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Authors Institution
Miss Amanda Ebejer
Mr Paul K Jones
Dr Sharon Hartwell
Professor Judy McKimm
Swansea College of Medicine
Theme
International Dimensions
Swansea-Gambia link - A global partnership developing local educational resources
Background

Clinical skills teaching at Swansea School of Medicine makes use of clinical skills videos to demonstrate gold standard clinical examinations to students. The videos form a pool of learning resources which all Swansea students have access to. 

In this way the standards by which all clinical teachers should use for their teaching is achieved as well as informing the students the way in which they ought to carry out these skills.

In contrast, clinical skills teaching at the Royal Victoria Teaching Hospital, Gambia relies on direct experience in the clinical area and is largely ad hoc bedside teaching by foreign clinicians. It was mutually recognised that the Gambia could benefit from a more structured approach, and a series of clinical skills videos were filmed as part of a project funded by the Welsh Government under the Wales-for-Africa scheme.

Summary of Work

Two experienced clinical skills tutors and one medical student from Swansea worked with Gambian medical students to produce standardised videos in clinical examination. It emerged that a need was for neurological examination. Each video consisted of a full, thorough examination with annotations and short presentation of clinical findings.

After editing in Swansea, these resources were taken back to the Gambia, along with a new computer to be used in a newly set up clinical skills laboratory.

 

In order to ensure sustainability and enthusiasm from the Gambian students it was important for them to develop ownership of these resources so the videos were filmed by Gambian medical students in their own country. Experienced Gambian medical educators approved the sequencing and techniques used in each of the videoed examinations. This local context contributed to the Gambian students having that sense of ownership over the learning resources which would be passed on to each new student cohort.

 

One of the reasons the Gambia was chosen as a site for these resources to be developed was that two cohorts of Swansea students undertake a two-week Apprenticeship in the Gambia in December and January of each year.  In this way, the efficacy of the videos can be evaluated and updated by future groups of Swansea medical students working alongside Gambian students as part of this medical apprenticeship scheme in the Gambia.  Sustainability was an important consideration in choosing this area as this formula allows for monitoring of such resources over time.

Summary of Results

Seven videos were filmed over a fortnight in the Gambia:

  • Cardiovascular system examination
  • Respiratory system examination
  • Gastro-intestinal system examination
  • Peripheral neurological examination of the upper limb
  • Peripheral neurological examination of the lower limb
  • Cranial nerve examination
  • General examination

Early evaluation of the students improved abilities were achieved by the completion of questionnaires by participating students which did demonstrate an increase in confidence when performing clinical examinations

Conclusion

E-learning resources and their development have been found to be the first step on the road to improved access to medical education (Frehywot et al, 2013).  The students found the filming of the videos useful and their clinical skills techniques appeared to be improved even in the early stages.  This was evidenced in completion of the questionnaires and that they have asked for further videos to be made. Future evaluation will be carried out by subsequent Swansea students during Apprenticeship experiences.

Take-home Messages
  •  The  growing partnership between Swansea School of Medicine and the medical school in the Gambia has allowed for such projects of mutual benefit to be undertaken.
  • E-learning resources such as clinical skills videos are an effective way of implementing structure to clinical skills training and providing students with an effective and timeless learning tool.
Acknowledgement

 

 We  would like to thank all the Gambian medical students who volunteered their time and patience to film the videos.

A special thank you for the support from all the medical staff, and of course the Media Resources team at Swansea University for their work with editing the videos

 

References

Frehywot S., Vovides Y., Talib Z., et al. E-learning in medical education in resource constrained low- and middle-income countries. Human Resources for Health 2013, 11:4.

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Background

The partnership between Swansea School of Medicine and the medical school in the Gambia continues to develop via the Swansea-Gambia Link; the sharing of knowledge, experience and resource is becoming increasingly feasible.

In response to the recognised requirement for structured skills teaching, a clinical team of educators from Swansea was accepted to help produce a series of videos similar to their own which would be a sustainable and inexpensive bank of resources available to all students.

Examination videos currently available to Swansea students are:

  • Cardiovascular system examination
  • Respiratory system examination
  • Gastrointestinal system examination
  • Upper and lower peripheral neurological system examinations
  • Musculoskeletal system examinations (ankle & foot, knee, hip, shoulder, elbow etc.)
  • Thyroid and neck examination

In order to ensure sustainability and enthusiasm from the Gambian students it was important for them to develop ownership of these resources so the videos were filmed by Gambian medical students in their own country. Experienced Gambian medical educators approved the sequencing and techniques used in each of the videoed examinations. This local context contributed to the Gambian students having that sense of ownership over the learning resources which would be passed on to each new student cohort.

Summary of Work

Swansea’s checklists were initially used as a starting point, with each being adapted by experienced Gambian clinicians in order for the examination to be more relevant to local practice.

The students then practised the examination with local student volunteers acting as the patient. The clinical techniques were perfected by the clinical skills trainers from Swansea.

Examples of examination alterations:

  • Confirmation of technique e.g. consensual pupillary reflex, soft touch (dab not stroke)
  • Addition of procedure – palpate muscle bulk, jaw jerk, corneal reflex
  • Removal of procedure – no test for blind spot.
Summary of Results
Conclusion

It is hoped that the production of these videos will encourage students from other countries to undertake their elective in Gambia thereby increasing the revenue by the local hospital which can, in time, be utilised on development of more substantial clinical skills equipment and also provide on-going financial resources to maintain them. 

The junior and senior students who were involved in the production of these resources will, in the future, as junior qualified clinicians have an input into the development of the clinical skills teaching in the Gambia assisted by Swansea’s biannual visits.

Take-home Messages
Acknowledgement
References
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