meet these real cases in a simulated environment. Do you think that future generations of specialists have enough opportunities to acquire this kind of training?

Although of course the idea is to pave the way in teaching, and although different options are being developed, there are very few or no platforms that manage teaching the way yours does. The problem is that all innovations in teaching cause problems—simulation and problem-based learning are expensive—expensive financially and expensive considering all the people that have to be involved. Moreover, these approaches are always limited to small groups, because otherwise they’re not effective. Clear examples of innovations like this are simulations, crisis management groups, and objective structured clinical assessments (OSCA),  which are all great, but complicated and not very feasible in the real world.

Therefore, in this sense Practicum is innovative and optimally fulfills teaching objectives; furthermore, since it is online, the classroom part can be totally eliminated as can all the difficulties involved in connecting to other types of platforms or other learning approaches, which can be very useful but also very difficult to carry out.

The fact that the course is online is also great for healthcare staff in general and residents in particular, who have such irregular timetables. You can go home after being on call or whenever you want—the platform is always there for you, whenever you can find the time.

Do you think that this exercise in clinical decision making in a wide variety of simulated clinical scenarios can help residents reach clinical maturity faster?

The answer is a resounding YES. As we said, repetition is very important in learning, especially for residents. Having to face 300 different clinical situations is clearly providing training in diagnostic algorithms, treatment algorithms, algorithms for ordering complementary tests—all this practice will surely help residents acquire the agility they need to apply these algorithms to real situations. Without a doubt.

"Although different options are being developed, none or very few of them handle teaching like Practicum Script"

Apart from that, another advantage is that the program enables learning experiences to be homogenized,  in the sense that, in normal training,  not all residents get the chance to do extensive rotations in all the different subspecialties. So there are areas that are not covered in the ordinary curriculum.  By contrast, in this platform, there is an enormous range of possible scenarios, with different types of clinical cases with different subtopics. This means that residents acquire experience in fields that would otherwise be full of gaps in their training. What’s more, the program lets them deal with very different situations that might never come up in their day-to-day training. For example, maybe they will never come across diabetic ketoacidosis or other syndromes during their residency, so decision making in these areas could be more complicated for them.

Do you think that the fact that the residents have to face controversial clinical cases where there can be more than one valid solution for the same patient can be beneficial for their future practice in the specialty?

Yes. Yes, of course. This is a very important part of Practicum. Real cases cannot normally be painted black or white—there are many shades of gray in disease or in the way a disease presents that can complicate decision making. So, in controversial cases, maybe there is no absolute truth in this sense of black or white that I mentioned—that holds true both for diagnostic suspicion and for complementary tests. What is essential is that, even if it is controversial, you know how to formulate your diagnostic hypotheses, and Practicum helps in this sense too. From this point in the process, the decision trees and actions will grow from each of your hypotheses, and I think that this one of the main goals of the platform.

More information: Agreement signed with the Catalan Society of Pediatrics