Exploration of simulation-based medical education for undergraduate students

Evolution of Clinical Simulation Training and Pandemic-Led Acceleration: The International Medical University (IMU), Malaysia Journey

In many universities, simulation-based learning has finally been inducted as a member of 'the accepted teaching modality community'. This paper is to share the challenges and successes in the journey towards the inclusion of simulation-based learning in the medical curriculum at the authors' university which saw a steep surge during the COVID-19 pandemic. Our teaching and learning that was heavily traditional based went through a dramatic change to adapt to the new norm when the actual environment and patients became out of reach. We followed five factors (5 Fs) that significantly influenced the successful change: fast, force, fellowship, flexibility, and favourable reception.

Novice medical students' perception about bad news training with simulation and spikes strategy

Objective

To analyze the medical students' perception about simulated consultations before and after training using the SPIKES protocol.

Methods

Quasi-experimental study, with a qualitative approach. It counted with the participation of 20 students as Simulated Physicians (SF), and 20 students as Simulated Patients (SP), all belonging to a medical course. Data were obtained from the responses given to a reflective question, applied before and after training with the SPIKES. The treatment and the analysis of the data were guided by the stages of thematic analysis.

Results

In the category "Simulated Medical Student's Self-Perception", the subcategories "Nervousness and Insecurity" were predominant after the first consultation, while "Tranquility and Security" after the second consultation after training. In the category "Simulated Medical Student's Perception about the Educational Process", the subcategory "Reflective Learning" emerged in the students' speeches, especially after the second consultation. In the speeches of SP, it was evidenced the improvement of the care provided by SF after training.

Conclusion

The strategy used for the development of communication skills showed evidence of short-term effectiveness.

Innovation

The research resulted in a teaching protocol for students in pre-clinical stages that involves four stages: simulation, self-assessment, feedback and new simulations.

Application of integrated problem-based learning combined with lecture-based classroom teaching in undergraduate medical education: An effective teaching model in a Medical School in China

The problem-based learning (PBL) is increasingly used in undergraduate education. However, the application of integrated PBL to medical undergraduate education has not been well assessed. An observational study was designed to compare integrated PBL combined with lecture-based classroom (LBC) with traditional LBC teaching in 2 semesters of a Medical School in China. This study was conducted from March 2021 to July 2022. A total of 118 undergraduates majoring in clinical medicine were randomly allocated in 2 groups, 1 group receiving the integrated PBL + LBC teaching (experimental group, n = 60) and another group receiving LBC teaching (control group, n = 58). The experimental group attended the integrated PBL courses for the basic and clinical medicine conducted in the 6th and 8th semesters, respectively, as well as taking the LBC courses. The experimental group was required to preview the course materials before class, make presentations in class and take online feedback questionnaires after class, while the control group was required to preview the textbooks and listen to the traditional LBC courses. The students' scores of these 2 groups were compared, and feedback questionnaires were performed to evaluate the effectiveness of the experimental group over the control group. Results showed that the experimental group scored significantly higher than the control group in Clinical Skills (95% confidence interval [CI] 4.19-5.89), Internal Medicine I (95% CI: 1.85-9.93), Internal Medicine II (95% CI: 8.07-15.90), Introduction to Surgery (95% CI: 5.08-10.25), Surgery (General Surgery) (95% CI: 7.82-12.72), Surgery (Specialty) (95% CI: 6.47-9.97), and Clinical Medical Level Test (95% CI: 1.60-5.15) (all P < .01). In the feedback questionnaires of integrated PBL, up to 80% and 90% of students were satisfied with the teaching methods and lecturers, respectively. More than 80% of students agreed that the integrated PBL improved their abilities to learn independently, understand knowledge, and to raise, analyze and solve problems. In terms of stress in and out of class, a small number of students, <36.7%, felt stressed. The integrated PBL combined with LBC is an effective teaching approach, which may provide new ideas for teaching research and reform on undergraduate medical education in clinical medicine specialty and other medical majors.

Adequacy of Orthopaedic Surgery Educational Teaching Methods amongst Medical Students in Enugu State

Introduction

Orthopaedic surgery educational teaching methods for medical students vary across different tertiary institutions in Nigeria.

Aims

To determine the perception of medical students on the adequacy of orthopaedic surgery teaching methods in Enugu state, Nigeria.

Materials and Methods

A cross-sectional online survey conducted using a well-structured questionnaire with the Google forms software and distributed to final year medical students at the two tertiary universities in Enugu state via online forums. SPSS was used for analysis. Significance set at P < 0.05.

Results

106 final year medical students filled the form. Response rate was 65.1%. 85.8% of the respondents reported that every student gets posted for orthopaedic surgery while 53% agreed that graphical illustrations were used. 50% reported that the learning environment were serene whereas 94.3% reported that their lecturers are well-trained. However, 55.6% reported that they do not have surgery simulations. Furthermore, 15.09% reported that they are aware of pitfalls in the teaching methods where only 27.36% alluded to using the library. There was no statistically significant association between gender and perception on quality of trainers/teaching methods of orthopaedic surgery in Enugu state (P value < 0.112).

Conclusion/Recommendation

The orthopaedic surgery teaching methods currently being used are not adequate. Efforts should be made to increase the quality of exposure of medical students to orthopaedic surgery and increase the use of graphical illustrations/simulations.

Communication Skills (CS) training of physicians in China and its role in actual challenges of patient-physician relationship: a cross-sectional survey

BACKGROUND

The Chinese healthcare system is affected by frequent disputes between physicians and patients. Although recent reforms have contributed towards improving the patient-physician relationship, distrust in physicians is still high. Communication skills (CS) training of physicians holds the key to improving patient confidence and diffusing stressful situations. This survey reports on the status of CS training in medical education in China, and the experiences and attitudes of physicians towards CS training.

METHODS

A cross-sectional survey was conducted at medical institutions across China. A questionnaire developed for this study included the status of CS training, current aspects of patient-physician relationships, perceived own CS and patient-centeredness with Likert-scaled items from 1 (most negative) to 6 (most positive). Physicians' attitude towards CS training was measured with the Communication Skills Attitude Scale (CSAS) and its subscales PAS (Positive Attitude Scale) and NAS (Negative Attitude Scale). Data were analyzed descriptively and for group differences between the hospital level and operating vs. non-operating physicians. Binary logistic regression analysis was done to find associations explaining the occurrence of verbal and physical attacks and the role of CS attitudes.

RESULTS

Out of 1080 questionnaires, 772 physicians met inclusion criteria. A total of 466/772 participants (60.4%) had received at least one CS training during their career. The participants rated the current situation related to patient-physician relationship in China as highly stressful (mean = 4.52, SD = 1.26, 95% CI: 4.43-4.60), experiencing verbal attacks in the past three years once a year in 372/772 cases (48.2%) and physical attacks 111/772 times (14.4%). The mean PAS was 62.96 (SD = 7.63, 95% CI: 62.41-63.47). Being female was associated with increased risk of verbal attacks (OR = 1.51, 95% CI: 1.01-2.25) while working in a tertiary hospital and showing high levels of PAS decreased this risk (OR = 0.62, 95% CI: 0.43-0.89, and OR = 0.95, 95% CI: 0.93-0.98). Having received a previous CS training decreased the odds of physical attacks (OR = 0.54, 95% CI: 0.35-0.83).

CONCLUSIONS

A majority of Chinese physicians showed a high positive attitude towards CS training, were trained in CS and would value further training. Our results highlight that CS training is likely to promote patient-centered communication and reduce attacks against physicians. Both of these effects are to improve the patient-physician-relationship in the long run. More CS training should be offered to Chinese physicians, especially at secondary- and primary-care hospitals, where such practices remain infrequent.

Evaluation of teaching effect of first-aid comprehensive simulation-based education in clinical medical students

Background

Although students mastered the composition skills, they lack of the ability to effectively integrate these composition skills in real clinical situations. To address the problem, we set up different levels of situational simulation training for medical students in grades 2-4, and evaluate the teaching effect of first-aid situation comprehensive simulation-based education (SBE) on clinical medical students.

Methods

The medical students in Grade 2, 3, and 4 received different situational SBE, respectively. The 2nd-year medical students received a single skill module which included cardiopulmonary resuscitation, endotracheal intubation, and electric defibrillation training. The 3rd-year medical students received a single subject module which included cardiovascular and respiratory system training. The 4th-year medical students received the integrated multidisciplinary module which combined first-aid skills, clinical thinking, and teamwork training. The primary outcome was the expert evaluation and peer evaluation. The secondary outcome was students' satisfaction questionnaire response. In our training, we arranged an adequate teaching staff for intensive training and timely feedback (the student-teacher ratio of 5:1), adequate time for repetitive practice (Each SBE was carried out within 4 h), curriculum design, and integration from real cases by clinicians, realistic computer-driven mannequins to ensure simulation fidelity, providing a different difficult level of SBE to different grades of students, and pre- and post-tests for outcome measurement.

Results

In all of the single skill module, single subject module or comprehensive disciplines module, the scores in the expert evaluation and peer assessment after the training were significantly higher than before the training, and the differences were statistically significant (p < 0.05). The integrated subject training, although having the lowest pre-and post-test marks, had the largest increase in score.

Conclusion

The first aid comprehensive simulation-based education in grade 2-4 clinical medical students, basing on timely feedback, repetitive practice, curriculum integration, simulation fidelity, and outcome measurement are effective in improving the students' proficiency in managing the real emergencies.

Exploring the Impact of Pre-course High-Fidelity Simulation on Professional Socialization of Medical Students in Emergency Medicine Internship Rotation—A Qualitative Approach

Background

Medical students in block clerkships constantly adapt to new environments and learn to interact with new people as they rotate between specialties. This frequent change potentially limited interns' opportunities for participation in real clinical practice. The aims of this study were to explore interns' conceptualization of their learning opportunities and experiences in the workplace during an emergency medicine (EM) block internship. In addition, the study also explored how participating in the pre-rotation high-fidelity simulation (HFS) orientation influenced interns' perception of their transition, participation and learning experiences in the real EM setting.

Methods

We implemented a newly developed pre-EM rotation orientation curriculum for interns. This orientation took place on the first day of the 2-week EM internship rotation. Two focus group discussions were held after each simulation training, one immediately after simulation to understand the students' perception and the educational impact of this activity, the other at the end of EM rotation to explore and compare their roles and perception in both simulation activity and the real clinical practice. A total of 151 seventh-year medical students enrolled in the pre-course HFS and post-hoc focus group discussions between 2017 and 2019. We applied thematic analysis to systemically identify, examine, and construct themes.

Results

Four major themes were constructed from the data; 1. Challenges in finding authentic learning experiences within the context of emergency medicine; 2. Effectiveness of the pre-course HFS 3. Limitations of EM internship rotation curriculum and pre-course simulation. 4. Suggestions for EM block-internship curriculum reforms. Our study's key findings indicate that pre-rotation orientation HFS activity, which offered a psychologically safe space for students to explore facets of EM and gain a contextualized understanding of the emergency work culture and environment, was essential for enhancing students' ability to identify and maximize practice affordances in real workplace.

Conclusion

Simulation, facilitates interns' negotiation of legitimate peripheral participation opportunities as they transition into the EM community of practice during their block internship rotation; putting students at the center of the learning process.

Adequate emergency department resource usage: Applying simulation-based workshop to improve teaching competence among elementary and junior high school teachers in Taiwan

INTRODUCTION

More than 80% of patients who visited Emergency Department (ED) was not urgent in Taiwan in 2019. It causes insufficient medical services and a latent fiscal threat to the Nation Health Insurance (NHI). This study adopted simulation-based educating modules to explore the effect in teaching competence among primary and middle school teachers for efficient AEDRU (adequate emergency department resource usage) education in the future.

METHOD

The subjects were 414 elementary and junior high school teachers in Taiwan. 214 participants attended the simulation-based workshop as the simulation-based group, whereas 200 participants took an online self-learning module as the self-learning group. The workshop was created by an expert panel for decreasing the unnecessary usage amount of ED medial resources. The materials are lecture, board games, miniature ED modules, and simulation-based scenarios. A teaching competence questionnaire including ED knowledge, teaching attitude, teaching skills, and teaching self-efficacy was conducted among participants before and after the intervention. Data were analyzed via McNemar, paired t test and the generalized estimating equations (GEE).

RESULTS

The study showed that teachers who participated in the simulation-based workshop had improved more in teaching competence than those who received the online self-learning module. In addition, there were significant differences between the pre-test and post-test among the two groups in teaching competence.

CONCLUSION

The simulation-based workshop is effective and it should be spread out. When students know how to use ED medical resources properly, they could affect their families. It can help the ED service to be used properly and benefits the finance of the NHI. The health care cost will be managed while also improving health.