“In every medical curriculum, as in every other field of study, clinical practical skills are of paramount importance. Without practical clinical skills, with theoretical knowledge alone, you cannot be a professional doctor,” said Professor Vaiva Hendrixson, Vice Dean of Education and Strategic Partnership at the Faculty of Medicine at Vilnius University, having agreed to talk about the project, SAFEMED+ (Simulation in Undergraduate MEDical Education for the Improvement of SAFEty and the Quality of Patient Care), which has been running since 2020 and in which Vilnius University Faculty of Medicine is actively involved.
It Began with Erasmus Mundus MEDEA collaboration
When asked about the origins of SAFEMED+, Professor Hendrixson talked about the Erasmus Mundus MEDEA (Medical Universities Alliance) project, which ran from 2014 to 2017 and was coordinated by the Paul Sabatier University in France and the Tbilisi State Medical University in Georgia: “The Erasmus Mundus project – MEDEA – was very successful. During the project, universities from Europe and from non-European countries cooperated very well, exchanging students, faculty staff and ideas, across the medical education arena.”
The professor explained that the MEDEA project had resulted in a special bond with the active partners from Georgia. As a result of this partnership, another project, Capacity Building in the Field of Higher Education, was submitted to the European Commission in 2018. According to the professor, it was then, that the idea of the SAFEMED+ project, which focuses on capacity-building in clinical skills during medical studies, was born. Although SAFEMED+ did not originally have the necessary financial support in 2018, the idea was not abandoned, the European and non-European partners brought together by MEDEA’s vision continued to work, and in 2020 the funds needed to fully develop the project were awarded.
The Main Objectives Are the Use of Simulations and the Introduction of the OSCE Exam
When asked which countries and their representative institutions are involved in the SAFEMED+ project, the professor replied that the European partners currently involved in the project are Vilnius University Faculty of Medicine, the University of Santiago de Compostela in Spain, and the University of Catania in Italy. The non-European partners are Tbilisi State Medical University and the Tbilisi Academy of Medicine in Georgia, the Ternopil National University of Medicine and the Bukovina State University of Medicine in the Ukraine, and the State University of Yerevan and the Yerevan Haybusak University in Armenia.
“What makes the capacity building project great, is that we share our experiences. All participants – European and non-European – have something to share, every new experience is very important, and encourages us to look at the situation from a different point of view, with creativity and innovation,” she said, noting that one of the main commitments of the European partners in this project is to help the non-European partners redesign their medical curricula by integrating practical clinical skills early on. The aim is to develop the concept of the Clinical Lines of the Competency Based Medical Education (CBME) through the integration of practical clinical skills from the very first course until completion of the studies, and to help establish and develop the use of manikin and human-based (Standardised Patient) simulations in medical education. One of the tasks, according to the professor, is the introduction of the Objectively Structured Clinical Exam (OSCE) which evaluates students at the end of their internships. Additionally, a textbook is being prepared, which will contain the examples of clinical scenarios and scenarios of the OSCE exam, as well as the training methodologies for various clinical and communication competencies and the evaluation strategies for these competencies.
Professor Hendrixson spoke of the sharing of responsibilities between the European partners in the development of the SAFEMED+ project: “Spain has extensive experience in organising the OSCE exam at national level. There, all medical graduates have to take the OSCE exam, therefore the University of Santiago de Compostela is responsible for the preparation and coordination of all the scenarios used in the exam. The University of Catania has an impressive Simulation Centre, so their remit was to advise on the acquisition of simulators, manikin-based and standardized patient.” Meanwhile, noted the professor, the responsibility of the Faculty of Medicine at Vilnius University, is to share its experience in the development and application of clinical and communicational skills in medical studies, as well as the strategies used to assess those skills.
© Prof. Vaiva Hendrixson, VU archive.
Project Partners Meeting in Vilnius in May
The professor highlighted that one of the tangible outcomes of the SAFEMED+ project, which will end in October this year, is the development of the textbook mentioned: it will contain OSCE exam scenarios, educational methodologies of various clinical and communicational skills, and strategies of their assessment. “Meetings were organised in each participating country. On 30-31 May, a meeting of SAFEMED+ partners will take place in Vilnius, Lithuania, during which this textbook will be presented and discussed. Each institution – the VU Faculty of Medicine, the University of Santiago de Compostela and the University of Catania – has been writing specific chapters, and the OSCE scenario set had been decided at the previous partner meeting in Armenia. So, in Vilnius, we will actually have the final meeting of partners to talk about the importance and practical application of the OSCE exam as part of the final part of the medical studies”, explained the professor.
She is delighted that the last meeting will take place in Vilnius, as the Faculty of Medicine at Vilnius University does not have a classical OSCE exam: “Until now, we have been successful in using a virtual model internship exam, which is essentially the same as the virtual OSCE exam. It is not a walk-through the designated clinical stops at the hospital, but students solve practical tasks virtually.” She further explained that the VU Faculty of Medicine’s strategic plan includes the development of an OSCE exam by 2024. “This is very important strategically for the recognition of our medical studies by the World Federation for Medical Education (WFME). Although we have the virtual equivalent of the OSCE exam, we do not have an actual equivalent held in a live clinical environment with manikin-based and standardised patient simulators. In order to have full recognition from WFME, we need to have this exam in place,” said the professor.
“The development of clinical practical skills does not start in residency, but from the very early years of study. In common with other professional practices, referred to as undergraduate and graduate competencies, in medical studies we do have to cultivate our clinical practical skills not in the postgraduate residency studies, but from the beginning of the first course right up to the end of residency when one becomes a doctor, because becoming a doctor is a gradual process, rather than fragmented,” continued Professor Hendrixson. “Of course, the financial side of the training was and always will be a challenge, therefore I am grateful to the Faculty of Medicine, in seeing the value of this training and contributing to it. Our academic community does have the knowledge and skills, and we really do have what we can share with others. That is what I wish for everyone.” In closing, the professor wanted to express her special gratitude to Associate Professor Andrius Klimašauskas, the internship coordinator, and Associate Professor Lina Zabulienė, the president of the final medical exam, who have made a significant contribution to the development of the concept of internship studies and the preparation of the content part of the OSCE exam, and also, to thank all other colleagues who have contributed in a significant way to the successful administration and realisation of the SAFEMED+ project.
Left to right: Assoc. Prof. Lina Zabulienė, Prof. Vaiva Hendrixson, Assoc. Prof. Andrius Klimašauskas © Prof. Vaiva Hendrixson