Manikins versus simulated patients in emergency medicine training: a comparative analysis

PURPOSE

Every physician must be able to sufficiently master medical emergencies, especially in medical areas where emergencies occur frequently such as in the emergency room or emergency surgery. This contrasts with the observation that medical students and young residents often feel insufficiently prepared to handle medical emergencies. It is therefore necessary to train them in the treatment of emergency patients. The aim of this study is to analyze the influence of the assignment of manikin versus simulated patients during a training for undergraduate medical students on learning outcomes and the perceived realism.

METHODS

The study had a prospective cross-over design and took place in a 3-day emergency medicine training for undergraduate medical students. Students completed three teaching units ('chest pain', 'impaired consciousness', 'dyspnea'), either with manikin or simulated patient. Using a questionnaire after each unit, overall impression, didactics, content, the quality of practical exercises, and the learning success were evaluated. The gained competences were measured in a 6-station objective structured clinical examination (OSCE) at the end of training.

RESULTS

126 students participated. Students rated simulated patients as significantly more realistic than manikins regarding the possibility to carry out examination techniques and taking medical history. 54.92% of the students would prefer to train with simulated patients in the future. Regarding the gained competences for 'chest pain' and 'impaired consciousness', students who trained with a manikin scored less in the OSCE station than the simulated patients-group.

CONCLUSION

Simulated patients are rated more realistic than manikins and seem to be superior to manikins regarding gained competence.

[The surgeon's balancing act-Teaching in the clinical routine]

BACKGROUND

Thus medical students must be inspired to undertake this specialty. Students complain that the teaching is subordinate to patient care and limited by a lack of time and medical personnel. Although there are many studies assessing student perceptions, few exist that focus on the issues that teachers face.

OBJECTIVE

To analyse student teaching in the daily routine and its potential' problems from the surgeon's perspectives.

MATERIAL AND METHODS

In this prospective study guidelines for semistructured interviews with formulated, open questions were created, which were specified with further questions. All interviews were conducted using these guidelines and recorded. The number of interviews were a function of the concept of content saturation.

RESULTS

All 22 participants perceived that the teaching in clinical practice is of paramount importance. Nevertheless, respondents described that learning goals in the clinical routine are not always achieved. The main reason is a lack of time; however, as clinical experience increases other factors will similarly become more important: Consultants and heads of departments complain about deficiencies in students' previous knowledge, including insufficient motivation. Most respondents described that they do not feel appreciated for teaching. Overall, student teaching was perceived as an additional burden but all respondents found the task to be extremely worthwhile.

CONCLUSION

In addition to the lack of personnel, a lack of appreciation is the most significant obstacle towards effective teaching. It is therefore important to increase the value of teaching by rewarding good achievements and the creation of effective transparency.

Influence of the Instructional Approach "Mastery Learning" versus "See One, Do One" on Acquiring Competencies in Abdomen Sonography: A Comparative Effectiveness Analysis

Ultrasound is an important diagnostic tool in patients with abdominal pain and after injury. However, it is highly dependent on the skills and training of the examiner. Thus, ultrasound competencies should be acquired early during medical education. The instructional approach affects the retention and performance of skills. A promising approach is "mastery learning." The aim of the study was to evaluate the effectiveness of "mastery learning" compared with the "see one, do one" approach by performing a focused assessment of sonography for trauma (FAST) in undergraduate medical students based using an academic assessment tool (Objective Structured Clinical Examination [OSCE]). In a prospective controlled trial, 146 participants were randomly allocated to two groups (see one, do one and mastery learning) and trained in a 90-min module. In the see one, do one group, the trainer demonstrated the complete FAST routine, and then the students trained each other on it under supervision and received direct oral feedback from the tutors. In the mastery learning group, each student received a routing slip. The routing slip contained five levels of competence for the FAST routine, each of which had to be achieved (e.g., choosing the correct probe) and verified by the trainer before working toward the next competency level. The acquired competencies were assessed after training using the OSCE, which is a standardized practical exam using checklists. The mastery learning group attained 40.69 ± 5.6 points on average (of a maximum of 46 points), and the see one, do one group, 33.85 ± 7.7 points (p < 0.001). Mastery learning is an effective teaching method for undergraduate medical students performing FAST and is superior to the see one, do one approach, as assessed with the OSCE.