Hybrid Simulation in Teaching Clinical Breast Examination to Medical Students

Assessment of performance and confidence level of simulation based clinical examination of respiratory system in undergraduate medical students of a medical college: a comparative cross-sectional study

Introduction

Students in the preclinical phase have adequate clinical exposure to normal physiological findings of clinical examinations performed in healthy peers but do not have exposure to pathological findings other than theoretical knowledge, which is challenging for students during the clinical phase of curricula in examining actual patients. Simulation based medical education (SBME) has recently emerged to address this gap. This study aimed to assess performance and confidence level of simulation based clinical examination of respiratory system in preclinical undergraduate medical students of a medical college.

Methods

A comparative cross-sectional study was conducted in the Department of Human Physiology of Medical College. All second year medical students using purposive sampling were taken. Students were divided into three groups and subdivided into six subgroups and each subgroup carried out examination in either healthy subjects or both healthy subjects and manikin. Predesigned proforma was used for assessment of students and the clinical examination process was invigilated by certified physiologists.

Results

Students who received both simulation and conventional tutoring methods were able to accurately identify all lung sounds better as compared to those with conventional tutoring with the percentage difference being maximum in identifying vesicular (29 vs 6), stridor (28 vs 6), and bronchial (25 vs 6) breath sounds and least in identifying coarse crackles (3 vs 2). Majority (39 out of 41) of the students receiving SBME of respiratory system were satisfied with the simulation based practice and 34 of those students were even confident on clinical examination.

Conclusion

SBME increases performance status and confidence level in medical students. A practical curriculum can be planned to incorporate simulation based clinical examination in preclinical medical students in practical sessions.

The effect of hybrid simulated burn care training on nursing students' knowledge, skills, and empathy: A randomised controlled trial

BACKGROUND

Although improvements in burn care have increased the probability of survival in recent years, major complications are still common in burn patients. Nursing students should be competent to evaluate and intervene in the burn.

OBJECTIVE

To examine the effects of hybrid simulated burn care training on nursing students' knowledge, skills, and empathy.

DESIGN

In this study, a randomised experimental design was used.

PARTICIPANTS

This study was conducted on third-year undergraduate nursing students.

METHODS

Students in this study were randomly assigned to one of two groups: the Hybrid Simulated Group (N = 26) and the Control Group (N = 30). Standard Education training was completed by all participants. Only the hybrid simulation group students received training on the standardised patient with wearable burn plasters. Students' knowledge of burn care was assessed using an information questionnaire immediately following the theoretical training and after training for three weeks. An Objective Structured Clinical Exam was used to assess students' abilities. The Objective Structured Clinical Exam was convened three weeks after the theoretical training. The Multidimensional Emotional Empathy Scale was used to assess the students' empathy ability level immediately following the theoretical training and three weeks later.

RESULTS

After the intervention, nursing students in the Hybrid Simulated group had improved empathy, knowledge, skills of physical assessment, and implementation of interventions and referral criteria on burn care (p < 0.05).

CONCLUSION

Simulated burn training could be utilised to improve nursing students' empathy, knowledge, and skills of physical assessment evaluation of interventions and referral criteria on burn care.

The effect of breast self-examination training on nursing students by using hybrid-based simulation on knowledge, skills, and ability to correctly evaluate pathological findings: Randomized Controlled Study

AIM

To investigate the effectiveness of hybrid simulation-based training and classical-based training with the Miller pyramids' ability to evaluate students' knowledge, skills and pathologies in breast self-examination.

BACKGROUND

Breast cancer incidence is becoming more common among women in developed and developing countries. Nurses should be capable of evaluating breast self-examination knowledge, abilities and pathologies.

METHOD

A randomized full experimental design was used. Two groups were formed: a hybrid simulation-based training group (n = 36) and a classical-based training group (n = 36)-students in the hybrid simulation-based group trained on a standardized patient with a wearable breast attachment. The classical-based training group received training on the breast model. The laboratory performance of the students was evaluated one week after the training. Their performance on the standardized patient was evaluated against the checklist in the clinical setting one week after the laboratory. Before and after the training, each student's knowledge of basic and Application steps was evaluated. Students completed the self-description form regarding the clinical process after the clinical performance. All participants received 60 min of theoretical and 60 min of demonstration training. While the students in the hybrid simulation-based training group completed the 55-minute simulation training, the students in the Classic-based training group practised on the desktop breast model for 10 min. The hybrid simulation-based training group received 175 min of total training time, whereas the classical-based training group received 130 min.

RESULTS

Compared with classical-based training, teaching BSE with hybrid simulation-based training raised students' total knowledge score, application step score, skill score and pathological evaluation score (p < 0.05). Students who trained using hybrid simulation-based training experienced low levels of anxiety but increased levels of excitement and motivation (p < 0.05). The education and counselling scores of students who received hybrid simulation -based simulation training were higher than those who received classical-based training (p < 0.05). There was no statistically significant difference between the groups' BSE mean pre-test basic knowledge scores (p = 0.186). BSE mean application steps knowledge scores difference (pre-test-post-test) of the groups was found to be statistically significant (p < 0.001) CONCLUSION: The ability to accurately evaluate breast self-examination on knowledge, skills and pathological findings of students in the hybrid simulation-based training group was higher than in the classical-based training group. Besides, the students' perceived communication, education and counselling efficiency in the hybrid simulation-based training group were higher compared with the classical-based training group.

Performance effects of simulation training for medical students - a systematic review

OBJECTIVE

Simulation based medical education (SBME) is fast becoming embedded into undergraduate medical curricula with many publications now describing its various modes and student self-reported impacts. This systematic review synthesizes the available literature for evidence of performance effects of SBME as an adjunct within traditional teaching programmes.

METHODS

A narrative systematic review was conducted according to PRISMA guidelines using Ovid MEDLINE, EMBASE, and PubMed databases for studies, published in English, reporting on general medical and surgical undergraduate SBME between 2010 to 2020. Two reviewers independently assessed potential studies for inclusion. Methods and topics of simulation with their assessments were evaluated. Descriptive statistics were used to describe pooled student cohorts.

RESULTS

3074 articles were initially identified using the search criteria with 92 full-text articles then screened for eligibility. Nineteen articles, including nine randomised trials, concerning 2459 students (median 79/study), were selected for review. Cardiac scenarios were commonest (n=6) with three studies including surgical topics. Nine studies used mannequin simulators (median time/session 17.5minutes) versus standardised patients in seven (median time/session=82 minutes). Educational impact was measured by written (n=10), checklist (n=5) and OSCEs (n=3) assessment either alone or in combination (n=1, OSCE/written assessment). All articles reported a positive effect of SBME on knowledge including improved retention in three.

CONCLUSION

SBME, as an adjunct to existing curricula, improves knowledge-based performance of medical students at least in the short-term. Future studies should broaden its topics, assess longer term impacts and cost-effectiveness while also considering whether and what areas of traditional undergraduate learning it can replace.

A Description of Breast Models Used to Teach Clinical Skills

Background: Health care trainees lack opportunities to practice breast assessment and clinical skills with patients, making breast models significant for hands-on training. Insufficient training leads to low competence across practitioners in breast health areas of practice, including clinical lactation. The aim of this review was to describe types of breast models used to teach clinical skills of the breast across breast health areas. The secondary aims were to describe education interventions that included each model and identify whether multiple skin tones were available in models. Methods: Authors conducted a scoping review to identify which types of breast models are used to teach clinical skills across breast health areas of practice and determine gaps in literature regarding how clinical lactation skills are taught. The literature search was conducted in PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Scopus, MedLine, and ProQuest. Inclusion criteria were students/professionals engaging in breast model simulation. Eighteen studies were reviewed. Authors extracted data on participants, breast health area, breast model, intervention, evaluation, general outcomes, skin tone, and research design. Results: The most common skill area was clinical breast exam (n = 7), while least was breastfeeding education (n = 1). Most models were commercial (n = 12). Zero studies described skin tone. Generally, breast model simulations were correlated with increased clinical skills and confidence regardless of model used. Conclusions: Despite demonstrated gain of skills, this review reveals inconsistent use of breast models and evaluation, exclusion of diverse skin tones, and lack of breast models reported to teach clinical lactation skills.

Implementing a cost effective and configurable hybrid simulation platform in healthcare education, using wearable and web-based technologies

There are many examples of hybrid simulation models in healthcare education which are designed to simulate specific scenarios. However, there appears to be a need for a cost effective and configurable hybrid simulation platform which can be used by educators of various healthcare disciplines to simulate different scenarios. The purpose of this paper is to develop a proof-of-concept platform that can be easily implemented at little cost and provide flexibility to healthcare instructors to develop a variety of simulation scenarios, and to determine the effectiveness of this platform. Using a standardized patient, a person acting as a patient in a scripted manner, along with wearable and web-based technologies, a congestive heart failure simulation was used as an evaluative exercise for a group of personal support worker students at a Canadian Community College. Personal support workers typically provide care to any person who may require personal assistance with activities of daily living such as feeding, lifting, bathing, skin care and oral hygiene to name a few. Standardized patients are typically used in healthcare education to educate and evaluate soft skills, such as caregiver to patient communication, professionalism, as well as hard skills, such as history taking, examination and diagnostic skills (Rosen in J Crit Care 23:157–166, 2008). Instructor feedback indicated that the platform was easy to use and capable of simulating a large variety of scenarios. Pre and post test results are evidence of initial findings of promise indicating that the platform seemed to be effective in enabling students to meet learning outcomes. Focus group results seem to indicate an increase in student confidence as it relates to their ability to handle a similar scenario in the workplace.

Breast Cancer Knowledge and Practice of Breast Self-Examination among Female University Students, Gaza

Breast cancer is the highest public detected cancer among female population in the majority of countries worldwide. Breast self-examination (BSE) is a useful screening tool to empower women and raise awareness about their breast tissues and help detect any breast abnormalities when they occur. This study aimed to assess the level of female university students' knowledge and practice of BSE. A self-administered questionnaire was used to assess the knowledge about breast cancer and related items, and an observation checklist was used to test practicing BSE using a breast simulator. Eighty-six students participated in the study, 58.1% studying nursing and 41.9% studying clinical nutrition in the third (40.7%) or the fourth level (59.3%). Of them, 24.4% had previous family history of breast cancer. The majority of the students (80.2%) had previous information about breast cancer acquired from different sources, university studies (57%), the Internet (45%), and social media (41%). Findings showed good scores (≥70%) regarding signs and symptoms and risk factors of breast cancer; however, low knowledge scores (<70%) were detected regarding general knowledge about breast cancer disease, methods of early detection and management, and applying steps of practicing BSE. Roughly all the students (96.5%) have heard about BSE, and 69.8% knew the time to do BSE; however, only 31.4% practice it regularly. Three barriers to practice were dominant among students who do not have a breast problem (39.7%), do not know how to do it (37.9%), and being busy 31%. On the other hand, breast cancer early detection purpose and the presence of family history of breast cancer were considered facilitators to regular practice BSE. A statistically significant relationship existed between knowledge about the steps of applying the BSE and regular practicing. A training program should be implemented to increase the level of awareness about BC and practicing BSE.

Medical Simulation-Based Learning Outcomes in Pre-Clinical Medical Education

Introduction Medical simulation is widely used in the United States medical curriculum. However, learning outcomes based on simulation have yet to be reported. In this study, we aim to characterize the objective performance of first- and second-year medical students following eight weeks of medical simulation-based learning. Methods First- (n=25) and second-year (n=15) medical students were recruited for this study. We designed and administered a novel pre-experience examination to collect participant demography and assess simulation and non-simulation knowledge. Following 14 high-fidelity simulation scenarios over the course of eight weeks, we administered an identical post-experience examination and compared performance, primarily using a within-subjects analytic design. Results Student performance improved by an average of 18% following the medical simulation experience, and first-year students demonstrated greater benefit (22%) as compared to second-years (12%). Relative to first-years, second-year students showed higher overall performance on both pre- and post-examination. Demographic factors and prior medical experience were not significantly associated with assessment performance and score improvement. Conclusions Our data supported the efficacy of simulation-based learning as evidenced by the significant improvement in objective performance on a standardized examination. That is, both first- and second-year medical students demonstrated test-score improvement following an eight-week medical simulation program. Of note, the first-year students exhibited greater benefit (at the group level). Importantly, these findings were statistically unrelated to participant demographic and background variables. Collectively, this study provides preliminary evidence that medical simulation in the pre-clinical phase of undergraduate medical education is an effective tool for student learning.

Improving Education About Breast Cancer for Medical Students in China

In traditional medical school curriculum of cancer education in China, there is a very limited amount of teaching about breast cancer. The current situation may result in indifference to breast cancer education among medical students. Case-based learning (CBL) is a popular teaching method based on clinical cases. To date, there are few research reports about the application and research of CBL in breast cancer education. The aim of this study is to explore the teaching effect about CBL combined with lecture-based learning (LBL) in breast cancer education. Questions of breast cancer in National Medical Licensing Examination (NMLE) from 2011 to 2018 were analyzed. The questions about breast cancer were used as the evaluation criteria for this study. In this pilot study, a total of 140 students were randomly divided into a lecture only group (control group) and a lecture plus CBL group (observation group). The students in the observation group had better academic performances and abilities of memory, understanding, and application. They also had higher favorable impressions of the learning experience. In conclusion, more active approaches yield more learning and are viewed more favorably. CBL plus lecture can significantly improve education about breast cancer among medical students, which may be an important message for the evolution of curriculum in Chinese medical schools.

The 2019 WACEM Expert Document on Hybrid Simulation for Transforming Health-care Simulation Through "Mixing and Matching"

With the multitude of options available under the umbrella of "simulation" today, we have a larger repertoire of choices in our educational journey and outreach. These provide a platform for us to really transform health-care simulation from the traditional, unimodality simulation, to more complex, high fidelity, integrated, and engaging multimodality techniques. The main thrust must be to enhance clinical decision-making in patient care, to solve real-world clinical problems. Hybrid simulation (HS) utilizes at least two different simulation modalities, whereby combining them will enable one type of simulation modality to enhance the other, with the proper alignment, coordination, and interfacing between the modalities. Although the term is often used interchangeably, HS is slightly different from multimodality simulation. The latter refers to the use of multiple types of simulation in the same scenario or place. The main objectives for using HS have to be as follows: (1) for the acquisition of knowledge and skills by the best combination of methodologies, (2) for clinical performance improvement at all levels of care through the creation of as close as possible to real-world situation and problems, (3) to be able to sustain motivation and passion of our spectrum learners in their educational continuum, and (4) to provide a rich, exciting, and stimulating learning platform and environment, which can trigger deep learning and understanding. This article will also share some examples and cases utilizing HS in transforming health-care simulation.

Conception d’un programme d’enseignement par simulation dans le DES de médecine d’urgence selon la méthode du modèle logique

Dans le cadre de la création du diplôme d’études spécialisées de médecine d’urgence (DESMU), l’intégration d’un programme national de simulation est difficile à promouvoir face à la grande variabilité des ressources de chaque université. Nous proposons une méthodologie de conception et de mise en oeuvre d’un programme de formation par simulation (PFS) fondée sur les spécificités de chaque université et intégrant une démarche évaluative selon une approche par compétences. La méthode du modèle logique a été utilisée pour définir les objectifs en lien avec le contexte de formation, préciser les ressources disponibles puis décrire le processus de mise en oeuvre et d’évaluation d’un PFS intégré au DESMU de l’université de Toulouse. La méthode du modèle logique a permis la conception d’un PFS à partir de six étapes successives : 1) l’objectif qui tient compte du contexte ; 2) les ressources ; 3) les activités ; 4) les groupes visés par le programme ; 5) les produits issus des activités ; 6) les résultats à court, moyen et long termes. Il a permis d’intégrer la simulation dans le cursus de formation des DESMU selon une approche réaliste et adaptée aux ressources locales avec un processus d’évaluation cohérent (satisfaction, mobilisation des compétences en situation de soins et impact sur l’organisation des soins). Dans le cadre d’une approche par compétences dans le cursus des DESMU, le modèle logique a mené à la conception, à la mise en oeuvre et à l’évaluation d’un PFS cohérent avec comme défi de rester dynamique afin d’intégrer l’évolution des variables pendant la période du projet.

To the Point: The expanding role of simulation in obstetrics and gynecology medical student education

This article, from the "To the Point" series prepared by the Association of Professors of Gynecology and Obstetrics (APGO) Undergraduate Medical Education Committee (UMEC), provides educators with an overview of the use of simulation in undergraduate medical education in the field of obstetrics and gynecology. Simulation plays an important role in the education of medical students. Students are increasingly serving as clinical observers and providing less direct patient care. Simulation can help standardize education and ensure quality and comparability across an enlarging educational environment. This article summarizes the expanding role of simulation in undergraduate medical education in obstetrics and gynecology and its effect on important learner outcomes such as confidence, knowledge, skills, workplace behaviors, and translation to patient care.