Pilot study comparing simulation-based and didactic lecture-based critical care teaching for final-year medical students

High-fidelity simulation versus case-based discussion for training undergraduate medical students in pediatric emergencies: a quasi-experimental study

OBJECTIVE

To evaluate the effect of high-fidelity simulation of pediatric emergencies compared to case-based discussion on the development of self-confidence, theoretical knowledge, clinical reasoning, communication, attitude, and leadership in undergraduate medical students.

METHODS

33 medical students were allocated to two teaching methods: high-fidelity simulation (HFS, n = 18) or case-based discussion (CBD, n = 15). Self-confidence and knowledge tests were applied before and after the interventions and the effect of HFS on both outcomes was estimated with mixed-effect models. An Objective Structured Clinical Examination activity was conducted after the interventions, while two independent raters used specific simulation checklists to assess clinical reasoning, communication, attitude, and leadership. The effect of HFS on these outcomes was estimated with linear and logistic regressions. The effect size was estimated with the Hedge's g.

RESULTS

Both groups had an increase in self-confidence (HFS 59.1 × 93.6, p < 0.001; CDB 50.5 × 88.2, p < 0.001) and knowledge scores over time (HFS 45.1 × 63.2, p = 0.001; CDB 43.5 × 56.7, p-value < 0.01), but no difference was observed between groups (group*time effect in the mixed effect models adjusted for the student ranking) for both tests (p = 0.6565 and p = 0.3331, respectively). The simulation checklist scores of the HFS group were higher than those of the CBD group, with large effect sizes in all domains (Hedges g 1.15 to 2.20).

CONCLUSION

HFS performed better than CBD in developing clinical reasoning, communication, attitude, and leadership in undergraduate medical students in pediatric emergency care, but no significant difference was observed in self-confidence and theoretical knowledge.

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.

Nursing students' experience during their practicum in an intensive care unit: A qualitative meta-synthesis

Background

Clinical practicum provides nursing students with more opportunities to learn their professional knowledge and develop basic nursing skills. Intensive care unit (ICU) is often used as one of the clinical practicum departments for nursing students. Due to the characteristic fast-paced working environments, high acuity of patient care, and technical complexities of an ICU, nursing students are more susceptible to experiencing stress and lack of confidence in these settings, which hinders their professionalization and affects patient care.

Objective

The study aimed to summarize and evaluate the nursing students' experience in an ICU during their practicum and to provide a supportive ICU clinical practicum environment for them. One of the main objectives was to increase the ICU specialty nurse reserve and improve nursing care in the ICU.

Methods

The following databases were searched for related qualitative publications in Chinese and English by systematic searches across January 2022, including the nursing students' experience in ICU during their practicum: PubMed, Cochrane Library, Web of Science, and so on. The qualitative meta-synthesis was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) recommendations. Two reviewers independently selected these studies and carefully evaluated the quality of each study. Meta-synthesis was then used to summarize the results.

Results

Eleven sub-themes and 3 themes were revealed in 9 studies: challenges of clinical practicum in the ICU, the expectation of support from multiple sources, and the importance and necessity of practicum in the ICU.

Conclusion

Performing one's practicum in ICU was considered by the nursing students in this review as a beneficial practicum despite the challenges involved. The appropriate guidance and monitoring should be given by hospital managers and college educators.

Off-site simulation-based training on management of postpartum hemorrhage amongst final-year medical students

Background

Postpartum hemorrhage (PPH) is an obstetric emergency, and training of health-care providers for early diagnosis and intervention improves morbidity and mortality. Regular simulation-based training modules are conducted in our institute for health-care providers. The objective of this study was to assess the final-year medical students on their subjective improvement in the management of PPH after an off-site simulation-based training which was conducted after a conventional lecture.

Methods

A survey was administered on medical students and their subjective retrospective analysis of both pre and post off-site simulation was collected. The survey was analyzed, and results were formulated.

Results

Forty-six students completed the survey. Although students felt their confidence level in enumerating the steps in management of PPH less than 50% before the drill, it increased to 70% after the drill. The confidence of the students in carrying out the procedures of PPH also increased. The results showed a considerable subjective improvement in skill and cognitive enhancement after an off-site simulation-based training. There was a significant improvement in the pre and postsimulation training scores in the test. The faculty felt that there was an enhancement in learning after the simulation training.

Conclusion

Off-site simulation of an emergency condition improves both knowledge and skill in students.

The Code Silver Exercise: a low-cost simulation alternative to prepare hospitals for an active shooter event

Mass-shooting incidents have been increasing in recent years and Code Silver—the hospital response to a person with a weapon such as an active shooter in many Provinces or States in North America—is quickly shifting from a theoretical safety measure to a realistic scenario for which hospitals must prepare their staff. A Code Silver Exercise (CSE) involving an independent mental practice exercise with written responses to scenarios and questions, followed by a facilitated debrief with all participants, was conceptualized and trialled for feasibility and efficacy. The CSE was piloted as a quality improvement and emergency preparedness initiative in three different settings including in situ within a hospital Emergency Department or Intensive Care Unit, offsite in a large conference room workshop, and online via virtual platform. These sessions took place in 4 different cities in Canada and included 3 academic teaching hospitals. Participants of the in situ and virtual CSE completed pre- and post-simulation surveys which showed improved understanding of Code Silver protocols following participation.

The CSE is a reproducible simulation alternative, designed to operationalize a Code Silver policy at a large healthcare institution in a sustainable way. This training model can be administered in multiple settings in-person (in situ or offsite), and virtually, making it versatile and easily accessible for participants. This exercise enables participants to mentally rehearse practical responses to an active shooter in their unique work environments and to discuss ethical and medical-legal implications of their responses during a facilitated debrief with fellow healthcare providers. Implementation of a CSE for training in hospitals may help staff to create a mental schema prior to an active shooter event, and thus indirectly improve the chances of survivability in the event of a real active shooter situation.

A Novel Blended Curriculum for Communication of Informed Consent With Surgical Interns

BACKGROUND

Interns often conduct procedural informed consent discussions (ICDs), identified as a core entrustable professional activity. Deficiencies in the training process for ICDs span across specialties.

OBJECTIVE

We provide evidence for a curriculum and assessment designed to standardize the training process and ensure ICD competency in surgical interns.

METHODS

In March 2019, PowerPoint educational materials were emailed to one academic institution's new surgical interns, who in June participated in an onsite 1-hour role-play "hot seat" group activity (GA) with an untrained simulated patient, and in October completed a single trained simulated patient (real-time raters) verification of proficiency (VOP) assessment. Curriculum evaluation was measured through intern pre-/post-confidence (5-point scale), and the VOP's Cronbach's alpha and test-retest were examined. Data were analyzed with descriptive statistics, paired t tests, and 2-way random effects models.

RESULTS

Of 44 new interns, 40 (91%) participated in the remote teaching and live GA and were assessed by the VOP. Pre-/post-GA confidence increased a mean difference of 1.3 (SD = 0.63, P < .001). The VOP's Cronbach's alpha was 0.88 and test-retest was 0.84 (95% CI 0.67-0.93, P < .001), with a 95% pass rate. The 2 first-time fail students required remediation. Time commitment included 1 hour maximum for individual training and implementation and 30 minutes for assessment. The use of volunteers and donated space mitigated additional costs.

CONCLUSIONS

Remote asynchronous and group skills teaching for new general surgical interns improved their confidence in conducting procedural ICDs. A patient-simulation verification process appeared feasible with preliminary evidence of retest and internal consistency.

The Power of an Active Shooter Simulation: Changing Ethical Beliefs

Introduction

During a hospital-based active shooter (AS) event, clinicians may be forced to choose between saving themselves or their patients. The Hartford Consensus survey of clinicians and the public demonstrated mixed feelings on the role of doctors and nurses in these situations. Our objective was to evaluate the effect of simulation on ethical dilemmas during a hospital-based AS simulation. The objective was to determine whether a hospital-based AS event simulation and debrief would impact the ethical beliefs of emergency physicians relating to personal duty and risk.

Methods

Forty-eight emergency physicians and physicians-in-training participated in this cohort study based in an urban academic hospital. Simulation scenarios presented ethical dilemmas for participants (eg, they decided between running a code or hiding from a shooter). Surveys based upon the Hartford Consensus were completed before and after the simulation. Questions focused on preparedness and ethical duties of physicians to their patients during an AS incident. We evaluated differences using a chi-squared test.

Results

Preparedness for an AS event significantly improved after the simulation (P = 0.0001). Pre-simulation, 56% of participants felt that doctors/nurses have a special duty like police to protect patients who cannot hide/run, and 20% reported that a provider should accept a very high/high level of personal risk to protect patients who cannot hide/run. This was similar to the findings of the Hartford Consensus. Interestingly, post-simulation, percentages decreased to 25% (P = 0.008) and 5% (P = 0.041), respectively.

Conclusion

Simulation training influenced ethical beliefs relating to the duty of emergency physicians during a hospital-based AS incident. In addition to traditional learning objectives, ethics should be another important design consideration for planning future simulations in this domain.

Development and implementation of a novel, mandatory competency-based medical education simulation program for pediatric emergency medicine faculty

Background

Maintaining acute care physician competence is critically important. Current maintenance of certification (MOC) programs has started to incorporate simulation-based education (SBE). However, competency expectations have not been defined. This article describes the development of a mandatory annual SBE, competency-based simulation program for technical and resuscitation skills for pediatric emergency medicine (PEM) physicians.

Methods

The competency-based medical education (CBME) program was introduced in 2016. Procedural skill requirements were based on a needs assessment derived from Royal College PEM training guidelines. Resuscitation scenarios were modified versions of pre-existing in-situ mock codes or critical incident cases. All full-time faculty were required to participate annually in both sessions. Delivery of educational content included a flipped classroom website, deliberate practice, and stop-pause debriefing. All stations required competency checklists and global rating scales.

Results

Between 2016 and 2018, 40 physicians and 48 registered nurses attended these courses. Overall course evaluations in 2018 were 4.92/5 and 4.93/5. Barriers to implementation include the need for many simulation education experts, time commitment, and clinical scheduling during course events.

Conclusion

We have developed a mandatory simulation-based, technical, and resuscitation CBME program for PEM faculty. This simulation-based CBME program could be adapted to other acute care disciplines. Further research is required to determine if these skills are enhanced both in a simulated and real environment and if there is an impact on patient outcomes.

Supplementary Information

The online version contains supplementary material available at 10.1186/s41077-021-00170-4.

Simulation-Based Learning Versus Didactic Lecture in Teaching Bronchial Asthma for Undergraduate Medical Students: a Step Toward Improvement of Clinical Competencies

BACKGROUND

Simulation-based learning (SBL), an effective teaching strategy, is still questionable on whether it can be an alternative to didactic lectures in medical education. Our study aimed to evaluate the effectiveness of SBL versus traditional lectures in retention of knowledge.

METHODS

A randomized controlled trial was conducted among medical students who were divided in two groups (36 students each). Each group received the same information about diagnosis and management of bronchial asthma, but with a different teaching method: didactic lecture or simulation. Knowledge level was tested before, immediately after the teaching sessions and 3 months later using multiple-choice questions. Student's satisfaction was evaluated using feedback questionnaire.

RESULTS

The simulation group scored higher than the lecture group in the post-test and the late test. However, these differences were not significant. Additionally, students' satisfaction scores were significantly higher in the simulation group than in the lecture group (p < 0.01). Students ranked simulation significantly better regarding motivation (71.9%), comfort (59.4%), understanding (59.4%), and effective communication (59.4%) (p < 0.01).

CONCLUSION

Simulation is as effective as lecture in retention of medical knowledge. Nonetheless, students agree that it is more satisfactory and interesting. SBL integration in medical programs is recommended to overcome obstacles in clinical training.

The effect of simulation-based training in non-physician anesthetists in Tigray region, Ethiopia

Objective

In Ethiopia simulation-based anesthesia education is a new way of teaching method which started in Mekelle University as of January, 2019. Hence, the purpose of this study is to evaluate whether simulation-based training improves non-physician anesthetists’ knowledge and attitude on maternal and neonatal anesthesia cares or not.

Results

Out of 50 study subjects, 66% had a working experience of less than 5 years. Knowledge score improved significantly from 49.78 to 66.22% in pretest and posttest results respectively. The posttest result was significantly improved (P < 0.001) for all knowledge questions. The respondents were asked about a negative statement and a positive statement about the need to have effective closed lope communication, maternal resuscitation and neonatal resuscitation. The attitude score improved from 72.45 to 79.11% in pretest and posttest respectively. From the 9 questions the attitudinal mean score for pretest was 6.52 and posttest 7.12. The null hypothesis of equal knowledge and attitude was rejected, t (49) = − 5.54, P < 0.001 and t (49) = − 2.25, P < 0.03 respectively.

Critical Care Education Day: A Novel, Multidisciplinary, and Interactive Critical Care Education Session for Emergency Medicine Residents

Critical care medicine (CCM) is central to emergency medicine (EM) resident education. We feel that the traditional lecture format is not the ideal way to teach EM critical care, which requires integration and prioritization of diagnostic workup and team-based resuscitation under time pressure. We describe a novel critical care education day where an interactive, practical, and multidisciplinary critical care educational experience was provided for EM residents using case-based small-group sessions and fast-paced simulation.

Ochsner Obstetrics and Gynecology Simulation Program: A Review of the Literature and Description of a Multidisciplinary Simulation Program Targeting Management of Obstetric Emergencies

Background: Simulation training improves the response to obstetric emergencies. Methods: We review the current literature regarding simulation training for provider education, team training, and obstetric outcomes and describe the implementation of a multidisciplinary obstetric simulation program. Results: A review of literature available at PubMed reveals many studies focused on provider education but few studies detailing the direct impact on patients. We review simulation reports that demonstrate improved clinical outcomes after obstetric emergencies-such as shoulder dystocia, postpartum hemorrhage, delivery of the second twin, operative vaginal delivery, urgent cesarean delivery, and neonatal resuscitation-as these studies formed the basis of the Ochsner Obstetrics and Gynecology Simulation Program in New Orleans, LA. We discuss the 3 principal simulation formats at Ochsner: a half-day course at the simulation training center, in-situ simulation on clinical care floors, and just-in-time training in the classroom. We also present detailed examples of simulation scenarios to assist others in creating a robust simulation program to ensure staff and providers are well trained to respond to obstetric emergencies. Conclusion: The Ochsner Obstetrics and Gynecology Simulation Program was formulated on published literature and incorporates a variety of clinical settings, scenarios, and approaches to improve educational opportunities and response to obstetric emergencies.

Evaluation of resident satisfaction and change in knowledge following use of high-fidelity simulation teaching for anaesthesia residents

Background and Aims:

Anaesthesia practice demands medical knowledge and skills as essential components for patient management in peri-operative emergencies. Since all residents are not exposed to such situations during their residency, training them using simulation technology could bridge this knowledge and skill gap. The aim of this study was to train and evaluate residents to manage anaesthesia emergencies on high fidelity simulators.

Methods:

Kirkpatrick model of program evaluation was carried out. Resident reaction was captured using a satisfaction questionnaire and the change in knowledge was assessed using pre-test and post-test Multiple Choice Questions (MCQs). Six scenarios were created and executed on a human patient simulator (HPS). All 22 residents participated in this teaching learning method. The steps of simulation teaching included pre-test, pre-briefing, orientation to manikins, performing/scribe, debriefing, feedback questionnaire, and post-test. The satisfaction questionnaire was administered following the second and fourth scenario.

Results:

95% residents agreed on overall satisfaction, that it helps in building team dynamics and clinical reasoning. All students agreed that this teaching had positive professional impact. 14% residents felt they were anxious during the class. The items in the questionnaire had a Cronbach's α value of 0.9. The mean score for pre-test was 24.22 ± 7 (Mean ± SD) and the post-test was 47.18 ± 5.6, the difference between the scores were statistically significant (P = 0.007).

Conclusion:

The use of high-fidelity simulation to train anaesthesia residents resulted in greater satisfaction scores and improved the residents' reasoning skills.

Implementation of an Intraoperative Instructional Timeout Just Prior to Stapler Use Improves Proficiency of Surgical Stapler Usage by Surgery Residents

INTRODUCTION

With the fragmented rotational structure of training, exposure to surgical staplers is not uniform across surgical residents. Traditionally, educational sessions dedicated to instruction in surgical staplers have taken place outside the operating room. This study implemented and evaluated an intraoperative timeout immediately prior to stapler use in cases with surgical residents.

METHODS

During general surgery cases from June 1, 2017 until December 31, 2017, surgical teams, including the surgical attending, surgical resident, and scrub nurse participated in an intraoperative instructional timeout, during which proper use of linear or circular staplers was reviewed. At the conclusion of the timeout, residents were required to demonstrate proper stapler assembly and verbalize all technical steps involved in stapler use. Duration of each timeout was recorded. Immediately following the case, a pre-post survey was administered to each participating junior (R1-R2) or senior (R4-R5) surgical resident. The primary outcome was change in stapler use knowledge by surgical residents. Survey questions with Likert scale responses were analyzed using paired ttests, and responses from junior residents were compared to those from senior residents with independent t tests.

RESULTS

Forty-three general surgery cases involved stapler use during the study period and implemented an intraoperative instructional timeout. The educational intervention increased stapler use knowledge significantly in all surgical residents. Prior to the timeout, junior residents reported significantly higher anxiety related to stapler usage compared to their senior counterparts; anxiety scores in junior residents decreased significantly for use of both linear and circular staplers. The mean timeout duration was 2.9 minutes (standard deviation 0.9 minutes, range 1.2-4.6 minutes). All participating surgical residents recommended routine implementation of an instructional timeout prior to intraoperative stapler use.

CONCLUSIONS

An intraoperative timeout dedicated to stapler teaching is effective in increasing proficiency and easing anxiety in all levels of surgical residents. Further research is warranted to determine whether this educational intervention would translate into fewer stapler use errors and decreased intraoperative complications.

Utilization of high-fidelity simulation to address challenges with the basic science immunology education of preclinical medical students

BACKGROUND

Immune function and dysfunction are highly complex basic science concepts introduced in the preclinical medical school curriculum. A challenge for early learners is connecting the intricate details and concepts in immunology with clinical manifestations. This impedes relevance and applicability. The impetus in medical education reform is promoting consolidation of basic science and clinical medicine during the first two years of medical school. Simulation is an innovation now widely employed in medical schools to enhance clinical learning. Its use in basic science curriculums is largely deficient. The authors piloted simulation as a novel curricular approach to enhance fundamental immunology knowledge and clinical integration.

METHODS

The authors introduced a Primary Immunodeficiency Disease (PIDD) simulation during a basic science immunology course for second-year medical students at the Zucker School of Medicine at Hofstra/Northwell. The simulation tasked small groups of students with evaluating, diagnosing and managing an infant with previously undiagnosed immunodeficiency. Joint facilitation by clinical and science faculty during terminal debriefings engaged students in Socratic discussion. Debriefing aimed to immerse basic science content in the context of the clinical case. Students completed a post-simulation Likert survey, assessing utility in reinforcing clinical reasoning, integration of basic science and clinical immunology, enhanced knowledge and understanding of immunodeficiency, and enhanced learning. A summative Immunodeficiency Objective Structured Clinical Examination (OSCE) question was created by faculty to assess students' recognition of a PIDD and clinical reasoning.

RESULTS

The simulation was well received by students with > 90% endorsing each of the objectives on the post-simulation survey. The authors also determined a statistically significant score variance on the summative OSCE question. Higher scores were achieved by the cohort of students completing the OSCE post-simulation versus the cohort completing the OSCE pre-simulation.

CONCLUSIONS

The innovative use of simulation in a highly complex basic science immunology course provides relevance and consolidation for preclinical learners. Additional data will be collected to continuously assess application of concepts and proficiency stemming from this novel curricular intervention. The authors advocate the initiation and/or expansion of simulation in non-clinical basic science courses such as immunology to bridge the gap between theory and practice.

Clinical Skills Simulation Complementing Core Content: Development of the Simulation Lab Integrated Curriculum Experience (SLICE)

Simulation is emerging as an essential component of the medical school curriculum. Simulation Lab Integrated Curriculum Experience (SLICE) is a student-organized program at the University of North Carolina School of Medicine (UNC SOM) for medical students that provides skills-based training sessions to augment didactic learning experiences. During its pilot year, SLICE conducted five events with respondents completing pre-and post-surveys evaluating participants' level of comfort with procedures. There was a significant increase in self-reported confidence after each session, with students providing overwhelmingly positive feedback regarding SLICE's ability to contextualize material presented in traditional lectures.

Design and evaluation of a subcutaneous contraceptive implant training simulator

OBJECTIVE

To design and fabricate a subcutaneous contraceptive implant insertion simulator, and to characterize the performance of nursing students trained with and without the simulator.

METHOD

A cross-sectional study was conducted on nursing students in Ghana who had no previous training in the insertion of contraceptive implants. They were given standardized training in insertion of implants from 25 April to 26 April, 2016, and then were randomly assigned to an intervention or control group. The control group watched insertions of live implants while the intervention group practiced using the simulator. Local materials were used to fabricate the simulator. The performance of both groups was assessed after the training.

RESULTS

The participants consisted of 50 nursing students. Those in the intervention group were more likely to: insert the implant accurately (95.2% vs 78.4%, P<0.001); take less time to complete an insertion (mean of 33.6 seconds vs 42.2 seconds, P<0.001); and commit fewer errors (1.9 vs 2.5, P=0.005) compared to the control group. In addition, participants rated the simulator high on 11/11 of the product requirements with the teaching (93.2%), learning (91.4%), and skill acquisition (88.6%) requirements being the highest rated.

CONCLUSION

A low-cost, locally fabricated simulator is an effective tool for augmenting the current training protocol by improving insertion skills of contraceptive implants.

Comparing Educational Outcomes of Online Module-Based Technology with and without Simulation on Attitudes Toward Care of the Dying in Second Semester BSN Students

BACKGROUND

Opportunities to provide competent and compassionate End-of Life (EOL) care to patients and families are limited for nursing students.

METHOD

A mixed methods approach was used to explore the students' attitudes towards caring for an EOL patient in two groups: an on-line-module only group and an on-line module plus simulation group.

RESULTS

Statistically significant effect of time was found across the two conditions (F [1, 69] = 7.83, p = .007), indicating that scores on the FATCOD-B significantly improved regardless of the condition over time. The qualitative responses indicated that the simulation experience was more impactful than the on-line module.

CONCLUSIONS

Innovative education modalities described in the study may assist in preparing the future workforce for the myriad of demands related to health, life, and death.

An Analysis of the Efficacy of Different Teaching Modalities in Imparting Adult Cardiopulmonary Resuscitation Skills among First-year Medical Students: A Pilot Study

Introduction

Our current medical curriculum devotes a large percentage of time to knowledge acquisition by means of didactic lectures. Psychomotor skill acquisition takes a back seat. Certain lifesaving skills like basic life support skill training have not even made an appearance in the current curriculum. Equal time distribution to cognitive and psychomotor skills should be allotted for MBBS trainees, which is a very practical subject. Simulation can prove to be a valuable tool in imparting skill training. The present study aims to evaluate the efficacy of different teaching modalities in imparting lifesaving skills among first-year MBBS students.

Materials and methods

This cross-sectional study was conducted among 33 first-year students who consented to participate. Approval was obtained from the institutional ethics committee. The students were divided into three groups, each undergoing either didactic lecture or animation-based videos or simulation studies. Pretest, posttest, and skills tests were administered to them. One-way analysis of variance (ANOVA) and paired t test were the statistical tests employed using SPSS version 21.

Results

The pretest and posttest scores were comparable in the three groups while the improvement in the posttest scores in all the three groups was significant. The skills test was significantly better in the group undergoing simulation training compared to the other groups.

Conclusion

Didactic, animation, and simulation are all good methods in imparting cognitive knowledge, but simulation is the method of choice in imparting psychomotor skills.

Clinical significance

An overhauling of the medical curriculum to include more skills training to the budding doctors using simulation-based techniques is recommended.

How to cite this article

Suseel A, Panchu P, Abraham SV, Varghese S, George T, Joy L. An Analysis of the Efficacy of Different Teaching Modalities in Imparting Adult Cardiopulmonary Resuscitation Skills among First-year Medical Students: A Pilot Study. IJCCM 2019;23(11): 509–512.

Interprofessional Healthcare Student Training in the Care of Sexual Assault Patients Utilizing Standardized Patient Methodology

BACKGROUND

The medical assessment of sexual assault (SA) is challenging because SA patients are often hesitant to disclose their medical needs, which puts them at further physical and psychological risk, and because of provider unease in conducting SA examinations. This challenge is compounded by a lack of provider training.

OBJECTIVES

The study goals were to develop an interprofessional simulation event that would foster SA interview skills, foster effective communication with SA patients, and increase learner confidence in assessing SA patients.

METHODS

Participants were senior-year school of medicine (n = 165) and advanced practice registered nursing (n = 30) students (N = 195) who were enrolled in a mandatory Military Sexual Assault Assessment and Treatment course, along with data provided by trained standardized patients (SPs, n = 16) who participated in the simulation event and in assessments of learners. Measures included the Sexual Assault Interview Skills Checklist, the Essential Elements of Communication, and the Confidence in SA Assessment scale. Data were analyzed using analysis of variance and t tests at the P < 0.05 threshold.

RESULTS

Postsimulation Sexual Assault Interview Skills Checklist and Essential Elements of Communication scores demonstrated an acceptable level of competence according to both students and SPs. Confidence in SA assessment rose significantly from presimulation to postsimulation. Before simulation, medical students were significantly lower than nursing students, but the simulation event closed the confidence in SA assessment gap.

CONCLUSIONS

This interprofessional simulation event resulted in SA interview competence, communication skills competence, and improved confidence scores. Combined, these findings support the efficacy of simulation to train emerging healthcare providers to properly assess SA.

Providing Transthoracic Echocardiography Training for Intensive Care Unit Trainees: An Educational Improvement Initiative

OBJECTIVE

Transthoracic echocardiography (TTE) is important in the management of critically ill patients, yet it has not been incorporated into many residency programs' curricula. Our objective is to determine if trainees undergoing a 60-minute training session on TTE have improved knowledge, ultrasound skills, and increases the utilization of TTE during their rotation in the intensive care unit (ICU). We will also compare the results of participants with prior TTE exposure to TTE-naïve trainees. Our hypothesis is that after the training, participants' will have improved knowledge and ultrasound skills compared to before training. Our secondary hypotheses are that TTE-naïve trainees will have greater improvements in knowledge scores compared to those who have had prior TTE experience and trainees will increase their use of TTE in the ICU.

DESIGN

Single-center, prospective trial.

SETTING

Brigham and Women's Hospital (academic hospital).

PARTICIPANTS

Residents and fellows rotating through the ICU, at any level of postgraduate training.

RESULTS

Forty-two trainees participated in the study. Statistically significant improvement after training was observed for all multiple choice questions (MCQ) and practical assessments (p < 0.001). When assessing the differences in score improvement between TTE-experienced versus TTE-naïve users, mean score improvements were notably higher for TTE-naïve participants (MCQ: 28.2 ± 11.6; echo clinical: 48.6 ± 23.4) compared to TTE-experienced users (MCQ: 18.6 ± 13.5, p = 0.01; echo clinical: 38.3 ± 30.2, p = 0.04).

CONCLUSIONS

A short didactic presentation on TTE use may be useful in teaching ICU trainees basic TTE skills and encouraging the use of bedside TTE in the ICU.

Medical Student Evaluation With a Serious Game Compared to Multiple Choice Questions Assessment

Background

The gold standard for evaluating medical students’ knowledge is by multiple choice question (MCQs) tests: an objective and effective means of restituting book-based knowledge. However, concerns have been raised regarding their effectiveness to evaluate global medical skills. Furthermore, MCQs of unequal difficulty can generate frustration and may also lead to a sizable proportion of close results with low score variability. Serious games (SG) have recently been introduced to better evaluate students’ medical skills.

Objectives

The study aimed to compare MCQs with SG for medical student evaluation.

Methods

We designed a cross-over randomized study including volunteer medical students from two medical schools in Paris (France) from January to September 2016. The students were randomized into two groups and evaluated either by the SG first and then the MCQs, or vice-versa, for a cardiology clinical case. The primary endpoint was score variability evaluated by variance comparison. Secondary endpoints were differences in and correlation between the MCQ and SG results, and student satisfaction.

Results

A total of 68 medical students were included. The score variability was significantly higher in the SG group (σ² =265.4) than the MCQs group (σ²=140.2; P=.009). The mean score was significantly lower for the SG than the MCQs at 66.1 (SD 16.3) and 75.7 (SD 11.8) points out of 100, respectively (P<.001). No correlation was found between the two test results (R²=0.04, P=.58). The self-reported satisfaction was significantly higher for SG (P<.001).

Conclusions

Our study suggests that SGs are more effective in terms of score variability than MCQs. In addition, they are associated with a higher student satisfaction rate. SGs could represent a new evaluation modality for medical students.

An Assessment of Intubation Skill Training in Novice Anesthesiology Residents of Tehran University of Medical Sciences With the Use of Mannequins

BACKGROUND

The goal of this study was to evaluate the impact of intubation skill training involving the use of mannequins on novice anesthesiology residents in a knowledge, attitudes, and practices designed study in which three different types of evaluation were implemented.

METHODS

All first-year anesthesiology residents (24) of Sina Hospital, affiliated to the Tehran University of Medical Sciences, were invited to participate in an intubating skills training course. The program comprised two theoretical and three practical sessions, lasting a total of 16 hours over four days. Faculty assessment of residents' practices was carried out using the questionnaire results, measured using a Likert scale, as the primary outcome. An improvement in the theoretical knowledge of the novice anesthesiology residents (using the Likert scale) and their attitudes towards the educational course in general (via a multiple choice question examination), were also evaluated.

RESULTS

The mean score following faculty assessment of the residents' practical skills was 4.6 out of 5.0 (92%) [standard deviation (SD) of 0.13]. The mean score with respect to the attitudes of the residents was 4.8 out of 5.0 (96%) (SD of 0.16). The overall mean theoretical score of the residents improved significantly upon completion of the training program (P = 0.001).

CONCLUSIONS

Our results suggest that the personnel in the five participating faculties were highly satisfied with the practical performance of the residents, who were found to hold good attitudes towards the program as a whole.

Integrating Soft Set Theory and Fuzzy Linguistic Model to Evaluate the Performance of Training Simulation Systems

The advancement of high technologies and the arrival of the information age have caused changes to the modern warfare. The military forces of many countries have replaced partially real training drills with training simulation systems to achieve combat readiness. However, considerable types of training simulation systems are used in military settings. In addition, differences in system set up time, functions, the environment, and the competency of system operators, as well as incomplete information have made it difficult to evaluate the performance of training simulation systems. To address the aforementioned problems, this study integrated analytic hierarchy process, soft set theory, and the fuzzy linguistic representation model to evaluate the performance of various training simulation systems. Furthermore, importance-performance analysis was adopted to examine the influence of saving costs and training safety of training simulation systems. The findings of this study are expected to facilitate applying military training simulation systems, avoiding wasting of resources (e.g., low utility and idle time), and providing data for subsequent applications and analysis. To verify the method proposed in this study, the numerical examples of the performance evaluation of training simulation systems were adopted and compared with the numerical results of an AHP and a novel AHP-based ranking technique. The results verified that not only could expert-provided questionnaire information be fully considered to lower the repetition rate of performance ranking, but a two-dimensional graph could also be used to help administrators allocate limited resources, thereby enhancing the investment benefits and training effectiveness of a training simulation system.