Formative Stations

Initial situation

The aim of this teaching format is to introduce practical sessions into the training of medical students. The idea is to offer students training sessions. These training stations, affiliated with each of the units that offer practical courses, allow students to practice their clinical skills by carrying out a simulation of a medical consultation.

Project implementation

The training stations allow students to practice clinical and interpersonal skills in a consultation with a standardized patient or a patient instructor. Standardized patients are healthy individuals trained to simulate the history of a real patient and to reproduce as realistically as possible the patient’s history, clinical signs, personality and emotional reactions. The patient instructors are real patients who use their own history and experience of their illness. They are trained to guide and give accurate feedback at the station. They are particularly useful in situations where only a patient can sense if a gesture is being performed correctly.

These simulated medical consultations are offered in 3 different formats: direct observation, video observation and office observation. A majority of students will experience all three formats during their training.

Direct observation: The station takes place in the clinical skills area of the HUG. The interaction between the student and the standardized patient is directly observed by a supervising physician through a one-way glass window. Before meeting the patient, the student defines his or her learning objectives with the supervisor. Instructions are posted outside the room indicating the name of the patient, the context of the encounter, any other information (e.g., vital signs), and the time available (20 minutes) and the tasks to be performed. The consultation is observed by the supervising physician. During the physical examination, the student must express aloud what he/she is doing in order to allow the supervisor to judge his/her actions.

Video observation: The station takes place at the Interprofessional Simulation Center and is recorded. A CIS staff member is present to guide the students through the video equipment. Instructions for students are available online. Directly after the consultation, the patient gives feedback to the student on the relational aspects of the encounter. The video is then uploaded to a secure server. Students are required to view the video before the feedback session with their supervisor. They must also complete a consultation report which is reviewed by a member of the Clinical Skills Program.

Office observation: Stations take place in different family physician offices in the city. The students go in groups of 3 and the station lasts 2 hours. This format allows them to observe their colleagues. Each student does a full consultation with the standardized patient who may be asked to play 3 different roles. The doctor gives the students instructions similar to those provided in the other types of stations. Students are observed by the supervising physician and their two colleagues who also provide feedback.

Each of these formats has a particular advantage. Direct observations allow for real-time feedback and immediate correction. Video stations provide students with the opportunity to perform a self-evaluation by viewing their consultation. The in-office stations are an opportunity to receive multiple feedbacks (practitioners and peers) and to express one’s own opinion on the peer consultations. All feedback received by students is recorded in a portfolio that will follow them throughout medical school.

These formative stations do not result in graded evaluations. The important thing is the training that the various feedbacks received allow, the objective being to prepare the students for the end of 3rd year exam. Indeed, during the exam, the students must perform the 3 stations with standardized patients.

Thoughts and advice

Training stations are widely used in health professions training. Standardized patients are trained by professionals, learn scenarios and typical responses and reactions. Its possible interactions capture all the dimensions and complexity of a consultation. Realism is reinforced by the design of the physical environment.

This teaching format is appreciated by all stakeholders, whether students, supervisors, standardized patients or instructors and practitioners. The supervisors are often part of the HUG or city practices. They are trained for several days on how to give constructive feedback to students.