The SECO Clinic

The SECO Clinic was conceived of in 2004 by two rural General Practitioners, Dr Trevor Walker and Dr Martyn Williamson, as a way for undergraduate medical students to learn about clinical practice. 

Key features of the SECO clinic are:

• unobserved, true-to-life patient encounters in a simulated general practice
• open access to resources (texts, internet or phone advice from a senior colleague)
• student control of time management for the duration of the clinic
• formative and summative assessment which aligns assessment, clinical teaching & learning, and future professional practice
• focus on the outcomes of the consultation

Performance measures are: safe and effective clinical outcomes (SECO) for the patient and the ease with which these are achieved (proficiency)

SECO criteria:

• Safe outcomes
  No increased risk of harm in the short or long term to either the patient or the doctor
• Effective outcomes
  Carefully defined and unique for each scenario
  Evidence-based, patient-centred, context-sensitive, resource-efficient
• Proficiency of practice
  The ease with which SECO is achieved: measured by duration of encounter and use of additional resources (eg telephone advice from senior colleagues)

Assessment and feedback methods

• Students are assessed on their achievement of predetermined SECO patient outcomes by reference to their written clinical notes and questionnaires completed by the simulated patients whilst still in role.
• Each questionnaire is specially prepared for each scenario.
• Students receive written feedback including the completed patient questionnaire, their own clinical notes, the list of outcomes to be achieved
  and detailed background of what constituted SECO for each scenario.

Every clinic is followed by a 90 minute group debrief to analyse outcomes and review learning issues identified by the participants.

Benefits of SECO Clinics - For students

• integrated clinical performance
• repeated practice and assessment in an authentic simulation of clinical practice
• prompt, detailed feedback on the achievement of outcomes
• outcomes based on relevant patient benefit - safety and effectiveness
• help in recognising their own limitations and developing ways of managing uncertainty

Martyn Williamson, Trevor Walker and Tony Egan