The Ventriloscope® as an innovative tool for assessing clinical examination skills: appraisal of a novel method of simulating auscultatory findings

Simulation-based education: deceiving learners with good intent

The level of performance of every clinician and of the overall multiprofessional team relies on the skills and expertise they have individually and collectively acquired through education, training, self-directed learning, and reflection. Simulation-based education (SBE) is playing an increasingly important role in that respect, and it is sometimes said that it is an art to facilitate. Many explanations can justify this assertion. Although there is generally an emphasis on making everything as realistic or "high-fidelity" as possible, it is often futile and this is where the art of simulation comes into play with an element of modulation of realism linked to the intended learning objectives. The atmosphere created by the educators; how the learners are made to engage and interact; how physical, technical, and contextual elements are simulated or represented; and what type of technology is used need to be appropriately adapted to contribute to the immersiveness of any SBE activity. Although it inevitably carries a negative connotation, some form of "deception" is more commonly used than one may think for the benefit of learners during SBE. High levels of realism are sometimes achieved by making learners believe something works or reacts as would be expected in real life, whereas it is achieved in a totally different manner. Learners do not need to know, see, or understand these "tricks of the trade", shortcuts, or artistic or technological aspects, and this can be considered a form of benevolent deception. Similarly, information may be withheld to recreate a realistic situation and push learners to demonstrate specific learning outcomes, but it needs to be practised with caution and be justifiable. These forms of "positive" deception are part of most SBE activities and are used to help learners bridge the reality gap so they can suspend disbelief more easily, exercise critical thinking, and treat the simulation more realistically without damaging the trust they place in their educators. This article will discuss how aspects of SBE activities are often manipulated, modified, or hidden from learners to facilitate the learning experience and present a simulation fidelity model encompassing the environmental, patient, semantical, and phenomenal dimensions.

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.

Nothing about me without me: a scoping review of how illness experiences inform simulated participants' encounters in health profession education

Background

Person-centred simulation in health professions education requires involvement of the person with illness experience.

Objective

To investigated how real illness experiences inform simulated participants' (SP) portrayals in simulation education using a scoping review to map literature.

Study selection

Arksey and O'Malley's framework was used to search, select, chart and analyse data with the assistance of personal and public involvement. MEDLINE, Embase, CINAHL, Scopus and Web of Science databases were searched. A final consultation exercise was conducted using results.

Findings

37 articles were within scope. Reporting and training of SPs are inconsistent. SPs were actors, volunteers or the person with the illness experience. Real illness experience was commonly drawn on in communication interactions. People with illness experience could be directly involved in various ways, such as through conversation with an SP, or indirectly, such as a recording of heart sounds. The impact on the learner was rarely considered.

Conclusion

Authentic illness experiences help create meaningful person-centred simulation education. Patients and SPs may both require support when sharing or portraying illness experience. Patients' voices profoundly enrich the educational contributions made by SPs.

Simulation-guided cardiac auscultation improves medical students' clinical skills: the Pavia pilot experience

Clinical evaluation is the cornerstone of any cardiac diagnosis, although excessive over-specialisation often leads students to disregard the value of clinical skills, and to overemphasize the approach to instrumental cardiac diagnosis. Time restraints, low availability of "typical" cardiac patients on whom to perform effective bedside teaching, patients' respect and the underscoring of the value of clinical skills all lead to a progressive decay in teaching. Simulation-guided cardiac auscultation may improve clinical training in medical students and residents. Harvey(©) is a mannequin encompassing more than 50 cardiac diagnoses that was designed and developed at the University of Miami (Florida, USA). One of the advantages of Harvey(©) simulation resides in the possibility of listening, comparing and discussing "real" murmurs. To objectively assess its teaching performance, the capability to identify five different cardiac diagnoses (atrial septal defect, normal young subject, mitral stenosis with tricuspid regurgitation, chronic mitral regurgitation, and pericarditis) out of more than 50 diagnostic possibilities was assessed in 523 III-year medical students (i.e. at the very beginning of their clinical experience), in 92 VI-year students, and in 42 residents before and after a formal 10-h teaching session with Harvey(©). None of them had previously experienced simulation-based cardiac auscultation in addition to formal lecturing (all three groups) and bedside teaching (VI-year students and residents). In order to assess the "persistence" of the acquired knowledge over time, the test was repeated after 3 years in 85 students, who did not repeat the formal 10-h teaching session with Harvey(©) after the III year. As expected, the overall response was poor in the "beginners" who correctly identified 11.0 % of the administered cardiac murmurs. After simulation-guided training, the ability to recognise the correct cardiac diagnoses was much better (72.0 %; p < 0.001 vs. baseline). Rather unexpectedly, before the tutorial, the performance of VI-year students and of residents was not significantly different from their III-year colleagues, since the two groups correctly identified 14.2 and 16.2 % of the diagnoses, respectively. After the tutorial, the VI-year students and the residents also improved their overall performance (to 73.1 and 76.1 %, respectively; p < 0.001 for both when compared to before the tutorial). The persistence of this capability after 3 years was remarkable, since the 85 students who repeated the test without any further exposure to the 10-h teaching session with Harvey(©) correctly identified 68.4 % of the possible cardiac diagnoses (p < 0.001 vs. baseline). These data underscore the importance of clinical training in order to improve auscultation skills in our academic setting, prompting to redesign teaching curricula. Simulation-based cardiac auscultation should be considered as the "missing link" between formal lecturing and bedside teaching of heart sounds and murmurs.

Keeping it real! Enhancing realism in standardised patient OSCE stations

BACKGROUND

Objective structured clinical examinations (OSCEs) are a commonly used method of assessing clinical competency in health care education. They can provide an opportunity to observe candidates interacting with patients. There are many challenges in using real patients in OSCEs, and increasingly standardised patients are being used as a preference. However, by using standardised patients there is a risk of making the encounter artificial and removed from actual clinical practice.

CONTEXT

Efforts made in terms of cognitive, auditory, visual, tactile, psychological and emotional cues can minimise the differences between a simulated and real clinical scenario. However, a number of factors, including feasibility, cost and usability, need to be considered if such techniques are to be practicable within an OSCE framework.

INNOVATION

This article describes a series of techniques that have been used in our institution to enhance the realism of a standardised patient encounter in an OSCE. Efforts in preparing standardised patient roles, and how they portray these roles, will be considered. A wide variety of equipment can also be used in combination with a patient and the surrounding environment, which can further enhance the authenticity of the simulated scenario.

IMPLICATIONS

By enhancing the realism in simulated patient OSCE encounters, there is potential to trigger more authentic conscious responses from candidates and implicit reactions that the candidates themselves may be less aware of. Furthermore, using such techniques may allow faculty members to select scenarios that were previously not thought possible in an OSCE.