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Oxford's Medical School are one of the first faculties to implement Practicum Script in the undergraduate level. The multi-centre study (also including Imperial College London) aims to investigate the effectiveness of Practicum Script as a standardised educational resource integrated into the medical school curriculum to enhance clinical reasoning and 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 a handful of other medical schools in the UK. It’s envisaged more than 2000 senior medical students from 25 top medical schools will benefit from this programme.


Current tools assessing applied knowledge in medical education are limited in their scope for testing clinical reasoning and the ability to manage uncertainty in clinical practice. Practicum Script is an online simulation-based programme aimed at enhancing problem-solving skills. The simulator presents challenges in dilemmatic contexts and after a successful career as a CPD/CME tool for more than 10 years, it starts a new cycle in undergraduate teaching and assessment. Amir H. Sam, Head of Curriculum and Assessment at Imperial College London, and Catherine Swales, Director of Clinical Studies at Oxford's Medical School, trusted the project since the very beginning and that’s why they’re leading this international experience at their respective faculties.

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 positive and negative findings. Subsequently, they will be required to report, in five different scenarios, how new data may affect their hypotheses. The students will be able to observe the agreement between their responses and those of a panel of experts, along with the literature-based clinical evidence. Practicum Script will allow the youngsters to self-assess their thinking abilities, boosting their clinical confidence.

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, Canada and Latin America. In retrospect, clinical cases were created by an editorial team from ICL 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,  the training experience will occur using a bank of 20 cases and 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 for ICL and Oxford medical students, every Monday and Thursday.

Fewer cognitive errors

Although medicine is a probabilistic science, students sometimes seem to take certain things as if they were truths of faith.That is to say, as a new qualified doctor, making correct clinical decisions is often challenging. This tool promotes active learning in a digital environment. 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. Sam, this is about gaining “experience in dealing with complexity and uncertainty, which is one of the new GMC outcomes for graduates”. Along similar lines,  Prof. Swales, who will be accessing the platform to moderate and give feedback, considers the hallmark of the tool lies in the fact it doesn’t imply any real risk for patients. Actually, it may contribute to reflect in action and broaden differential diagnoses. 

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