Maximising the acquisition of core communication skills at the start of medical training

Background Clinical communication teaching for medical undergraduates may involve real patient contact alongside simulated patient contact. However, there is still comparatively little known about the experience of learning with real patients and how that may impact on the simulated patient encounter. Aim To explore the impact of real patient contact on the experience of communication skills training and simulated patient contact for first year medical undergraduate students. Methods As part of the six-year MBBS undergraduate medical degree at Imperial College London, students are obliged to undertake communication skills training, which involves teaching with simulated and real patients. In 2017 (toward the end of formal teaching), a small sample of Year 1 medical students, who had taken part in extra-curricular teaching with real patients were recruited for the study to compare their performance with a control group in a simulated patient encounter. The performance of both groups was analysed alongside follow up focus group data from a sample of the study group. Results Quantitative analysis revealed there was no significant difference in communication skills during a scored simulated patient interview between students with real patient contact and those without. Focus group data, however, revealed valuable insights into the experience of learning with real patients. Students reported a marked increase in their confidence and ability to naturalise their communication skills as a result of real patient contact. Students also reported that skills gained through real patient contact may not always transfer easily to the simulated patient setting. Conclusion Real patient contact is an invaluable component of communication training for undergraduate medical students. For successful implementation there needs to be a clear curricular purpose at pedagogical, practical and organisational levels. Students’ experience of real patient contact can provide an informed foundation upon which to implement other modes of teaching. Keywords: Real patient contact, Communication skills training, Early years curriculu

Cardiovascular magnetic resonance in pulmonary hypertension

Pulmonary hypertension represents a group of conditions characterized by higher than normal pulmonary artery pressures. Despite improved treatments, outcomes in many instances remain poor. In recent years, there has been growing interest in the use of Cardiovascular Magnetic Resonance (CMR) in patients with pulmonary hypertension. This technique offers certain advantages over other imaging modalities since it is well suited to the assessment of the right ventricle and the proximal pulmonary arteries. Reflecting the relatively sparse evidence supporting its use, CMR is not routinely recommended for patients with pulmonary hypertension. However, it is particularly useful in patient with pulmonary arterial hypertension associated with congenital heart disease. Furthermore, it has proven informative in a number of ways; illustrating how right ventricular remodeling is favorably reversed by drug therapies and providing explicit confirmation of the importance of the right ventricle to clinical outcome. This review will discuss these aspects and practical considerations before speculating on future applications