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Yan J, Wen Y, Liu X, Deng M, Ye B, Li T, Wang H, Jia C, Liao J, Zhang L. The effectiveness of problem-based learning and case-based learning teaching methods in clinical practical teaching in TACE treatment for hepatocellular carcinoma in China: a bayesian network meta-analysis. BMC MEDICAL EDUCATION 2024; 24:665. [PMID: 38886707 PMCID: PMC11184776 DOI: 10.1186/s12909-024-05615-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Accepted: 05/29/2024] [Indexed: 06/20/2024]
Abstract
PURPOSE To investigate the effectiveness of problem-based learning (PBL) and case-based learning (CBL) teaching methods in clinical practical teaching in transarterial chemoembolization (TACE) treatment in China. MATERIALS AND METHODS A comprehensive search of PubMed, the Chinese National Knowledge Infrastructure (CNKI) database, the Weipu database and the Wanfang database up to June 2023 was performed to collect studies that evaluate the effectiveness of problem-based learning and case-based learning teaching methods in clinical practical teaching in TACE treatment in China. Statistical analysis was performed by R software (4.2.1) calling JAGS software (4.3.1) in a Bayesian framework using the Markov chain-Monte Carlo method for direct and indirect comparisons. The R packages "gemtc", "rjags", "openxlsx", and "ggplot2" were used for statistical analysis and data output. RESULTS Finally, 7 studies (five RCTs and two observational studies) were included in the meta-analysis. The combination of PBL and CBL showed more effectiveness in clinical thinking capacity, clinical practice capacity, knowledge understanding degree, literature reading ability, method satisfaction degree, learning efficiency, learning interest, practical skills examination scores and theoretical knowledge examination scores. CONCLUSIONS Network meta-analysis revealed that the application of PBL combined with the CBL teaching mode in the teaching of liver cancer intervention therapy significantly improves the teaching effect and significantly improves the theoretical and surgical operations, meeting the requirements of clinical education.
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Affiliation(s)
- Jingxin Yan
- West China Hospital, Sichuan University, Chengdu, China
| | - Yonghao Wen
- Department of Hepatopancreatobiliary Surgery, Affiliated Hospital of Qinghai University, Xining, China
- Department of Postgraduate, Qinghai University, Xining, China
| | - Xinlian Liu
- Department of Pathology and Pathophysiology, Chengdu Medical College, Chengdu, China
| | - Manjun Deng
- Department of Hepatopancreatobiliary Surgery, Affiliated Hospital of Qinghai University, Xining, China
- Department of Postgraduate, Qinghai University, Xining, China
| | - Bin Ye
- Department of General Surgery, Rongxian People's Hospital, Zigong, China
| | - Ting Li
- Department of Orthopedics, Sichuan Provincial People's Hospital, Chengdu, China
| | - Huanwei Wang
- Department of Ultrasonography, Hainan General Hospital/Hainan Affiliated Hospital of Hainan Medical University, Haikou, 570100, China
| | - Cui Jia
- Department of Pathology and Pathophysiology, Chengdu Medical College, Chengdu, China
| | - Jinsong Liao
- Department of Anesthesiology, Affiliated Hospital of Chengdu University, Chengdu University, Chengdu, China.
| | - Lushun Zhang
- Department of Pathology and Pathophysiology, Chengdu Medical College, Chengdu, China.
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Rumbach AF, Aldridge D, Hill AE. Student Perceptions of Simulation to Enhance Clinical Readiness for Assessment and Management of Adults With Voice Disorders. J Voice 2024; 38:641-653. [PMID: 34848106 DOI: 10.1016/j.jvoice.2021.10.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Revised: 10/08/2021] [Accepted: 10/11/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Simulation is a safe, supported, and accessible learning method for students to gain skills and experience, especially in difficult to access range of practice areas such as voice. OBJECTIVE The study aimed to explore change in students' perceptions of knowledge, confidence, anxiety, and clinical readiness for assessment and management of an adult with a voice disorder after participation in simulation-based learning activities. METHODS Participants (N = 113) were students enrolled in a mandatory course dedicated to the voice and voice disorders. Students completed 32 hours of academic coursework which included lectures and tutorials and two 30-minute simulation-based learning activities with a standardized patient playing the role of an adult with a voice disorder. The impact of the simulation-based learning activities on student perceptions of their knowledge, confidence, anxiety, and clinical readiness for work within the area of voice were surveyed at three time points: (1) pre lectures, (2) post lectures but pre simulation, and (3) post simulation. Change across time was analyzed using repeated measures analysis of variance with post hoc Bonferroni adjustment. RESULTS All students perceived significant (P ≤ 0.001) positive changes in knowledge and confidence across time points for all activities, except for writing an assessment report. Anxiety related to the management of a client with a voice disorder fluctuated significantly (P ≤ 0.001) throughout the program. Overall, the majority (>90%) of students agreed or strongly agreed that the simulation-based learning activities were useful and helped them to develop clinical skills, apply content taught in lectures, and gain confidence and interest in voice. CONCLUSION This study supports incorporation of simulation-based learning as part of students' clinical preparation for the assessment and management of voice disorders.
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Affiliation(s)
- Anna F Rumbach
- Speech Pathology, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia.
| | - Danielle Aldridge
- Speech Pathology, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Anne E Hill
- Speech Pathology, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
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Walji HD, Ellis SA, Martin-Ucar AE, Hernandez L. Simulation in thoracic surgery-A mini review of a vital educational tool to maximize peri-operative care and minimize complications. Front Surg 2023; 10:1146716. [PMID: 37206340 PMCID: PMC10189136 DOI: 10.3389/fsurg.2023.1146716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 04/14/2023] [Indexed: 05/21/2023] Open
Abstract
Thoracic surgery is an increasingly expanding field, and the addition of national screening programs has resulted in increasing operative numbers and complexity. Thoracic surgery overall has an approximately 2% mortality and 20% morbidity with common specific complications including persistent air leak, pneumothorax, and fistulas. The nature of the surgery results in complications being unique to thoracic surgery and often very junior members of the surgical team feel underprepared to deal with these complications after very little exposure during their medical school and general surgical rotations. Throughout medicine, simulation is being increasingly used as a method to teach the management of complicated, rare, or significant risk occurrences and has shown significant benefits in learner confidence and outcomes. In this mini review we explain the learning theory and benefits of simulation learning. We also discuss the current state of simulation in thoracic surgery and its potential future in aiding complication management and patient safety.
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Affiliation(s)
- Hasanali David Walji
- Department of Cardio-Thoracic Surgery, University Hospitals Coventry and Warwickshire, Coventry, United Kingdom
- Department of Medical Education, University Hospitals Coventry and Warwickshire, Coventry, United Kingdom
| | - Steven Aaron Ellis
- Department of Medical Education, University Hospitals Coventry and Warwickshire, Coventry, United Kingdom
| | - Antonio Eduardo Martin-Ucar
- Department of Cardio-Thoracic Surgery, University Hospitals Coventry and Warwickshire, Coventry, United Kingdom
| | - Luis Hernandez
- Department of Cardio-Thoracic Surgery, University Hospitals Coventry and Warwickshire, Coventry, United Kingdom
- Correspondence: Luis Hernandez
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Ando K, Ando A, Tanaka A, Koba S, Sagara H. Educational Effects of Simulation and Non-Simulation Training in Airway Management according to Levels of the Kirkpatrick Model: A Systematic Review and Network Meta-Analysis. J Clin Med 2022; 11:jcm11195614. [PMID: 36233481 PMCID: PMC9571641 DOI: 10.3390/jcm11195614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 09/20/2022] [Accepted: 09/22/2022] [Indexed: 11/27/2022] Open
Abstract
There is insufficient validation of the effectiveness of simulation-based training (Sim) or non-simulation-based training (non-Sim) for teaching airway management to healthcare professionals within the literature. We thus conducted a network meta-analysis comparing the effectiveness of Sim, non-Sim, and no educational intervention (NI) for airway management. The primary endpoints were knowledge scores (KnS) and behavioral performance scores (BpS) corresponding to assessments at levels 2 and 3 of the Kirkpatrick model, respectively. Effect sizes were expressed as standardized mean differences (Std. MD) and 95% credible intervals (CrIs). Regarding KnS, the educational effects of Sim and non-Sim were significantly improved compared to those of NI (Std. MD [95% CI]: 1.110 [0.903–1.316] and 0.819 [0.209–1.429], respectively); there was no significant difference between Sim and non-Sim. The educational effect of Sim in BpS was significantly improved compared to that of non-Sim and NI (0.850 [0.015–1.691] and 0.660 [0.241–1.076]); there were no differences between non-Sim and NI. Surface under the cumulative rank curve values demonstrated that Sim ranked highest in efficacy for KnS and BpS. This study provides valuable information regarding the educational efficacy of Sim and non-Sim in airway management. Larger randomized controlled trials are needed to confirm these findings.
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Affiliation(s)
- Koichi Ando
- Division of Respiratory Medicine and Allergology, Department of Medicine, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo 142-8666, Japan
- Division of Internal Medicine, Showa University Dental Hospital Medical Clinic, Senzoku Campus, Showa University, 2-1-1 Kita-senzoku, Ohta-ku, Tokyo 145-8515, Japan
- Correspondence: ; Tel.: +81-3784-8532
| | - Akane Ando
- Department of Anesthesiology, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo 142-8666, Japan
| | - Akihiko Tanaka
- Division of Respiratory Medicine and Allergology, Department of Medicine, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo 142-8666, Japan
| | - Shinji Koba
- Division of Internal Medicine, Showa University Dental Hospital Medical Clinic, Senzoku Campus, Showa University, 2-1-1 Kita-senzoku, Ohta-ku, Tokyo 145-8515, Japan
- Division of Cardiology, Department of Medicine, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo 142-8666, Japan
| | - Hironori Sagara
- Division of Respiratory Medicine and Allergology, Department of Medicine, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo 142-8666, Japan
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Booth E, McFetridge K, Ferguson E, Paton C. Teaching undergraduate medical students virtual consultation skills: a mixed-methods interventional before-and-after study. BMJ Open 2022; 12:e055235. [PMID: 35710246 PMCID: PMC9207740 DOI: 10.1136/bmjopen-2021-055235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES To evaluate the impact and transferability of a novel teaching method on virtual communication skills for final year medical students. DESIGN Mixed-methods, interventional before-and-after study. SETTING NHS Lanarkshire, Scotland. PARTICIPANTS 21 final year medical students on their obstetrics and gynaecology (O&G) placement from September to December 2020. INTERVENTIONS A two-part teaching session on virtual communication skills. MAIN OUTCOME MEASURES Self-reported confidence in conducting consultations preteaching and post-teaching, exposure to virtual consultations, usefulness of teaching and transferability to primary care. Data were collected using preteaching and post-teaching evaluation tools and an online survey. RESULTS Of 21 participants, 1 student did not attend the second session so was excluded from post-teaching evaluation results and the online survey. Preteaching results were collected from 21 participants and post-teaching results from 20. Mean confidence scores increased across all domains post-teaching. Mean confidence in opening the consultation increased from 2.67 (95% CI 2.21 to 3.13) to 4.70 (95% CI 4.50 to 4.90); history-taking from 3.38 (95% CI 3.07 to 3.69) to 4.45 (95% CI 4.19 to 4.71); decision-making and forming a management plan from 2.62 (95% CI 2.28 to 2.96) to 3.90 (95% CI 3.66 to 4.14) and closing the consultation from 2.81 (95% CI 2.45 to 3.17) to 4.60 (95% CI 4.38 to 4.81). There was no change in exposure to virtual consultations during O&G placement. 16 (80%) participants responded to the online survey; 14 (87.5%) rated the sessions 'very useful' and all 16 considered them worthwhile continuing. 12 (75%) had the opportunity to practise virtual consultations on general practitioner, mostly via telephone. CONCLUSIONS We found that teaching students virtual consultation skills improved short term confidence and were transferable to primary care placements. Future research is suggested to assess this teaching model following adaptation and incorporation into medical education and training across specialties and grades. It would be useful to evaluate the impact on competence post intervention through observed skills.
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Affiliation(s)
- Edie Booth
- Department of Medical Education, NHS Lanarkshire, Bothwell, UK
- Department of Medical Education Glasgow, University of Glasgow College of Medical Veterinary and Life Sciences, Glasgow, UK
| | - Kate McFetridge
- Department of Medical Education, NHS Lanarkshire, Bothwell, UK
- Department of Medical Education Glasgow, University of Glasgow College of Medical Veterinary and Life Sciences, Glasgow, UK
| | - Evelyn Ferguson
- Department of Medical Education Glasgow, University of Glasgow College of Medical Veterinary and Life Sciences, Glasgow, UK
- Department of Obstetrics and Gynaecology, University of Glasgow, Glasgow, UK
| | - Catherine Paton
- Department of Medical Education, NHS Lanarkshire, Bothwell, UK
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Alanazi AA, Mohamud MS, AlSuwailem SS. The effect of simulation learning on audiology and speech-language pathology students’ self-confidence related to early hearing detection and intervention: a randomized experiment. SPEECH, LANGUAGE AND HEARING 2022. [DOI: 10.1080/2050571x.2020.1846839] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Ahmad A. Alanazi
- Department of Audiology and Speech Pathology, College of Applied Medical Sciences, King Saud bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Mohamud S. Mohamud
- Department of Medical Education, College of Medicine, King Saud bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Saleh S. AlSuwailem
- Child Development Center, King Abdullah bin Abdulaziz University Hospital, Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia
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Trullàs JC, Blay C, Sarri E, Pujol R. Effectiveness of problem-based learning methodology in undergraduate medical education: a scoping review. BMC MEDICAL EDUCATION 2022; 22:104. [PMID: 35177063 PMCID: PMC8851721 DOI: 10.1186/s12909-022-03154-8] [Citation(s) in RCA: 44] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Accepted: 02/02/2022] [Indexed: 05/31/2023]
Abstract
BACKGROUND Problem-based learning (PBL) is a pedagogical approach that shifts the role of the teacher to the student (student-centered) and is based on self-directed learning. Although PBL has been adopted in undergraduate and postgraduate medical education, the effectiveness of the method is still under discussion. The author's purpose was to appraise available international evidence concerning to the effectiveness and usefulness of PBL methodology in undergraduate medical teaching programs. METHODS The authors applied the Arksey and O'Malley framework to undertake a scoping review. The search was carried out in February 2021 in PubMed and Web of Science including all publications in English and Spanish with no limits on publication date, study design or country of origin. RESULTS The literature search identified one hundred and twenty-four publications eligible for this review. Despite the fact that this review included many studies, their design was heterogeneous and only a few provided a high scientific evidence methodology (randomized design and/or systematic reviews with meta-analysis). Furthermore, most were single-center experiences with small sample size and there were no large multi-center studies. PBL methodology obtained a high level of satisfaction, especially among students. It was more effective than other more traditional (or lecture-based methods) at improving social and communication skills, problem-solving and self-learning skills. Knowledge retention and academic performance weren't worse (and in many studies were better) than with traditional methods. PBL was not universally widespread, probably because requires greater human resources and continuous training for its implementation. CONCLUSION PBL is an effective and satisfactory methodology for medical education. It is likely that through PBL medical students will not only acquire knowledge but also other competencies that are needed in medical professionalism.
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Affiliation(s)
- Joan Carles Trullàs
- Medical Education Cathedra, School of Medicine, University of Vic-Central University of Catalonia, Vic, Barcelona, Spain
- Internal Medicine Service, Hospital de Olot i Comarcal de La Garrotxa, Olot, Girona, Spain
- The Tissue Repair and Regeneration Laboratory (TR2Lab), University of Vic-Central University of Catalonia, Vic, Barcelona, Spain
| | - Carles Blay
- Medical Education Cathedra, School of Medicine, University of Vic-Central University of Catalonia, Vic, Barcelona, Spain
- Catalan Institute of Health (ICS) - Catalunya Central, Barcelona, Spain
| | - Elisabet Sarri
- The Tissue Repair and Regeneration Laboratory (TR2Lab), University of Vic-Central University of Catalonia, Vic, Barcelona, Spain
| | - Ramon Pujol
- Medical Education Cathedra, School of Medicine, University of Vic-Central University of Catalonia, Vic, Barcelona, Spain
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Braun VPB, Nunninger M, Hamm B, Scheel M, Jahnke P. Training of CT-guided Periradicular Therapy in a Realistic Simulation Environment - Evaluation and Recommendations for a Training Curriculum. Acad Radiol 2021; 28:1296-1303. [PMID: 32807605 DOI: 10.1016/j.acra.2020.07.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 07/07/2020] [Accepted: 07/17/2020] [Indexed: 11/28/2022]
Abstract
RATIONALE AND OBJECTIVES To evaluate the training of computed tomography (CT)-guided periradicular therapy in a realistic simulation environment and to derive recommendations for a training curriculum. MATERIALS AND METHODS A novel simulation environment including the use of a 3D printed, patient-mimicking phantom was used to train medical students to perform CT-guided periradicular therapy of the lumbar spine. Seventeen participants underwent three training sessions (day 0, day 7, and after day 28) with six procedures per session. Procedure duration and the number of fluoroscopy image acquisitions were recorded. Participants' performance was assessed by an independent investigator using a six-point checklist scale (0 = lowest, 6 = highest). In addition, participants self-evaluated their skills and the simulation training in questionnaires. RESULTS Procedure durations and image acquisitions decreased after one training session (p < 0.001) without further improvement thereafter (p > 0.6). They also decreased within training sessions and were lowest after five procedures in all sessions. Performance scores improved after the first session to nearly perfect scores in the second session (mean 5.7; 95%CI: 5.5-6.0; p < 0.001) and decreased again in the third session (mean 4.9; 95%CI: 4.6-5.3; p = 0.008). Participants were satisfied with their training progress and felt adequately prepared to perform CT-guided periradicular therapies on patients after the training. CONCLUSION Simulation-based training of CT-guided periradicular therapy in a realistic environment is effective and should ideally be performed with one training session consisting of five procedures shortly before treating the first patient.
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Affiliation(s)
- Victor Paul Bela Braun
- Department of Radiology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, Berlin 10117, Germany
| | - Maximilian Nunninger
- Department of Radiology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, Berlin 10117, Germany
| | - Bernd Hamm
- Department of Radiology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, Berlin 10117, Germany
| | - Michael Scheel
- Department of Neuroradiology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Paul Jahnke
- Department of Radiology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, Berlin 10117, Germany.
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Kurz S, Lohse J, Buggenhagen H, Schmidtmann I, Laufenberg-Feldmann R, Engelhard K. Improving competence and safety in pain medicine: a practical clinical teaching strategy for students combining simulation and bedside teaching. BMC MEDICAL EDUCATION 2021; 21:133. [PMID: 33632210 PMCID: PMC7905916 DOI: 10.1186/s12909-021-02554-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Accepted: 02/09/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND Pain is a devastating sensation and has to be treated immediately. Therefore, we developed a training program to improve the knowledge of medical students in the field of pain medicine. In the present study, the applicability and efficacy of this training program was tested. METHODS Half of the students attended first a training with simulated patients (SP) followed by bedside teaching (Group 1). Group 2 performed the training programs in reverse order. The evaluation based on standardized questionnaires completed by students (self-assessment) and all students took part in two practical examinations after the learning interventions. RESULTS This study included 35 students. The quality of the simulation was evaluated by the students with average grade 1.1 (1 = very good, 6 = very bad). The practical work on the ward with patients was rated with grade 1.4 of 6, the whole course with 1.1. Students of Group A were significantly better in the final examination (grade 1.7 vs. grade 2.2, p < 0.05). To rate the improvement of skills (self-assessment) we used a Likert Scale (1 = very certain, 5 = very uncertain). The following skills were similar in both groups and significantly better after the course: taking responsibility, expert knowledge, empathy, relationship building and communication. CONCLUSIONS Training with simulated patients in combination with small-group teaching at the bedside with real patients achieves a dramatic increase in student competence. Students prefer learning from the simulation before bedside teaching and propose to include simulation into the curricular teaching of pain medicine.
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Affiliation(s)
- Sandra Kurz
- University Medical Center of the Johannes Gutenberg-University, Langenbeckstraße 1, 55131, Mainz, Germany.
| | - Jana Lohse
- University Medical Center of the Johannes Gutenberg-University, Langenbeckstraße 1, 55131, Mainz, Germany
| | - Holger Buggenhagen
- University Medical Center of the Johannes Gutenberg-University, Langenbeckstraße 1, 55131, Mainz, Germany
| | - Irene Schmidtmann
- University Medical Center of the Johannes Gutenberg-University, Langenbeckstraße 1, 55131, Mainz, Germany
| | - Rita Laufenberg-Feldmann
- University Medical Center of the Johannes Gutenberg-University, Langenbeckstraße 1, 55131, Mainz, Germany
| | - Kristin Engelhard
- University Medical Center of the Johannes Gutenberg-University, Langenbeckstraße 1, 55131, Mainz, Germany
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Galland J, Martis N, Levraut M, Hani H, Baumann C, Fournier JP, Braun M. Impact of Simulation-Based Learning on National Ranking Medical Examination Results in France. ACTA ACUST UNITED AC 2020; 15:259-265. [DOI: 10.1097/sih.0000000000000431] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Mutter MK, Martindale JR, Shah N, Gusic ME, Wolf SJ. Case-Based Teaching: Does the Addition of High-Fidelity Simulation Make a Difference in Medical Students' Clinical Reasoning Skills? MEDICAL SCIENCE EDUCATOR 2020; 30:307-313. [PMID: 34457672 PMCID: PMC8368304 DOI: 10.1007/s40670-019-00904-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
CONTEXT Situativity theory posits that learning and the development of clinical reasoning skills are grounded in context. In case-based teaching, this context comes from recreating the clinical environment, through emulation, as with manikins, or description. In this study, we sought to understand the difference in student clinical reasoning abilities after facilitated patient case scenarios with or without a manikin. METHODS Fourth-year medical students in an internship readiness course were randomized into patient case scenarios without manikin (control group) and with manikin (intervention group) for a chest pain session. The control and intervention groups had identical student-led case progression and faculty debriefing objectives. Clinical reasoning skills were assessed after the session using a 64-question script concordance test (SCT). The test was developed and piloted prior to administration. Hospitalist and emergency medicine faculty responses on the test items served as the expert standard for scoring. RESULTS Ninety-six students were randomized to case-based sessions with (n = 48) or without (n = 48) manikin. Ninety students completed the SCT (with manikin n = 45, without manikin n = 45). A statistically significant mean difference on test performance between the two groups was found (t = 3.059, df = 88, p = .003), with the manikin group achieving higher SCT scores. CONCLUSION Use of a manikin in simulated patient case discussion significantly improves students' clinical reasoning skills, as measured by SCT. These results suggest that using a manikin to simulate a patient scenario situates learning, thereby enhancing skill development.
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Affiliation(s)
- Mary Kathryn Mutter
- Department of Emergency Medicine, University of Virginia School of Medicine, PO Box 800699, Charlottesville, VA 22908-0699 USA
| | - James R. Martindale
- University of Virginia School of Medicine, Box 800866 Suite 2008 Pinn Hall, Charlottesville, VA 22908-0866 USA
| | - Neeral Shah
- Division of Gastroenterology and Hepatology, University of Virginia School of Medicine, Box 800708, GI West Complex - 2nd Floor, Charlottesville, VA 22908 USA
| | - Maryellen E. Gusic
- University of Virginia School of Medicine, Box 800866 Suite 2008 Pinn Hall, Charlottesville, VA 22908-0866 USA
| | - Stephen J. Wolf
- Department of Emergency Medicine, Denver Health Medical Center, University of Colorado School of Medicine, Denver Health Medical Center, 777 Bannock St., Pavilion A, Denver, CO 80204 USA
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Beasley D, Welsh J. 'Benefits of simulated general practice clinics in the preparation of medical students for primary healthcare’; a response. EDUCATION FOR PRIMARY CARE 2019; 30:396. [DOI: 10.1080/14739879.2019.1663133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Daniel Beasley
- Department of Medicine, Faculty of Medicine, Imperial College London, London, UK
| | - Joshua Welsh
- Department of Medicine, Faculty of Medicine, Imperial College London, London, UK
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Massoth C, Röder H, Ohlenburg H, Hessler M, Zarbock A, Pöpping DM, Wenk M. High-fidelity is not superior to low-fidelity simulation but leads to overconfidence in medical students. BMC MEDICAL EDUCATION 2019; 19:29. [PMID: 30665397 PMCID: PMC6341720 DOI: 10.1186/s12909-019-1464-7] [Citation(s) in RCA: 97] [Impact Index Per Article: 19.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Accepted: 01/09/2019] [Indexed: 05/11/2023]
Abstract
BACKGROUND Simulation has become integral to the training of both undergraduate medical students and medical professionals. Due to the increasing degree of realism and range of features, the latest mannequins are referred to as high-fidelity simulators. Whether increased realism leads to a general improvement in trainees' outcomes is currently controversial and there are few data on the effects of these simulators on participants' personal confidence and self-assessment. METHODS One-hundred-and-thirty-five fourth-year medical students were randomly allocated to participate in either a high- or a low-fidelity simulated Advanced Life Support training session. Theoretical knowledge and self-assessment pre- and post-tests were completed. Students' performance in simulated scenarios was recorded and rated by experts. RESULTS Participants in both groups showed a significant improvement in theoretical knowledge in the post-test as compared to the pre-test, without significant intergroup differences. Performance, as assessed by video analysis, was comparable between groups, but, unexpectedly, the low-fidelity group had significantly better results in several sub-items. Irrespective of the findings, participants of the high-fidelity group considered themselves to be advantaged, solely based on their group allocation, compared with those in the low-fidelity group, at both pre- and post-self-assessments. Self-rated confidence regarding their individual performance was also significantly overrated. CONCLUSION The use of high-fidelity simulation led to equal or even worse performance and growth in knowledge as compared to low-fidelity simulation, while also inducing undesirable effects such as overconfidence. Hence, in this study, it was not beneficial compared to low-fidelity, but rather proved to be an adverse learning tool.
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Affiliation(s)
- Christina Massoth
- Department of Anesthesiology and Intensive Care, University Hospital Münster, Albert-Schweitzer-Campus 1 (A1), 48149 Münster, Germany
| | - Hannah Röder
- Department of Anesthesiology and Intensive Care, University Hospital Münster, Albert-Schweitzer-Campus 1 (A1), 48149 Münster, Germany
| | - Hendrik Ohlenburg
- Department of Anesthesiology and Intensive Care, University Hospital Münster, Albert-Schweitzer-Campus 1 (A1), 48149 Münster, Germany
| | - Michael Hessler
- Department of Anesthesiology and Intensive Care, University Hospital Münster, Albert-Schweitzer-Campus 1 (A1), 48149 Münster, Germany
| | - Alexander Zarbock
- Department of Anesthesiology and Intensive Care, University Hospital Münster, Albert-Schweitzer-Campus 1 (A1), 48149 Münster, Germany
| | - Daniel M. Pöpping
- Department of Anesthesiology and Intensive Care, University Hospital Münster, Albert-Schweitzer-Campus 1 (A1), 48149 Münster, Germany
| | - Manuel Wenk
- Department of Anesthesiology and Intensive Care, University Hospital Münster, Albert-Schweitzer-Campus 1 (A1), 48149 Münster, Germany
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Lenihan M, Parotto M, Djaiani G. Education on Management of Cerebrospinal Fluid Drainage: What Does Really Matter? J Cardiothorac Vasc Anesth 2018; 33:1001-1002. [PMID: 30529175 DOI: 10.1053/j.jvca.2018.08.204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Indexed: 11/11/2022]
Affiliation(s)
- Martin Lenihan
- Department of Anesthesia and Pain Management, Toronto General Hospital, University Health Network, Toronto, Canada
| | - Matteo Parotto
- Department of Anesthesia and Pain Management, Toronto General Hospital, University Health Network, Toronto, Canada; Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Canada
| | - George Djaiani
- Department of Anesthesia and Pain Management, Toronto General Hospital, University Health Network, Toronto, Canada
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The Effectiveness of Medical Simulation in Teaching Medical Students Critical Care Medicine: A Systematic Review and Meta-Analysis. Simul Healthc 2018; 12:104-116. [PMID: 28704288 DOI: 10.1097/sih.0000000000000189] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
STATEMENT We aimed to assess effectiveness of simulation for teaching medical students critical care medicine and to assess which simulation methods were most useful. We searched AMED, EMBASE, MEDLINE, Education Resources Information Centre, British Education Index, Australian Education Index, and bibliographies and citations, in July 2013. Randomized controlled trials comparing effectiveness of simulation with another educational intervention, or no teaching, for teaching medical students critical care medicine were included. Assessments for inclusion, quality, and data extraction were duplicated and results were synthesized using meta-analysis.We included 22 randomized control trials (n = 1325). Fifteen studies comparing simulation with other teaching found simulation to be more effective [standardized mean difference (SMD) = 0.84; 95% confidence interval (CI) = 0.43 to 1.24; P < 0.001; I = 89%]. High-fidelity simulation was more effective than low-fidelity simulation, and subgrouping supported high-fidelity simulation being more effective than other methods. Simulation improved skill acquisition (SMD = 1.01; 95% CI = 0.49 to 1.53) but was no better than other teaching in knowledge acquisition (SMD = 0.41; 95% CI = -0.09 to 0.91).
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Galland J. [Simulation-based learning development: More haste, less speed]. Rev Med Interne 2018; 39:543-545. [PMID: 29571581 DOI: 10.1016/j.revmed.2018.02.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Accepted: 02/26/2018] [Indexed: 11/28/2022]
Affiliation(s)
- J Galland
- Service de médecine interne, hôpital Tenon, Assistance publique-Hôpitaux de Paris, 4, rue de la Chine, 75020 Paris, France; Sorbonne université, faculté de médecine Sorbonne université, 75013 Paris, France.
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Katz A, Tepper R, Shtub A. Simulation Training: Evaluating the Instructor's Contribution to a Wizard of Oz Simulator in Obstetrics and Gynecology Ultrasound Training. JMIR MEDICAL EDUCATION 2017; 3:e8. [PMID: 28432039 PMCID: PMC5420066 DOI: 10.2196/mededu.6312] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/03/2016] [Revised: 01/01/2017] [Accepted: 02/26/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND Workplaces today demand graduates who are prepared with field-specific knowledge, advanced social skills, problem-solving skills, and integration capabilities. Meeting these goals with didactic learning (DL) is becoming increasingly difficult. Enhanced training methods that would better prepare tomorrow's graduates must be more engaging and game-like, such as feedback based e-learning or simulation-based training, while saving time. Empirical evidence regarding the effectiveness of advanced learning methods is lacking. Objective quantitative research comparing advanced training methods with DL is sparse. OBJECTIVES This quantitative study assessed the effectiveness of a computerized interactive simulator coupled with an instructor who monitored students' progress and provided Web-based immediate feedback. METHODS A low-cost, globally accessible, telemedicine simulator, developed at the Technion-Israel Institute of Technology, Haifa, Israel-was used. A previous study in the field of interventional cardiology, evaluating the efficacy of the simulator to enhanced learning via knowledge exams, presented promising results of average scores varying from 94% after training and 54% before training (n=20) with P<.001. Two independent experiments involving obstetrics and gynecology (Ob-Gyn) physicians and senior ultrasound sonographers, with 32 subjects, were conducted using a new interactive concept of the WOZ (Wizard of OZ) simulator platform. The contribution of an instructor to learning outcomes was evaluated by comparing students' knowledge before and after each interactive instructor-led session as well as after fully automated e-learning in the field of Ob-Gyn. Results from objective knowledge tests were analyzed using hypothesis testing and model fitting. RESULTS A significant advantage (P=.01) was found in favor of the WOZ training approach. Content type and training audience were not significant. CONCLUSIONS This study evaluated the contribution of an integrated teaching environment using a computerized interactive simulator, with an instructor providing immediate Web-based immediate feedback to trainees. Involvement of an instructor in the simulation-based training process provided better learning outcomes that varied training content and trainee populations did not affect the overall learning gains.
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Affiliation(s)
- Aric Katz
- Technion, Industrial Engineering & Management, Technion, Haifa, Israel
| | - Ronnie Tepper
- Simultech, Department of Obstetrics & Gynecology, Meir Medical Center, Kfar-Saba, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Avraham Shtub
- Technion - Israel Institute of Technology, Industrial Engineering & Management, Technion, Haifa, Israel
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Ott T, Gerth MA, Emrich L, Buggenhagen H, Werner C. Simulation. ZEITSCHRIFT FUR HERZ THORAX UND GEFASSCHIRURGIE 2017. [DOI: 10.1007/s00398-016-0135-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Sun Y, Pan C, Li T, Gan TJ. Airway management education: simulation based training versus non-simulation based training-A systematic review and meta-analyses. BMC Anesthesiol 2017; 17:17. [PMID: 28143389 PMCID: PMC5286685 DOI: 10.1186/s12871-017-0313-7] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Accepted: 01/27/2017] [Indexed: 12/02/2022] Open
Abstract
Background Simulation-based training (SBT) has become a standard for medical education. However, the efficacy of simulation based training in airway management education remains unclear. Methods The aim of this study was to evaluate all published evidence comparing the effectiveness of SBT for airway management versus non-simulation based training (NSBT) on learner and patient outcomes. Systematic review with meta-analyses were used. Data were derived from PubMed, EMBASE, CINAHL, Scopus, the Cochrane Controlled Trials Register and Cochrane Database of Systematic Reviews from inception to May 2016. Published comparative trials that evaluated the effect of SBT on airway management training in compared with NSBT were considered. The effect sizes with 95% confidence intervals (CI) were calculated for outcomes measures. Results Seventeen eligible studies were included. SBT was associated with improved behavior performance [standardized mean difference (SMD):0.30, 95% CI: 0.06 to 0.54] in comparison with NSBT. However, the benefits of SBT were not seen in time-skill (SMD:-0.13, 95% CI: −0.82 to 0.52), written examination score (SMD: 0.39, 95% CI: −0.09 to 0.86) and success rate of procedure completion on patients [relative risk (RR): 1.26, 95% CI: 0.96 to 1.66]. Conclusion SBT may be not superior to NSBT on airway management training.
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Affiliation(s)
- Yanxia Sun
- Department of Anesthesiology, Beijing Tong Ren Hospital, Capital Medical University, Beijing, China.
| | - Chuxiong Pan
- Department of Anesthesiology, Beijing Tong Ren Hospital, Capital Medical University, Beijing, China
| | - Tianzuo Li
- Department of Anesthesiology, Beijing Shi Ji Tan Hospital, Capital Medical University, Beijing, China
| | - Tong J Gan
- Department of Anesthesiology, Stony Brook University, Stony Brook, USA
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Ott T, Schmidtmann I, Limbach T, Gottschling PF, Buggenhagen H, Kurz S, Pestel G. [Simulation-based training and OR apprenticeship for medical students : A prospective, randomized, single-blind study of clinical skills]. Anaesthesist 2016; 65:822-831. [PMID: 27678137 DOI: 10.1007/s00101-016-0221-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Revised: 07/05/2016] [Accepted: 08/15/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND Simulation-based training (SBT) has developed into an established method of medical training. Studies focusing on the education of medical students have used simulation as an evaluation tool for defined skills. A small number of studies provide evidence that SBT improves medical students' skills in the clinical setting. Moreover, they were strictly limited to a few areas, such as the diagnosis of heart murmurs or the correct application of cricoid pressure. Other studies could not prove adequate transferability from the skills gained in SBT to the patient site. Whether SBT has an effect on medical students' skills in anesthesiology in the clinical setting is controversial. To explore this issue, we designed a prospective, randomized, single-blind trial that was integrated into the undergraduate anesthesiology curriculum of our department during the second year of the clinical phase of medical school. OBJECTIVES This study intended to explore the effect of SBT on medical students within the mandatory undergraduate anesthesiology curriculum of our department in the operating room with respect to basic skills in anesthesiology. MATERIALS AND METHODS After obtaining ethical approval, the participating students of the third clinical semester were randomized into two groups: the SIM-OR group was trained by a 225 min long SBT in basic skills in anesthesiology before attending the operating room (OR) apprenticeship. The OR-SIM group was trained after the operating room apprenticeship by SBT. During SBT the students were trained in five clinical skills detailed below. Further, two clinical scenarios were simulated using a full-scale simulator. The students had to prepare the patient and perform induction of anesthesia, including bag-mask ventilation after induction in scenario 1 and rapid sequence induction in scenario 2. Using the five-point Likert scale, five defined skills were evaluated at defined time points during the study period. 1) application of the safety checklist, 2) application of basic patient monitoring, 3) establishment of intravenous access, 4) bag-and-mask ventilation, and 5) adjustment of ventilatory parameters after the patients' airways were secured. A cumulative score of 5 points was defined as the best and a cumulative score of 25 as the worst rating for a defined time point. The primary endpoint was the cumulative score after day 1 in the operating room apprenticeship and the difference in cumulative scores from days 1 to 4. Our hypothesis was that the SIM-OR group would achieve a better score after day 1 in the operating room apprenticeship and would gain a larger increase in score from day 1 to day 4 than the OR-SIM group. RESULTS 73 students were allocated to the OR-SIM group and 70 students to the SIM-OR group. There was no significant difference between the two groups after day 1 of the operating room apprenticeship and no difference in increase of the cumulative score from day 1 to day 4 (median of cumulative score on day 1: 'SIM-OR' 11.2 points vs. 'OR-SIM' 14.6 points; p = 0.067; median of difference from day 1 to day 4: 'SIM-OR' -3.7 vs. 'OR-SIM' -6.4; p = 0.110). CONCLUSION With the methods applied, this study could not prove that 225 min of SBT before the operating room apprenticeship increased the medical students' clinical skills as evaluated in the operating room. Secondary endpoints indicate that medical students have better clinical skills at the end of the entire curriculum when they have been trained through SBT before the operating room apprenticeship. However, the authors believe that simulator training has a positive impact on students' acquisition of procedural and patient safety skills, even if the methods applied in this study may not mirror this aspect sufficiently.
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Affiliation(s)
- T Ott
- Klinik für Anästhesiologie, Universitätsmedizin Mainz, Johannes Gutenberg-Universität Mainz, Langenbeckstr. 1, 55131, Mainz, Deutschland.
| | - I Schmidtmann
- Institut für Medizinische Biometrie, Epidemiologie und Informatik, Universitätsmedizin Mainz, Johannes Gutenberg-Universität Mainz, Mainz, Deutschland
| | - T Limbach
- Klinik für Anästhesiologie, Universitätsmedizin Mainz, Johannes Gutenberg-Universität Mainz, Langenbeckstr. 1, 55131, Mainz, Deutschland
| | - P F Gottschling
- Klinik für Anästhesiologie, Universitätsmedizin Mainz, Johannes Gutenberg-Universität Mainz, Langenbeckstr. 1, 55131, Mainz, Deutschland
| | - H Buggenhagen
- Klinik für Anästhesiologie, Universitätsmedizin Mainz, Johannes Gutenberg-Universität Mainz, Langenbeckstr. 1, 55131, Mainz, Deutschland
| | - S Kurz
- Klinik für Anästhesiologie, Universitätsmedizin Mainz, Johannes Gutenberg-Universität Mainz, Langenbeckstr. 1, 55131, Mainz, Deutschland
| | - G Pestel
- Klinik für Anästhesiologie, Universitätsmedizin Mainz, Johannes Gutenberg-Universität Mainz, Langenbeckstr. 1, 55131, Mainz, Deutschland
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Sqalli Houssaini T, Alaoui Belghiti K, Boukatta B, Houari N, Kabbali N, Arrayhani M, Kanjaa N. [Medical simulation in hemodialysis]. Nephrol Ther 2016; 12 Suppl 1:S83-8. [PMID: 26972099 DOI: 10.1016/j.nephro.2016.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Simulation is an innovative educational tool based on learning experience in a secure environment without fear of repercussions especially in critical situations such as in emergencies. It offers great prospects in the development of dialysis training. METHODS We report the results of an observational study comparing medical simulation to conventional training methods in the management of hemodialysis in emergency situations. We discuss afterwards the possibilities currently allowed by medical simulation in dialysis training. RESULTS The training was beneficial (significant difference between initial and final level of knowledge) for all participants. There was no significant difference between the conventional approach, simulation training and the two combined tools. However, satisfaction rate was higher in simulation training. We observed a tendency to have better results in "active players" of the simulation compared to observers. CONCLUSION We emphasize the importance of integrating medical simulation training in our dialysis training strategies as a complementary tool to classical teaching/learning methods.
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Affiliation(s)
- Tarik Sqalli Houssaini
- Équipe de recherche Rein, faculté de médecine et de pharmacie de Fès, BP 1877, Agence Atlas, 30000 Fès, Maroc; Service de néphrologie, centre hospitalier universitaire Hassan-II, Fès, Maroc.
| | | | - Brahim Boukatta
- Service de réanimation polyvalente (E4), centre hospitalier universitaire Hassan-II, Fès, Maroc
| | - Nawfal Houari
- Service de réanimation polyvalente (E4), centre hospitalier universitaire Hassan-II, Fès, Maroc
| | - Nadia Kabbali
- Équipe de recherche Rein, faculté de médecine et de pharmacie de Fès, BP 1877, Agence Atlas, 30000 Fès, Maroc; Service de néphrologie, centre hospitalier universitaire Hassan-II, Fès, Maroc
| | - Mohamed Arrayhani
- Équipe de recherche Rein, faculté de médecine et de pharmacie de Fès, BP 1877, Agence Atlas, 30000 Fès, Maroc; Service de néphrologie, centre hospitalier universitaire Hassan-II, Fès, Maroc
| | - Nabil Kanjaa
- Service de réanimation polyvalente (E4), centre hospitalier universitaire Hassan-II, Fès, Maroc
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Bowling AM, Underwood PW. Effect of simulation on knowledge, self-confidence, and skill performance in the USA: A quasi-experimental study. Nurs Health Sci 2016; 18:292-8. [PMID: 26834000 DOI: 10.1111/nhs.12267] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Revised: 10/04/2015] [Accepted: 11/07/2015] [Indexed: 11/28/2022]
Abstract
In health care, high-fidelity simulation has been shown to result in increased student learning outcomes when compared to low-fidelity simulation. With educational facilities investing significant amounts of money into purchasing high-fidelity simulators, it is imperative to identify if the midlevel simulator, which is less costly, will result in the same learning outcomes. In this study, we examined the effect of midlevel-fidelity simulation versus low-fidelity simulation on Bachelor of Science in Nursing nursing students' knowledge, self-confidence, and skill performance. A quasi-experimental design examined the effects of midlevel-fidelity simulation (n = 37) versus low-fidelity simulation (case study) (n = 37) in junior-level nursing students. There was a significant difference for both groups in knowledge and skill performance (measured with a mini Objective Structured Clinical Examination), but not between the groups. Unexpectedly, the case-study group had a higher level of self-confidence (self-reported). The results of this study indicate that further research is needed to support faculties' selection of learning strategies with the lowest cost and highest effectiveness in achieving the desired learning outcomes.
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Affiliation(s)
- Ann M Bowling
- College of Nursing and Health, Wright State University - Miami Valley, Dayton
| | - Patricia W Underwood
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio, USA
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Neuhaus C, Röhrig R, Hofmann G, Klemm S, Neuhaus S, Hofer S, Thalheimer M, Weigand MA, Lichtenstern C. [Patient safety in anesthesiology : Multimodal strategies for perioperative care]. Anaesthesist 2015; 64:911-926. [PMID: 26636142 DOI: 10.1007/s00101-015-0115-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The concept of patient safety is more of a presence in modern day medicine than ever before. All measures and processes aiming at preempting and preventing critical incidents and accidents in patient care are collectively grouped under this concept. With the Declaration of Helsinki in 2010 modern anesthesiology has undertaken a fundamental role in the clinical implementation and perioperative clinicians are confronted with a multitude of theories, models, methods and tools targeted at improving or facilitating optimized patient safety. One of the biggest challenges lies in their synergistic combination to create a functioning concept for perioperative risk management while also incorporating individual strengths and weaknesses. The aim of the present paper is to provide a structured overview of the various components presently available for increasing perioperative patient safety.
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Affiliation(s)
- C Neuhaus
- Klinik für Anästhesiologie, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Deutschland.
| | - R Röhrig
- Abteilung Medizinische Informatik, Carl von Ossietzky Universität, Oldenburg, Deutschland
| | - G Hofmann
- Klinik für Anästhesiologie, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Deutschland
| | - S Klemm
- Klinik für Anästhesiologie, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Deutschland
| | - S Neuhaus
- Klinik für Anästhesiologie, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Deutschland
| | - S Hofer
- Klinik für Anästhesiologie, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Deutschland
| | - M Thalheimer
- Abteilung Qualitätsmanagement/Medizincontrolling, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | - M A Weigand
- Klinik für Anästhesiologie, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Deutschland
| | - C Lichtenstern
- Klinik für Anästhesiologie, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Deutschland
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Rajan S, Khanna A, Argalious M, Kimatian SJ, Mascha EJ, Makarova N, Nada EM, Elsharkawy H, Firoozbakhsh F, Avitsian R. Comparison of 2 resident learning tools-interactive screen-based simulated case scenarios versus problem-based learning discussions: a prospective quasi-crossover cohort study. J Clin Anesth 2015; 28:4-11. [PMID: 26796607 DOI: 10.1016/j.jclinane.2015.08.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2014] [Accepted: 08/12/2015] [Indexed: 01/06/2023]
Abstract
STUDY OBJECTIVE Simulation-based learning is emerging as an alternative educational tool in this era of a relative shortfall of teaching anesthesiologists. The objective of the study is to assess whether screen-based (interactive computer simulated) case scenarios are more effective than problem-based learning discussions (PBLDs) in improving test scores 4 and 8 weeks after these interventions in anesthesia residents during their first neuroanesthesia rotation. DESIGN Prospective, nonblinded quasi-crossover study. SETTING Cleveland Clinic. PATIENTS Anesthesiology residents. INTERVENTIONS Two case scenarios were delivered from the Anesoft software as screen-based sessions, and parallel scripts were developed for 2 PBLDs. Each resident underwent both types of training sessions, starting with the PBLD session, and the 2 cases were alternated each month (ie, in 1 month, the screen-based intervention used case 1 and the PBLD used case 2, and vice versa for the next month). MEASUREMENTS Test scores before the rotation (baseline), immediately after the rotation (4 weeks after the start of the rotation), and 8 weeks after the start of rotation were collected on each topic from each resident. The effect of training method on improvement in test scores was assessed using a linear mixed-effects model. MAIN RESULTS Compared to the departmental standard of PBLD, the simulation method did not improve either the 4- or 8-week mean test scores (P = .41 and P = .40 for training method effect on 4- and 8-week scores, respectively). Resident satisfaction with the simulation module on a 5-point Likert scale showed subjective evidence of a positive impact on resident education. CONCLUSIONS Screen-based simulators were not more effective than PBLD for education during the neuroanesthesia rotation in anesthesia residency.
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Affiliation(s)
- Shobana Rajan
- Staff Anesthesiologist, Department of General Anesthesiology, Cleveland Clinic, 9500 Euclid Ave- E30, Cleveland, OH 44195.
| | - Ashish Khanna
- Staff Intensivist, Center for Critical Care, and Staff Anesthesiologist, Department of General Anesthesiology and Department of Outcomes Research, Cleveland Clinic Foundation, Cleveland, OH 44195.
| | - Maged Argalious
- Residency Program Director, Anesthesiology Institute and Associate Professor of Anesthesiology, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Department of General Anesthesiology, Cleveland Clinic, 9500 Euclid Ave- E30, Cleveland, OH 44195.
| | - Stephen J Kimatian
- Vice Chair for Education, Anesthesiology Institute and Chairman, Pediatric Anesthesiology, Pediatric Anesthesiology, Cleveland Clinic, 9500 Euclid Avenue/P20, Cleveland, OH 44195.
| | - Edward J Mascha
- Associate Staff Biostatistician, Department of Quantitative Health Sciences, Cleveland Clinic, 9500 Euclid Avenue/P77, Cleveland, OH 44195.
| | - Natalya Makarova
- Biostatistician, Department of Quantitative Health Sciences, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195.
| | - Eman M Nada
- Anesthesiology Resident, Department of General Anesthesiology, University of Arkansas for Medical Sciences, Little Rock, AR, USA.
| | - Hesham Elsharkawy
- Assistant Professor of Anesthesiology Cleveland Clinic Lerner College of Medicine of Case Western Reserve University and Staff Anesthesiologist, Department of General Anesthesiology, 9500 Euclid Ave- E30, Cleveland, OH 44195.
| | - Farhad Firoozbakhsh
- Anesthesiology Resident, Anesthesiology Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195.
| | - Rafi Avitsian
- Vice Chair for Professional Development, Department of General Anesthesiology and Associate Professor of Anesthesiology Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Department of General Anesthesiology, 9500 Euclid Ave- E30, Cleveland, OH 44195.
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Ott T, Fischer M, Limbach T, Schmidtmann I, Piepho T, Noppens RR. The novel intubating laryngeal tube (iLTS-D) is comparable to the intubating laryngeal mask (Fastrach) - a prospective randomised manikin study. Scand J Trauma Resusc Emerg Med 2015; 23:44. [PMID: 26051498 PMCID: PMC4459456 DOI: 10.1186/s13049-015-0126-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2014] [Accepted: 05/29/2015] [Indexed: 11/16/2022] Open
Abstract
Background Supraglottic devices are helpful for inexperienced providers who perform ventilation in emergency situations. Most supraglottic devices do not allow secondary tracheal intubation through the device. The novel intubating laryngeal tube (iLTS-D®) and the intubating laryngeal mask (Fastrach™) are devices that offer supraglottic ventilation and secondary tracheal intubation. Methods We evaluated the novel iLTS-D and compared it to the established Fastrach using a manikin-based study. Participants used both devices in a randomised order. The participants conducted four consecutive trials on a manikin. One trial was composed of the following procedures. First, participants ventilated the manikin using either iLTS-D or Fastrach. ‘Time to ventilation’, success rates and number of attempts were recorded for the supraglottic device. Second, participants intubated the manikin through the previously inserted supraglottic device. ‘Time to tracheal ventilation’, success rate and tube localisation were recorded. The primary endpoint was the results of the final fourth trial, which mirrored the standardised training of trials 1, 2 and 3. Results A total of 64 participants were enrolled. All of the participants successfully inserted both devices on their first attempt in trial 4. Fastrach was applied 1 s faster in trial 4 than the iLTS-D (median ‘time to ventilation’ Fastrach: 13.5 s., iLTS-D: 14.5 s., p = 0.04). All participants successfully intubated through both devices in trial 4. There was no difference in ‘time to tracheal ventilation’ by tracheal intubation between either device (median ‘time to tracheal ventilation’: Fastrach: 14.0 s., iLTS-D: 14.0 s., p = 0.16). Conclusion The iLTS-D performed similarly to the ILMA in insertion and intubation times in a manikin setting.
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Affiliation(s)
- Thomas Ott
- Department of Anaesthesiology, University Medical Centre of the Johannes Gutenberg-University Mainz, Langenbeckstrasse 1, Mainz, 55131, Germany.
| | - Matthias Fischer
- Department of Anaesthesiology, University Medical Centre of the Johannes Gutenberg-University Mainz, Langenbeckstrasse 1, Mainz, 55131, Germany.
| | - Tobias Limbach
- Department of Anaesthesiology, University Medical Centre of the Johannes Gutenberg-University Mainz, Langenbeckstrasse 1, Mainz, 55131, Germany.
| | - Irene Schmidtmann
- Institute of Medical Biostatistics, Epidemiology, and Informatics, University Medical Centre of the Johannes Gutenberg University Mainz, Mainz, Germany.
| | - Tim Piepho
- Department of Anaesthesiology, University Medical Centre of the Johannes Gutenberg-University Mainz, Langenbeckstrasse 1, Mainz, 55131, Germany.
| | - Ruediger R Noppens
- Department of Anaesthesiology, University Medical Centre of the Johannes Gutenberg-University Mainz, Langenbeckstrasse 1, Mainz, 55131, Germany.
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Abstract
BACKGROUND Other than the Advanced Trauma Life Support course, usually run for postgraduate trainees, there are few trauma courses available for medical students. It has been shown that trauma teaching for medical students is sadly lacking within the undergraduate curriculum. We stated that students following formal teaching, even just theory and some practice in basic skills significantly improved their management of trauma patients. METHODS Hadassah-Hebrew University in Israel runs an annual 2-week trauma course for final-year medical students. The focus is on hands-on practice in resuscitation, diagnosis, procedures, and decision making. After engaging a combination of instructional and interactive teaching methods including practice on simulated injuries that students must assess and treat through the 2 weeks, the course culminates in a disaster drill where students work alongside the emergency services to rescue, assess, treat, and transfer patients. The course is evaluated with a written precourse and postcourse test, an Objective Structured Clinical Examination and detailed feedback from the drill. RESULTS We analyzed student feedback at the end of each course during a 6-year period from 2007 to 2012. Correct answers for the posttest results were higher each year with good reliability as assessed by Chronbach's α and with significant variation from pretest scores assessed using paired-samples t tests. Best scores were achieved in knowledge acquisition and practical skills gained. Students were also asked whether the course contributed to self-preparedness in treating trauma patients, and this consistently achieved high scores. CONCLUSION We believe that students benefit substantially from the course and gain lasting skills and confidence in trauma management, decision making, and organizational skills. The course provides students with the opportunity to learn and ingrain trauma principles along Advanced Trauma Life Support guidelines and prepares them for practice as safe doctors. We advocate the global implementation of a student trauma training course as a mandatory educational initiative and propose our course format as a model for similar courses.
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The effect of simulation on skill performance: a need for change in pediatric nursing education. J Pediatr Nurs 2015; 30:439-46. [PMID: 25595245 DOI: 10.1016/j.pedn.2014.12.010] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2014] [Revised: 12/19/2014] [Accepted: 12/19/2014] [Indexed: 11/20/2022]
Abstract
BACKGROUND This study sought to determine if student's performance of safety skills improved following a simulated educational experience. METHODS Further analysis of data from a quasi-experimental design (n=73) was examined to identify if student's skill performance improved following a simulated educational intervention. RESULTS Students did show an improvement in skill performance, but even after the intervention over half the students did not assess patient identification, over half did not administer medications safely, and students struggled with communicating nursing recommendations. CONCLUSION Further research needs to focus on skill performance and assessing students' ability to provide safe nursing care.
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Lee YC, Wu WL. The effects of situated learning and health knowledge involvement on health communications. Reprod Health 2014; 11:93. [PMID: 25542070 PMCID: PMC4297390 DOI: 10.1186/1742-4755-11-93] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2014] [Accepted: 12/16/2014] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Many patients use websites, blogs, or online social communities to gain health knowledge, information about disease symptoms, and disease diagnosis opinions. The purpose of this study is to use the online platform of blogs to explore whether the framing effect of information content, situated learning of information content, and health knowledge involvement would affect health communication between doctors and patients and further explore whether this would increase patient willingness to seek treatment. METHODS This study uses a survey to collect data from patient subjects who have used online doctor blogs or patients who have discussed medical information with doctors on blogs. The number of valid questionnaire samples is 278, and partial least square is used to conduct structural equation model analysis. RESULTS Research results show that situated learning and health knowledge involvement have a positive effect on health communication. The negative framing effect and health knowledge involvement would also affect the patient's intention to seek medical help. In addition, situated learning and health knowledge involvement would affect the intention to seek medical help through communication factors. CONCLUSIONS Blogs are important communication channels between medical personnel and patients that allow users to consult and ask questions without time limitations and enable them to obtain comprehensive health information.
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Affiliation(s)
- Yi-Chih Lee
- Department of International Business, Chien Hsin University of Science and Technology, No.229, Jianxing Road, Zhongli City, Taoyuan County 320 Taiwan
| | - Wei-Li Wu
- Department of International Business, Chien Hsin University of Science and Technology, No.229, Jianxing Road, Zhongli City, Taoyuan County 320 Taiwan
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Koppenberg J, Henninger M, Gausmann P, Bucher M. Simulationsbasierte Trainings zur Verbesserung der Patientensicherheit. Notf Rett Med 2014. [DOI: 10.1007/s10049-013-1802-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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Kayhan Z. Teaching Our Students, Our Residents and Ourselves. Turk J Anaesthesiol Reanim 2014; 42:1-5. [PMID: 27366380 DOI: 10.5152/tjar.2014.26121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2013] [Accepted: 10/08/2013] [Indexed: 11/22/2022] Open
Abstract
Even though postgraduate medical education has been the focus of interest in anaesthesiology education, in a broader sense the entire medical community can be considered appropriate learners of anaesthesiology. Anaesthesiologists are equipped to teach physiology, pharmacology, resuscitation, pain management, perioperative assessment, and medical technology. For residency training, an approach based on competencies, skills and professionalism should be used instead of the traditional "apprenticeship" model. When teaching ourselves as qualified anaesthesiologists, areas of continuing professional development, academic career training and continuing medical education should be taken into account. Whereas the responsibility for undergraduate medical education rests with university medical schools, postgraduate medical education is carried out by universities and/or the national health authorities/services. Establishment of partnerships between health-care services and universities should be central to the provision of postgraduate education so as not to dissociate various stages of education. When determining educational strategies, institutional preferences, target populations and their learning styles should be taken into account. To this end, especially for high risk situations simulation-based approaches, scenarios, standardized patients, research, mentoring, journal clubs, seminars, lectures, case discussions, bed-side discussions, courses, games and portfolios have been and are being used widely. Departments of anaesthesiology should establish and maintain a strong presence in undergraduate medical education. Besides being good clinicians, anaesthesiologists should understand all aspects of education and educational outcome in order to better teach students, residents and themselves. Quality of education and the teaching environment should continually be evaluated within the context of quality assurance.
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Affiliation(s)
- Zeynep Kayhan
- Department of Anaesthesiology, Faculty of Medicine, Başkent University, Ankara, Turkey
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Lorello G, Cook D, Johnson R, Brydges R. Simulation-based training in anaesthesiology: a systematic review and meta-analysis. Br J Anaesth 2014; 112:231-45. [DOI: 10.1093/bja/aet414] [Citation(s) in RCA: 146] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
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Iglesias BM, Fernandez-Vara C, Fernandez-Manjon B. E-Learning Takes the Stage: From La Dama Boba to a Serious Game. IEEE REVISTA IBEROAMERICANA DE TECNOLOGIAS DEL APRENDIZAJE 2013. [DOI: 10.1109/rita.2013.2285023] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Does training with human patient simulation translate to improved patient safety and outcome? Curr Opin Anaesthesiol 2013; 26:159-63. [PMID: 23339975 DOI: 10.1097/aco.0b013e32835dc0af] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW In this review, we evaluate several articles in an attempt to qualify the effect of human patient simulation in anaesthesia on patient outcome. The recognition of medical error as a significant cause of patient morbidity and mortality has sparked an increased focus on improving healthcare quality and patient safety. Simulation in anaesthesia is a potential tool to help achieve this goal by allowing anaesthesia providers to learn, practice and perfect their craft without a potential harm to patients. It has gained growing traction in the field and is recently a required element in the American Board of Anesthesiology's Maintenance of Certification in Anesthesia programme. RECENT FINDINGS Very few studies have evaluated the effect of simulation on patient outcome. To date, one study has demonstrated improved individual clinical performance in anaesthesia after simulation training. Research suggests that simulation-based team training can reduce patient mortality and improve the quality of care as measured by surgical quality improvement measures. Simulation may improve healthcare systems by serving as a tool to detect latent error and drive process improvement. SUMMARY Despite the adoption of simulation, further study is needed to better qualify its effect on patient safety and outcome.
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Feng JY, Chang YT, Chang HY, Erdley WS, Lin CH, Chang YJ. Systematic review of effectiveness of situated e-learning on medical and nursing education. Worldviews Evid Based Nurs 2013; 10:174-83. [PMID: 23510119 DOI: 10.1111/wvn.12005] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/04/2012] [Indexed: 01/08/2023]
Abstract
OBJECTIVES Because of the complexity of clinical situations, traditional didactic education is limited in providing opportunity for student-patient interaction. Situated e-learning can enhance learners' knowledge and associated abilities through a variety of activities. Healthcare providers who interact with virtual patients in designed situations may avoid unnecessary risks and encounters with real patients. However, the effectiveness of situated e-learning is inconsistent. The purpose of this study is to determine the effectiveness of situated e-learning in prelicensure and postlicensure medical and nursing education. METHODS Literature databases of PubMed, Medline, CINAHL, ERIC, and Cochrane Library were searched. The study eligibility criteria included articles published in English, which examined the effectiveness of situated e-learning on the outcomes of knowledge and performance for clinicians or students in medicine and nursing. Effect sizes were calculated with 95% confidence intervals. RESULTS Fourteen articles were included for meta-analysis. Situated e-learning could effectively enhance learners' knowledge and performance when the control group received no training. Compared to traditional learning, the effectiveness of situated e-learning on performance diminished but still remained significant whereas the effect become insignificant on knowledge. The subgroup analyses indicate the situated e-learning program significantly improved students' clinical performance but not for clinicians. CONCLUSIONS Situated e-learning is an effective method to improve novice learners' performance. The effect of situated e-learning on the improvement of cognitive ability is limited when compared to traditional learning. Situated e-learning is a useful adjunct to traditional learning for medical and nursing students.
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Affiliation(s)
- Jui-Ying Feng
- Department of Nursing & Institute of Allied Health Sciences, National Cheng Kung University and Hospital, Taiwan
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Liaw SY, Scherpbier A, Rethans JJ, Klainin-Yobas P. Assessment for simulation learning outcomes: a comparison of knowledge and self-reported confidence with observed clinical performance. NURSE EDUCATION TODAY 2012; 32:e35-e39. [PMID: 22064013 DOI: 10.1016/j.nedt.2011.10.006] [Citation(s) in RCA: 101] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/03/2011] [Revised: 09/20/2011] [Accepted: 10/12/2011] [Indexed: 05/27/2023]
Abstract
BACKGROUND With extensive use of simulation in nursing education, researchers around the world are evaluating learning outcomes from simulation. Numerous studies reported the use of knowledge tests and self-reported measures to evaluate simulation outcomes. AIM To determine whether self-reported confidence and knowledge measures are indicators of clinical performance observed in a simulation-based assessment. METHOD Thirty-one third year nursing students were randomized into intervention and control group. The intervention group received a six hour simulation-based programme in care of a patient with physiological deterioration. Pre and post-tests using knowledge test, confidence scale and simulation-based assessment were conducted immediately before and after the simulation program. RESULTS The intervention group had a significantly higher post-test mean score than the control group for knowledge and clinical performances. Both groups demonstrated a significant improvement on post-test scores from pre-test scores for self-confidence with no significant differences detected among the two groups. Correlation tests indicated no significant correlation between self-confidence and clinical performance, and between knowledge and clinical performance. CONCLUSION The study did not provide evidence to support the validity of the knowledge test and self-confidence measures for predicting clinical performance. Most importantly, it revealed potential danger of a simulation-based assessment that could lead toward overestimation of self-confidence.
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Affiliation(s)
- Sok Ying Liaw
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Level 2, Clinical Research Centre, Block MD11 10 Medical Drive 117597, Singapore.
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Baxter P, Akhtar-Danesh N, Landeen J, Norman G. Teaching critical management skills to senior nursing students: videotaped or interactive hands-on instruction? Nurs Educ Perspect 2012; 33:106-10. [PMID: 22616409 DOI: 10.5480/1536-5026-33.2.106] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
This study examined and compared the effectiveness of videotape training versus hands-on instruction in preparing senior nursing students to respond to emergency clinical situations. Fourth year nursing students (n=27) were randomly assigned to one of three groups; one group received videotaped instruction, one group engaged in a hands-on experience, and one group, a control, received no instruction. Students were evaluated using a three-station objective structured clinical examination that involved high-fidelity simulations. Differences between the control and the two instructional groups were significant (p = .007); however, there was no significant difference between the two types of instruction. It was concluded that instruction on crisis management with a high-fidelity simulator, using either video or hands-on instruction, can result in a significant improvement in performance.
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Norman G, Dore K, Grierson L. The minimal relationship between simulation fidelity and transfer of learning. MEDICAL EDUCATION 2012; 46:636-47. [PMID: 22616789 DOI: 10.1111/j.1365-2923.2012.04243.x] [Citation(s) in RCA: 279] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
CONTEXT High-fidelity simulators have enjoyed increasing popularity despite costs that may approach six figures. This is justified on the basis that simulators have been shown to result in large learning gains that may transfer to actual patient care situations. However, most commonly, learning from a simulator is compared with learning in a 'no-intervention' control group. This fails to clarify the relationship between simulator fidelity and learning, and whether comparable gains might be achieved at substantially lower cost. OBJECTIVES This analysis was conducted to review studies that compare learning from high-fidelity simulation (HFS) with learning from low-fidelity simulation (LFS) based on measures of clinical performance. METHODS Using a variety of search strategies, a total of 24 studies contrasting HFS and LFS and including some measure of performance were located. These studies referred to learning in three areas: auscultation skills; surgical techniques, and complex management skills such as cardiac resuscitation. RESULTS Both HFS and LFS learning resulted in consistent improvements in performance in comparisons with no-intervention control groups. However, nearly all the studies showed no significant advantage of HFS over LFS, with average differences ranging from 1% to 2%. DISCUSSION The factors influencing learning, and the reasons for this surprising finding, are discussed.
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Affiliation(s)
- Geoff Norman
- Department of Clinical Epidemiology and Biostatistics, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada.
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Review article: simulation in anesthesia: state of the science and looking forward. Can J Anaesth 2011; 59:193-202. [PMID: 22179792 DOI: 10.1007/s12630-011-9638-8] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2011] [Accepted: 11/16/2011] [Indexed: 10/14/2022] Open
Abstract
PURPOSE Within the field of anesthesia, simulation has been used as a tool for training and assessment for over 30 years. The purpose of this review is to evaluate the state of the science in terms of its effectiveness as an approach to both training and assessment in anesthesia. Articles in the area of simulation and anesthesia published up to and including 2011 were reviewed for inclusion in this narrative review. PRINCIPAL FINDINGS Simulation-based training is generally well received by participants, it can lead to improved performance in subsequent simulation events, and some transfer of learning to the clinical setting is evident. There is also some early evidence that well-designed performance assessments could have the required reliability and validity to support high-stakes examinations. However, further work is needed in order to set standards and establish the predictive validity to support such assessments. CONCLUSION For simulation to realize its potential impact, further research is needed to understand how to optimize this modality of learning more effectively, how to transfer knowledge of research findings to practice, and also how to broaden the simulation modalities used in anesthesia. In future, the optimal use of simulation will depend on a clear understanding of what can and cannot be accomplished with simulation and its various modalities.
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Lin K, Travlos DV, Wadelin JW, Vlasses PH. Simulation and introductory pharmacy practice experiences. AMERICAN JOURNAL OF PHARMACEUTICAL EDUCATION 2011; 75:209. [PMID: 22345728 PMCID: PMC3279018 DOI: 10.5688/ajpe7510209] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/01/2010] [Accepted: 04/07/2011] [Indexed: 05/11/2023]
Abstract
This paper reviews the literature on the various types of simulation and their incorporation into health professions curricula, describes how simulation training is recognized in other professions, and evaluates the feasibility of integrating simulation into experiential education programs of colleges and schools of pharmacy. The Accreditation Council for Pharmacy Education (ACPE) Board of Directors develop standards and guidelines on the use of simulation as part of introductory pharmacy practice experiences within the doctor of pharmacy (PharmD) curriculum.
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Roberts D, Greene L. The theatre of high-fidelity simulation education. NURSE EDUCATION TODAY 2011; 31:694-698. [PMID: 20880617 DOI: 10.1016/j.nedt.2010.06.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/25/2010] [Revised: 04/29/2010] [Accepted: 06/05/2010] [Indexed: 05/29/2023]
Abstract
High-fidelity simulation is a useful mechanism to aid progression, development and skill acquisition in nurse education. However, nurse lecturers are daunted by sophisticated simulation technology. This paper presents a new method of introducing human patient simulation to students and educators, whilst seeking to demystify the roles, responsibilities and underpinning pedagogy. The analogy of simulation as theatre outlines the concepts of the theatre and stage (simulation laboratory); the play itself (Simulated Clinical Experience, SCE); the actors (nursing students); audience (peer review panel); director (session facilitator); and the production team (technical coordinators). Performing in front of people in a safe environment, repeated practice and taking on a new role teaches students to act, think and be like a nurse. This in turn supports student learning and enhances self confidence.
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Affiliation(s)
- Debbie Roberts
- School of Nursing and Midwifery, University of Salford, Mary Seacole Building, Frederick Road Campus, Salford, M6 6PU, UK.
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Barker CA, Mutter RW, Shapiro LQ, Zhang Z, Wolden SL, Yahalom J. Contrast media use in radiation oncology: a prospective, controlled educational intervention study with retrospective analysis of patient outcomes. J Am Coll Radiol 2011; 7:967-74. [PMID: 21129689 DOI: 10.1016/j.jacr.2010.05.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2010] [Accepted: 05/12/2010] [Indexed: 11/26/2022]
Abstract
PURPOSE Intravenous contrast media (ICM) administration is recommended as part of radiation therapy simulation in a variety of clinical scenarios but can cause adverse events. The aims of this study were to assess radiation oncology residents' knowledge about ICM and to determine if an educational intervention (EI) could improve this level of knowledge. In conjunction, risk factors and adverse events related to ICM use were retrospectively analyzed before and after the EI to determine whether any improvements in patient outcomes could be realized. METHODS Over 2 years, 21 residents in radiation oncology at Memorial Sloan-Kettering Cancer Center participated in a pretest-EI-posttest study based on the ACR's Manual on Contrast Media. Medical and radiation therapy records were reviewed, and ICM use, risk factors, and adverse events were recorded. RESULTS There was no significant difference in residents' understanding of ICM use in residents of different years of training (P = .85). Understanding of ICM use increased in residents who attended the EI (P < .05), but this was not sustained 1 year after the EI (P = .48). Of the 6,852 radiation therapy simulations that were performed at Memorial Sloan-Kettering, 1,350 (19.7%) involved ICM. Mild adverse events occurred in a few patients (<5%) simulated with ICM, but there was no difference in the number of risk factors or adverse events before and after the EI. CONCLUSIONS The EI effectively improved short-term understanding of ICM use. However, the effect was not sustained. The frequency of adverse events related to ICM use was small and not significantly affected by the EI.
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Affiliation(s)
- Christopher A Barker
- Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA
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Goodman WM, Lamers A. Said another way: asking the right questions regarding the effectiveness of simulations. Nurs Forum 2011; 45:246-52. [PMID: 21077893 DOI: 10.1111/j.1744-6198.2010.00199.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Applying simulations in healthcare practice and education is increasingly accepted, yet a number of recent authors have questioned the effectiveness of these technologies. The contention is that while high-fidelity simulators may contribute to educational gains, their gains compared to low-tech alternatives are often "not significant." That assessment, however, and the evidence it is based on, may be a consequence of asking the wrong questions. Typical studies often compare a measure for "average success" for one group's members versus another's on some criteria, but this can mask important information about the "tails" of the distribution for how trainees are performing. An alternative approach, adapted from quality control, compares error rates for each group in the experiment, in aggregate. The statistical results of evaluations can change if this method is used, as illustrated by a recent study showing that simulation training can significantly reduce the frequency of medication administration errors among student nurses on placement. The paper includes a case study to tangibly demonstrate how the way we frame our evaluation test question can reverse the apparent statistical finding of the significance test.
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Moreno-Ger P, Torrente J, Bustamante J, Fernández-Galaz C, Fernández-Manjón B, Comas-Rengifo MD. Application of a low-cost web-based simulation to improve students' practical skills in medical education. Int J Med Inform 2010; 79:459-67. [PMID: 20347383 DOI: 10.1016/j.ijmedinf.2010.01.017] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2009] [Revised: 01/29/2010] [Accepted: 01/30/2010] [Indexed: 11/26/2022]
Abstract
BACKGROUND Practical sessions in undergraduate medical education are often costly and have to face constraints in terms of available laboratory time and practice materials (e.g. blood samples from animals). This makes it difficult to increase the time each student spends at the laboratory. We consider that it would be possible to improve the effectiveness of the laboratory time by providing the students with computer-based simulations for prior rehearsal. However, this approach still presents issues in terms of development costs and distribution to the students. OBJECTIVE This study investigates the employment of low-cost simulation to allow medical students to rehearse practical exercises through a web-based e-learning environment. The aim is to maximize the efficiency of laboratory time and resources allocated by letting students become familiarized with the equipment and the procedures before they attend a laboratory session, but without requiring large-scale investment. Moreover, students can access the simulation via the Internet and rehearse at their own pace. We have studied the effects of such a simulation in terms of impact on the laboratory session, learning outcomes and student satisfaction. METHODS We created a simulation that covers the steps of a practical exercise in a Physiology course (measuring hematocrit in a blood sample). An experimental group (EG, n=66) played the simulation 1 week before the laboratory session. A control group (CG, n=77) attended the laboratory session without playing the simulation. After the session, all students completed a survey about their perception of the difficulty of the exercise on a scale of 1-10 and the HCT final value that they obtained. The students in the EG also completed a survey about their satisfaction with the experience. RESULTS After the laboratory session, the perceived difficulty of the procedure was lower on average in the EG compared to the CG (3.52 vs. 4.39, 95% CI: 0.16-1.57, P=.016). There was no significant difference in terms of perceived difficulty using the equipment. The HCT measures reported by the EG group also presented a much lower dispersion, meaning a higher reliability, in determining the HCT value (3.10 vs. 26.94, SD; variances significantly different, P<.001, F: 75.25, Dfd: 68.19 for EG and CG). In the satisfaction test, the majority of the students in the EG reported that the experience was positive or very positive (80.7%) and reported that it had helped them to identify and use the equipment (78%) and to perform the exercise (66%). CONCLUSIONS The simulation was well received by students in the EG, who felt more comfortable during the laboratory session, and it helped them to perform the exercise better, obtaining more accurate results, which indicates more effective training. EG students perceived the procedure as easier to perform, but did not report an improvement in the perceived difficulty in using the equipment. The increased reliability demonstrates that low-cost simulations are a good complement to the laboratory sessions.
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Affiliation(s)
- Pablo Moreno-Ger
- Department of Software Engineering and Artificial Intelligence, Complutense University of Madrid, Madrid, Spain.
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Pfenninger EG, Domres BD, Stahl W, Bauer A, Houser CM, Himmelseher S. Medical student disaster medicine education: the development of an educational resource. Int J Emerg Med 2010; 3:9-20. [PMID: 20414376 PMCID: PMC2850977 DOI: 10.1007/s12245-009-0140-9] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2009] [Accepted: 11/04/2009] [Indexed: 11/29/2022] Open
Abstract
Background Disaster medicine education is an enormous challenge, but indispensable for disaster preparedness. Aims We aimed to develop and implement a disaster medicine curriculum for medical student education that can serve as a peer-reviewed, structured educational guide and resource. Additionally, the process of designing, approving and implementing such a curriculum is presented. Methods The six-step approach to curriculum development for medical education was used as a formal process instrument. Recognized experts from professional and governmental bodies involved in disaster health care provided input using disaster-related physician training programs, scientific evidence if available, proposals for education by international disaster medicine organizations and their expertise as the basis for content development. Results The final course consisted of 14 modules composed of 2-h units. The concepts of disaster medicine, including response, medical assistance, law, command, coordination, communication, and mass casualty management, are introduced. Hospital preparedness plans and experiences from worldwide disaster assistance are reviewed. Life-saving emergency and limited individual treatment under disaster conditions are discussed. Specifics of initial management of explosive, war-related, radiological/nuclear, chemical, and biological incidents emphasizing infectious diseases and terrorist attacks are presented. An evacuation exercise is completed, and a mass casualty triage is simulated in collaboration with local disaster response agencies. Decontamination procedures are demonstrated at a nuclear power plant or the local fire department, and personal decontamination practices are exercised. Mannequin resuscitation is practiced while personal protective equipment is utilized. An interactive review of professional ethics, stress disorders, psychosocial interventions, and quality improvement efforts complete the training. Conclusions The curriculum offers medical disaster education in a reasonable time frame, interdisciplinary format, and multi-experiential course. It can serve as a template for basic medical student disaster education. Because of its comprehensive but flexible structure, it should also be helpful for other health-care professional student disaster education programs.
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Affiliation(s)
- Ernst G Pfenninger
- Department of Anesthesiology, University Hospital of Ulm, Steinhövelstr. Ulm, Germany.
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Farrell SE, Coates WC, Khun GJ, Fisher J, Shayne P, Lin M. Highlights in emergency medicine medical education research: 2008. Acad Emerg Med 2009; 16:1318-1324. [PMID: 20053253 DOI: 10.1111/j.1553-2712.2009.00570.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES The purpose of this article is to highlight medical education research studies published in 2008 that were methodologically superior and whose outcomes were pertinent to teaching and education in emergency medicine. METHODS Through a PubMed search of the English language literature in 2008, 30 medical education research studies were independently identified as hypothesis-testing investigations and measurements of educational interventions. Six reviewers independently rated and scored all articles based on eight anchors, four of which related to methodologic criteria. Articles were ranked according to their total rating score. A ranking agreement among the reviewers of 83% was established a priori as a minimum for highlighting articles in this review. RESULTS Five medical education research studies met the a priori criteria for inclusion and are reviewed and summarized here. Four of these employed experimental or quasi-experimental methodology. Although technology was not a component of the structured literature search employed to identify the candidate articles for this review, 14 of the articles identified, including four of the five highlighted articles, employed or studied technology as a focus of the educational research. Overall, 36% of the reviewed studies were supported by funding; three of the highlighted articles were funded studies. CONCLUSIONS This review highlights quality medical education research studies published in 2008, with outcomes of relevance to teaching and education in emergency medicine. It focuses on research methodology, notes current trends in the use of technology for learning in emergency medicine, and suggests future avenues for continued rigorous study in education.
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de Giovanni D, Roberts T, Norman G. Relative effectiveness of high- versus low-fidelity simulation in learning heart sounds. MEDICAL EDUCATION 2009; 43:661-8. [PMID: 19573189 DOI: 10.1111/j.1365-2923.2009.03398.x] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
CONTEXT Although there are increasing numbers of studies of outcomes of high-fidelity patient simulators, few contrast their instruction with that provided by equivalent low-fidelity, inexpensive simulators. Further, examination of decays in learning and application (transfer) to real patient problems is rare. In this study, we compared the effects of training using a high-fidelity heart sound simulator (Harvey) and a low-fidelity simulator (a CD) on recognition of both simulated heart sounds and those in actual patients. METHODS A pilot study with 10 students was conducted to show the feasibility of the methods and some evidence of modality-specific learning (the Harvey-trained group scored 72% correct on Harvey and 36% correct on CD test examples; the CD-trained group scored 60% correct on both CD and Harvey test examples). A main study was then initiated involving 37 Year 3 medical students from the University of Leeds. They received 1 hour of common instruction, after which one group received 3 hours of specific instruction on Harvey. The second group received 3 hours of instruction using a CD. Six weeks later, both groups were tested blind with real patients with stable heart sounds. Stations were observed by an examiner who scored communication skills and examination skills using 5-point scales. RESULTS The Harvey-trained group was slightly but not significantly better than the CD-trained group at identifying heart sounds (3.11 versus 2.47, respectively; P = 0.06). However, there was no difference between the Harvey and CD-trained groups in diagnosis (2.94 versus 2.84, respectively), communication skills (18.9 versus 19.6, respectively) or examination skills (17.4 versus 17.5, respectively). CONCLUSIONS The study found little evidence that students trained with a high-fidelity simulator were more able to transfer skills to real patients than a control group. Although there was some suggestion that the Harvey-trained group was better at recognising heart sounds, there was no difference between groups in diagnostic accuracy or clinical skills.
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