2022, Number 41
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Inv Ed Med 2022; 11 (41)
Performance in cardiac examination and diagnostic accuracy after training medical students with simulators vs. patients
Gomez ML, Campos GJ, Ramos AA, Cervantes BRM, Cedillo AC
Language: English
References: 25
Page: 44-52
PDF size: 632.00 Kb.
ABSTRACT
Introduction: To ensure a good medical preparation and
reduce the risk of mistakes, different methods and techniques
for the development of clinical practice are used;
cardiac examination skills decrease along the time. For
this purpose simulation is implemented on the teaching
process, and the impact of it on performance of cardiac
auscultation should be assessed.
Objective: We aimed to compare 4th-year med students’
performance and diagnostic accuracy during the cardiac
examination, before and after training.
Method: The sample comprised forty-six 4th year med
students randomized into two groups. One group was
trained with cardiac simulators and the other with patients
exclusively. We assessed their ability to perform
a cardiac examination and the diagnostic accuracy by
using a standardized assessment checklist for a cardiac
examination and then performed a statistic test to compare
both groups’ performance.
Results: There was a difference between both groups’ initial
scores of 2 decimals (7.1 and 7.3 on a 0-10 scale). After
training, we found that the patients’ trained group had an
average score of 8.6 while the simulators trained group had
an average score of 8.8 and higher diagnosis accuracy.
Conclusions: Clinical simulation and patient training are
two different ways of achieving the same goal. There
are many reports that claim simulation is best to train
medical students, but in this report, we did not observe
a statistical difference among them. This is not however,
a disadvantage. Clinical simulation offers better learning
experience, shown as a tendency in the scores and better
diagnostic accuracy. The lack of significant difference
between the simulator/patient groups can be explained
by a small sample size.
REFERENCES
Kamei RK, Cook S, Puthucheary J, Starmer & CF. 21 st Century Learning in Medicine: Traditional Teaching versus Team-based Learning. J Int Assoc Med Sci Educ Med Sci Educ. 2012;22(2):57-64.
McGaghie WC, Issenberg SB, Cohen ER, Barsuk JH, Wayne DB. Does simulation-based medical education with deliberate practice yield better results than traditional clinical education? A meta-analytic comparative review of the evidence. Acad Med. 2011 Jun;86(6):706-11. DOI: 10.1097/ACM.0b013e318217e119. PMID: 21512370; PMCID: PMC3102783.
Institute of Medicine; Committee on Quality of Health Care in America. To Err Is Human: Building a Safer Health System. Ed. Kohn LT, Corrigan JM editor. Washington, D.C.: National Academies Press; 2000. Available from: http:// www.nap.edu/catalog/9728
Ker J, Bradley P. Simulation in Medical Education. Understanding Medical Education: Evidence, Theory and Practice. 2010;32(3):164-80. Available from: https://doi. org/10.1002/9781444320282.ch12
Cooper JB, Taqueti VR. A brief history of the development of mannequin simulators for clinical education and training. Postgrad Med J. 2008;84(997):563-70.
Stern DT, Mangrulkar RS, Gruppen LD, Lang AL, Grum CM, Judge RD. Using a multimedia tool to improve cardiac auscultation knowledge and skills. J Gen Intern Med. 2001;16(11):763-9.
Doering S, Schneider G, Burgmer M, Sensmeier J, Schrewe FB, Friederichs H, et al. Evaluation des Praktikums »Psychosomatik und Psychotherapie« mit standardisierten Patienten. Z Psychosom Med Psychother [Internet]. 2010 Dec 1;56(4):385-98. Available from: https://www.vr-elibrary.de/ doi/10.13109/zptm.2010.56.4.385
Yu JH, Chang HJ, Kim SS, Park JE, Chung WY, Lee SK, et al. Effects of high-fidelity simulation education on medical students’ anxiety and confidence. PLoS One [Internet]. 2021 May 13;16(5):e0251078-e0251078. Available from: https:// pubmed.ncbi.nlm.nih.gov/33983983
Friederichs H, Weissenstein A, Ligges S, Möller D, Becker JC, Marschall B. Combining simulated patients and simulators: Pilot study of hybrid simulation in teaching cardiac auscultation. Adv Physiol Educ. 2014;38(4):343-7.
Vukanovic-Criley JM, Boker JR, Criley SR, Rajagopalan S, & Criley JM. Using virtual patients to improve cardiac examination competency in medical students. Clinical cardiology. 2008;31(7):334-9. https://doi.org/10.1002/clc.20213
Mangione S, Nieman LZ. Cardiac Auscultatory Skills of Internal Medicine and Family Practice Trainees: A Comparison of Diagnostic Proficiency. JAMA [Internet]. 1997 Sep 3;278(9):717-22. Available from: https://doi.org/10.1001/ jama.1997.03550090041030
Owen SJ, Wong K. Cardiac auscultation via simulation: A survey of the approach of UK medical schools Medical Education. BMC Res Notes. 2015;8(1):1-4. DOI: 10.1186/ s13104-015-1419-y. PIMD: 26358413
Gosai J, Purva M, Gunn J. Simulation in cardiology: state of the art. Eur Heart J. 2015 Apr 1;36(13):777-83. DOI: 10.1093/ eurheartj/ehu527. Epub 2015 Jan 13. PMID: 25586121.
Ericsson KA, Krampe RT, & Tesch-Römer C. The role of deliberate practice in the acquisition of expert performance. Psychological Review. 1993;100(3):363-406. https://doi. org/10.1037/0033-295X.100.3.363
Dreyfus S, & Dreyfus H. A Five-Stage Model of the Mental Activities Involved in Directed Skill Acquisition. Berkeley: University of California (Berkeley). Operations Research Center, 1980; Available from: https://www.researchgate.net/ publication/235125013_A_Five-Stage_Model_of_the_Mental_ Activities_Involved_in_Directed_Skill_Acquisition
Barakat K. The role of simulation-based education in cardiology. Heart. 2019 May;105(9):728-732. DOI: 10.1136/ heartjnl-2017-311153. Epub 2019 Jan 19. PMID: 30661036.
Issenberg SB, McGaghie WC, Gordon DL, Symes S, Petrusa ER, Hart IR, Harden RM. Effectiveness of a cardiology review course for internal medicine residents using simulation technology and deliberate practice. Teach Learn Med. 2002 Fall;14(4):223-8. DOI: 10.1207/S15328015TLM1404_4. PMID: 12395483.
Kern DH, Mainous AG 3rd, Carey M, Beddingfield A. Simulation- based teaching to improve cardiovascular exam skills performance among third-year medical students. Teach Learn Med. 2011 Jan; 23(1):15-20. DOI: 10.1080/10401334.2011.536753. PMID: 21240777.
Gauthier N, Johnson C, Stadnick E, Keenan M, Wood T, Sostok M, Humphrey-Murto S. Does Cardiac Physical Exam Teaching Using a Cardiac Simulator Improve Medical Students’ Diagnostic Skills? Cureus. 2019 May 7;11(5):e4610. doi: 10.7759/cureus.4610.
McGaghie WC, Issenberg SB, Petrusa ER, Scalese RJ. A critical review of simulation-based medical education research: 2003-2009. Med Educ. 2010 Jan;44(1):50-63. DOI: 10.1111/j.1365-2923.2009.03547.x. PMID: 20078756.
Davoudi M, Wahidi M, M, Zamanian Rohani N, Colt H, G: Comparative Effectiveness of Low- and High-Fidelity Bronchoscopy Simulation for Training in Conventional Transbronchial Needle Aspiration and User Preferences. Respiration. 2010;80:327-334. DOI: 10.1159/000318674
McKinney J, Cook DA, Wood D, Hatala R. Simulation-based training for cardiac auscultation skills: Systematic review and meta-analysis. J Gen Intern Med. 2013;28(2):283-91. DOI: 10.1007/s11606-012-2198-y. PMID: 22968795
Savoldelli GL, Naik VN, Park J, Joo HS, Chow R, Hamstra SJ. Value of debriefing during simulated crisis management: oral versus video-assisted oral feedback. Anesthesiology. 2006 Aug;105(2):279-85. DOI: 10.1097/00000542- 200608000-00010. PMID: 16871061.
Barrows HS. Problem-based learning in medicine and beyond: A brief overview. New Dir Teach Learn [Internet]. 1996;1996(68):3-12. Available from: https://onlinelibrary. wiley.com/doi/10.1002/tl.37219966804
Pezel T, Coisne A, Picard F, Gueret P; French Commission of Simulation Teaching of the French Society of Cardiology. How simulation teaching is revolutionizing our relationship with cardiology. Arch Cardiovasc Dis. 2020 May;113(5):297- 302. DOI: 10.1016/j.acvd.2020.03.010. Epub 2020 Apr 11. PMID: 32291188.