[Actor as a simulated patient in medical education at the University of Pécs]

INTRODUCTION

Medical training in the 21st century faces simulation-based education as one of the challenges that efficiently contributes to clinical skills development while moderating the burden on the clinicians and patients alike.

AIM

The University of Pécs, Medical School has launched a simulation program in the MediSkillsLab based on history taking with actors to improve patient interviewing communication skills.

METHOD

This new program was inspired by experiences gathered in previous medical language teaching and integrates the method of the "Standardized Patient Program". The method has been applied in America since the 1960s.

RESULTS

This is the first time the program has been introduced in Hungary and implemented in an interdisciplinary design, where medical specialists, linguists, actor-patients and medical students collaborate to improve professional, language and communicative competence of the students.

CONCLUSION

A course like this has its pivotal role in the medical training, and as a result more efficient and patient-oriented communication may take place at the clinical setting. Orv Hetil. 2017; 158(26): 1022-1027.

Systematic Review of Voluntary Participation in Simulation-Based Laparoscopic Skills Training: Motivators and Barriers for Surgical Trainee Attendance

OBJECTIVE

To examine and report on evidence relating to surgical trainees' voluntary participation in simulation-based laparoscopic skills training. Specifically, the underlying motivators, enablers, and barriers faced by surgical trainees with regard to attending training sessions on a regular basis.

DESIGN

A systematic search of the literature (PubMed; CINAHL; EMBASE; Cochrane Collaboration) was conducted between May and July 2015. Studies were included on whether they reported on surgical trainee attendance at voluntary, simulation-based laparoscopic skills training sessions, in addition to qualitative data regarding participant's perceived barriers and motivators influencing their decision to attend such training. Factors affecting a trainee's motivation were categorized as either intrinsic (internal) or extrinsic (external).

RESULTS

Two randomised control trials and 7 case series' met our inclusion criteria. Included studies were small and generally poor quality. Overall, voluntary simulation-based laparoscopic skills training was not well attended. Intrinsic motivators included clearly defined personal performance goals and relevance to clinical practice. Extrinsic motivators included clinical responsibilities and available free time, simulator location close to clinical training, and setting obligatory assessments or mandated training sessions. The effect of each of these factors was variable, and largely dependent on the individual trainee. The greatest reported barrier to attending voluntary training was the lack of available free time.

CONCLUSION

Although data quality is limited, it can be seen that providing unrestricted access to simulator equipment is not effective in motivating surgical trainees to voluntarily participate in simulation-based laparoscopic skills training. To successfully encourage participation, consideration needs to be given to the factors influencing motivation to attend training. Further research, including better designed randomised control trials and large-scale surveys, is required to provide more definitive answers to the degree in which various incentives influence trainees' motivations and actual attendance rates.

Optimizing learner assessment in a respiratory therapy clinical simulation course

The purpose of this participatory action research project was to evaluate the effectiveness and objectiveness of learner evaluation methods used in a clinical simulation course offered at a community college as part of the 3-year Respiratory Therapy advanced diploma program. A mixed-method approach to data collection was used. A paper-based questionnaire was completed by 47 participants and was utilized to identify learner satisfaction with the simulation experience. An online questionnaire was completed by 16 participants and utilized to identify learner satisfaction with the evaluation methods used in the course, as well as to gather suggestions for improvement of those methods. Two focus groups further explored 7 participants' impressions of how evaluation practice in the course affected their learning process and competence in preparation for formal assessment. Data analysis found that the majority of participants were generally satisfied with the current evaluation process considering the practice objective and found that it was effective in helping learners achieve their learning goals. Areas identified for improvement included practice improvement, such as team and communication skills assessment; student self-reflection assessment; and changing the grading system from a numerical grade system to a pass/fail system. The project offers suggestions for future research, including the development of a standard evaluation rubric in high-fidelity simulation in respiratory therapy in Canada based on the national competency profile for entry to practice.

Development and Evaluation of a Simulation-based Curriculum for Ultrasound-guided Central Venous Catheterization

OBJECTIVE

To develop a simulation-based curriculum for residents to learn ultrasound-guided (USG) central venous catheter (CVC) insertion, and to study the volume and type of practice that leads to technical proficiency.

METHODS

Ten post-graduate year two residents from the Departments of Emergency Medicine and Anesthesiology completed four training sessions of two hours each, at two week intervals, where they engaged in a structured program of deliberate practice of the fundamental skills of USG CVC insertion on a simulator. Progress during training was monitored using regular hand motion analysis (HMA) and performance benchmarks were determined by HMA of local experts. Blinded assessment of video recordings was done at the end of training to assess technical competence using a global rating scale.

RESULTS

None of the residents met any of the expert benchmarks at baseline. Over the course of training, the HMA metrics of the residents revealed steady and significant improvement in technical proficiency. By the end of the fourth session six of 10 residents had faster procedure times than the mean expert benchmark, and nine of 10 residents had more efficient left and right hand motions than the mean expert benchmarks. Nine residents achieved mean GRS scores rating them competent to perform independently.

CONCLUSION

We successfully developed a simulation-based curriculum for residents learning the skills of USG CVC insertion. Our results suggest that engaging residents in three to four distributed sessions of deliberate practice of the fundamental skills of USG CVC insertion leads to steady and marked improvement in technical proficiency with individuals approaching or exceeding expert level benchmarks.

Communication Capacity Building through Pharmacy Practice Simulation

Objective. To examine the effectiveness of simulated learning modules (SLMs) encompassing EXcellence in Cultural Experiential Learning and Leadership (EXCELL) core competencies in enhancing pharmacy students' professional communication skills. Methods. Students completed three hours of preparatory lectures and eight hours of workshops comprising six SLMs themed around pharmacy practice and pharmacy placements. Each SLM comprised role-plays with actors, facilitation using EXCELL Social Interaction Maps (SIMs), and debriefing. Evaluations of SLMs included quantitative and qualitative survey responses collected before, during and after workshops, and after placements. Facilitators reflected on SLMs as a pedagogic modality. Results. Student feedback was positive about SLMs as an effective learning tool. The majority indicated areas of new learning and found SLMs enhanced their professional skills and confidence. Facilitator feedback was positive, and suggested SLM optimization strategies. Conclusion. Student and teaching team recommendations will inform future curriculum development including the optimization of SLMs in pharmacy education.

A Comparison of Teaching Modalities and Fidelity of Simulation Levels in Teaching Resuscitation Scenarios

INTRODUCTION

The purpose of our study was to examine the ability of novices to learn selected aspects of Advanced Cardiac Life Support (ACLS) in training conditions that did not incorporate simulation compared to those that contained low- and high-fidelity simulation activities. We sought to determine at what level additional educational opportunities and simulation fidelity become superfluous with respect to learning outcomes.

METHODS

Totally 39 medical students and physician assistant students were randomly assigned to 4 training conditions: control (lecture only), video-based didactic instruction, low-, and high-fidelity simulation activities. Participants were assessed using a baseline written pretest of ACLS knowledge. Following this, all participants received a lecture outlining ACLS science and algorithm interpretation. Participants were then trained in specific aspects of ACLS according to their assigned instructional condition. After training, each participant was assessed via a Megacode performance examination and a written posttest.

RESULTS

All groups performed significantly better on the written posttest compared with the pretest (p < 0.001); however, no groups outperformed any other groups. On the Megacode performance test, the video-based, low-, and high-fidelity groups performed significantly better than the control group (p = 0.028, p < 0.001, p = 0.019). Equivalence testing revealed that the high-fidelity simulation condition was statistically equivalent to the video-based and low-fidelity simulation conditions.

CONCLUSION

Video-based and simulation-based training is associated with better learning outcomes when compared with traditional didactic lectures only. Video-based, low-fidelity, and high-fidelity simulation training yield equivalent outcomes, which may indicate that high-fidelity simulation is superfluous for the novice trainee.

Human patient simulation in a pharmacotherapy course

OBJECTIVE

To incorporate human patient simulation (HPS) into a pharmacotherapy course and evaluate its impact on students' satisfaction and mastery of course objectives.

DESIGN

Various levels of HPS were used for clinical skills assessments, reinforcement of concepts previously introduced in class, and presentation of simulated patient case scenarios requiring critical-thinking and problem-solving abilities. Pre- and post-simulation examinations and a satisfaction survey instrument were administered.

ASSESSMENT

Significant improvement was seen in students' knowledge on post-simulation examinations. On problem-solving skills, the majority of student groups received a final case grade >95%. Students indicated high levels of satisfaction with the use of HPS in the course and showed increased levels of confidence in their pharmacotherapy/patient care skills.

CONCLUSION

Human patient simulation provided a unique opportunity for students to apply what they learned and allowed them to practice problem-solving skills. Students grew in confidence and knowledge through exposure to realistic simulation of clinical scenarios. Students showed improvement in knowledge and ability to resolve patient treatment problems, as well as in self-confidence.