0209 Simulated Patients Versus Real Patients As Learning Resources In The Clinical Skill Training Of Medical Students – A Randomised Crossover Trial Of Their Effectiveness

Physical examination is a critical component of medical practice yet the focus on efficient patient turnover has impacted the availability of patients with clinical findings willing to be examined by students and skills' teaching is not consistent across clinical rotations. This work evaluates simulation methodologies for teaching of the peripheral arterial examination and evaluates whether skills learnt are transferable to clinical practice.Second-year medical students were taught peripheral arterial examination on a SimMan 3G or with simulated patients (SPs). Both groups were assessed by Objective Structured Clinical Examination (OSCE) with outpatients who have been diagnosed with peripheral arterial disease.There was no difference in the pass rate at OSCE between the two groups. SimMan better facilitated repeated practice, group learning, peer teaching and discussion, which were highly valued by the students. Students felt that the SImMan tutorial did not facilitate development of spatial cognition or pattern recognition. They also felt less well prepared to deal with real patients in terms of having practised appropriate language, issuing instructions and attempting to reassure patients.Both methods of simulation teaching have distinct merits and the ideal approach maybe to use the SimMan in combination with SPs.

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A comparison of real patients, simulated patients and videotaped interview in teaching medical students about alcohol misuse

Medical Teacher ◽

10.3109/01421590109177949 ◽

2001 ◽

Vol 23 (5) ◽

pp. 490-493 ◽

Cited By ~ 11

Author(s):

John Eagles ◽

Sheila Calder ◽

Kirsteen Nicoll ◽

Kirsteen Nicoll

Keyword(s):

Medical Students ◽

Alcohol Misuse ◽

Simulated Patients ◽

Real Patients

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A qualitative analysis of third-year medical students’ reflection essays regarding the impact of COVID-19 on their education

BMC Medical Education ◽

10.1186/s12909-021-02906-2 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Erin L. Kelly ◽

Allison R. Casola ◽

Kelsey Smith ◽

Samantha Kelly ◽

Maria Syl D. de la Cruz

Keyword(s):

Medical Students ◽

Skill Training ◽

Clinical Skill ◽

Healthcare Delivery ◽

Leadership Roles ◽

Medicine Clerkship ◽

Patient Advocates ◽

Professional Pride ◽

Clinical Interactions ◽

The Impact

Abstract Background The COVID-19 pandemic fundamentally changed every aspect of healthcare delivery and training. Few studies have reported on the impact of these changes on the experiences, skill development, and career expectations of medical students. Method Using 59 responses to a short reflection essay prompt, 3rd year medical students in Philadelphia described how the COVID-19 pandemic affected their education in mid-2020. Using conventional content analysis, six main themes were identified across 14 codes. Results Students reported concerns regarding their decreased clinical skill training and specialty exposure on their career development due to the loss of in-person experience during their family medicine clerkship. A small number felt very let down and exploited by the continued high cost of tuition while missing clinical interactions. However, many students also expressed professional pride and derived meaning from limited patient and mentorship opportunities. Many students developed a new sense of purpose and a call to become stronger public health and patient advocates. Conclusions The medical field will need to adapt to support medical students adversely impacted by the COVID-19 pandemic, from an educational and mental health standpoint. However, there are encouraging signs that this may also galvanize many students to engage in leadership roles in their communities, to become more empathetic and thoughtful physicians, and to redesign healthcare in the future to better meet the needs of their most vulnerable patients.

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Comparison of the effects of simulated patient clinical skill training and student roleplay on objective structured clinical examination performance among medical students in Australia

Journal of Educational Evaluation for Health Professions ◽

10.3352/jeehp.2019.16.3 ◽

2019 ◽

Vol 16 ◽

pp. 3 ◽

Cited By ~ 4

Author(s):

Silas Taylor ◽

Matthew Haywood ◽

Boaz Shulruf

Keyword(s):

Medical Students ◽

Physical Examination ◽

Communication Skills ◽

Skill Training ◽

Clinical Skill ◽

Skills Training ◽

Performance Outcomes ◽

Simulated Patient ◽

Procedural Skills ◽

Clinical Communication

Purpose: Optimal methods for communication skills training (CST) are an active research area, but the effects of CST on communication performance in objective structured clinical examinations (OSCEs) has not been closely studied. Student roleplay (RP) for CST is common, although volunteer simulated patient (SP) CST is cost-effective and provides authentic interactions. We assessed whether our volunteer SP CST program improved OSCE performance compared to our previous RP strategy. Methods: We performed a retrospective, quasi-experimental study of 2 second-year medical student cohorts’ OSCE data in Australia. The 2014 cohort received RP-only CST (N=182) while the 2016 cohort received SP-only CST (N=148). The t-test and analysis of variance were used to compare the total scores in 3 assessment domains: generic communication, clinical communication, and physical examination/procedural skills. Results: The baseline characteristics of groups (scores on the Australian Tertiary Admission Rank, Undergraduate Medicine and Health Sciences Admission Test, and medicine program interviews) showed no significant differences between groups. For each domain, the SP-only CST group demonstrated superior OSCE outcomes, and the difference between cohorts was significant (P<0.01). The superiority of volunteer SP CST over student RP CST in terms of OSCE performance outcomes was found for generic communication, clinical communication, and physical examination/procedural skills. Conclusion: The better performance of the SP cohort in physical examination/procedural skills might be explained by the requirement for patient compliance and cooperation, facilitated by good generic communication skills. We recommend a volunteer SP program as an effective and efficient way to improve CST among junior medical students.

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Pandangan Mahasiswa terhadap Hambatan pada Pelaksanaan Skill Lab di Fakultas Kedokteran Universitas Andalas

Jurnal Pendidikan Kedokteran Indonesia The Indonesian Journal of Medical Education ◽

10.22146/jpki.25181 ◽

2013 ◽

Vol 2 (3) ◽

pp. 180

Author(s):

Hardisman Hardisman ◽

Yulistini Yulistini

Keyword(s):

Medical Students ◽

Learning Process ◽

Skill Training ◽

Clinical Skill ◽

Optimal Learning ◽

Model And Simulation ◽

Learning Barriers ◽

Depth Interview ◽

Skills Lab

Background: Skills lab is a clinical skill training using model and simulation, which is very important in the learning process to develop clinical skill competencies of medical students. Through the process, the next step of learning on real patients will be safer and more effective. The study was conducted to explore learning barriers of medical students in the skill lab training to obtain experiences and competencies.Method: A qualitative study was conducted to explore the problems using in-depth interview as method of data collection. Thematic analysis was used to analyze the data. The respondents of the study were 46 medical students in semester V and VII in the Faculty of Medicine, Andalas University.Results: The main barriers that the students faced were clinical instructor factors, such as late attendance and replacement time with shorter allocation. Due to these factors, the students could not obtain optimal learning process, supervision and required competencies. Other factors such as lack of simulation model and limited time had also significant impact.Conclusion: Learning barriers of skill lab training were caused by multi factors. Therefore, systematic arrangement, facility and assessment, and the quality of instructors’ performance need to be improved.

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AB0682 RHEUMATOLOGY TEACHING IN TIMES OF COVID-19

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2021-eular.2635 ◽

2021 ◽

Vol 80 (Suppl 1) ◽

pp. 1374.1-1374

Author(s):

Y. Chang ◽

J. Nicholls

Keyword(s):

Medical Education ◽

Medical Students ◽

Clinical Skills ◽

Standardized Patients ◽

Simulated Patients ◽

Bedside Teaching ◽

Multiple Choice Questions ◽

Educational Method ◽

Telephone Consultation ◽

Real Patients

Background:The COVID-19 pandemic has affected the delivery of face-to-face teaching especially bedside teaching for medical students in the hospitals. Rheumatology outpatient clinics have mostly become virtual or telephone consultation clinics which prevent medical students from seeing patients in person. Students are deprived of the opportunities to take rheumatology history, examining patients and seeing signs of rheumatologic diseases. New adaptations have to be made to ensure equitability and that students still receive the relevant teaching in line with their learning curriculum and to help them prepare for their examinations.Objectives:Our aims are:1)To adapt bedside teaching in the wards to simulated teaching in the classroom using trained simulated ‘patients’; and2)To create simulation teaching of patient journeys in Objective Structured Clinical Examination (OSCE) format known as Clinically Observed Medical Education Tutorials (COMET) (Nair et al., 2001).Methods:1)For simulated teaching in the classroom, we have trained our teaching colleagues as simulated or standardized patients (SPs). We write up fictitious patient histories which simulate common presentations at rheumatology clinics. We train the SPs to give as accurate a history as possible and to simulate pains in different joints (e.g. pain at the metacarpophalangeal joints and proximal interphalangeal joints in rheumatoid arthritis) on clinical examinations. For clinical presentations that are not easily simulated, we use photographs of the relevant signs. This method is used not only as formative assessments but also as end-of-placement summative assessments.2)COMET comprises 3 OSCE-style stations with a tutor each where the students perform different tasks based on a patient’s clinical problem (e.g. acute hot swollen joint). The first station is initial A-to-E assessment of the patient (using a simulator), followed by investigations and interpretations of lab results and imaging (station 2) and lastly, management (including prescribing medications) and communication skills (e.g. explain arthrocentesis to the patient).Results:The overall feedback from students is very positive. We use Likert scale to assess confidence level before and after the teaching session, and pre-session and post-session multiple choice questions to assess learning and knowledge gained.Conclusion:While simulated teaching cannot replace encounters with real patients, students do enjoy these sessions as they get to ‘experience’ a large variety of rheumatologic cases and practice their clinical skills which at times are limited with real patients due to reluctance and pain of the patients.References:[1]Nair, R., Morrissey, J., Carasco, D., Desilva, S. & Patel, V. (2001) COMET: Clinically Observed Medical Education Tutorial - a novel educational method in clinical skills. International Journal of Clinical Skills[2]Van der Vleuten, C.P.M. & Swanson, D.B. (1990) Assessment of clinical skills with standardized patients: state of the art. Teach Learn Med, 2: 58-76.Disclosure of Interests:None declared

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Preferred Learning Style and Study Characteristics among Undergraduate Clinical Medical Students: A Study in National Defense University of Malaysia

Journal of Advances in Medicine and Medical Research ◽

10.9734/jammr/2020/v32i1930669 ◽

2020 ◽

pp. 51-60

Author(s):

Sheikh Salahuddin Ahmed ◽

Sagili Chandrasekhara Reddy

Keyword(s):

Medical Students ◽

Learning Style ◽

Clinical Skill ◽

Simulated Patients ◽

National Defense ◽

Real Patient ◽

National Defense University ◽

Study Characteristics ◽

E Learning ◽

Methods Of Learning

Purpose: Learning clinical science depends on the learning style and characteristics of the student as well as the learning environment and teaching characteristics. The aim of this study was to determine the preferred methods of learning style and study characteristics of undergraduate senior clinical medical students. Methods: This study was conducted among 89 medical students of 4th and 5th year of the Faculty of Medicine and Defense Health, National Defense University of Malaysia, from 1st November 2019 to 31st July 2020. Each of the students was given a structured questionnaire for their responses to determine their preferred learning style and study characteristics. Results: The mean age of the students was 23.5 years (range 23-27 years). A combination of various methods of learning style that included reading/writing, hearing, seeing (observing), and practicing of skills was used in 69.7% of students. Preference of learning from making and reviewing notes of class teachings was 98.9%; e-learning 53.9%; memorizing key features 71.9%; and silent study 94.3% of students. Learning by a discussion with fellow students was preferred by 65.2% and interactions in the class were preferred by 56.2% of students. Observing skill demonstration by a teacher was preferred by 77.5% of students. Learning of a clinical skill by practicing on a real patient was preferred by 94.4% of students. Conclusion: A combination of various learning styles is preferred by the majority of students for their learning. The students prefer to take and review class notes, study silently, use e-learning uploaded materials, interact in the class and learn a clinical skill by practicing on a real patient rather than simulated patients or mannequins. The preference of the student learning style and their choice should be taken into account for constructing teaching methods to achieve a better academic outcome.

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Evaluating the effectiveness of a single-day simulation-based program in psychiatry for medical students: a controlled study

BMC Medical Education ◽

10.1186/s12909-021-02708-6 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Nadia Younes ◽

Anne Laure Delaunay ◽

M. Roger ◽

Pierre Serra ◽

France Hirot ◽

...

Keyword(s):

Medical Students ◽

Factor Structure ◽

Internal Consistency ◽

Controlled Study ◽

Simulated Patients ◽

Control Group ◽

Retest Reliability ◽

Knowledge And Attitudes ◽

Simulation Group ◽

Test Retest Reliability

Abstract Background Training in psychiatry requires specific knowledge, attitudes, and skills that are obtainable by simulation, of which the use is only recent and still needs further development. Evidence is accumulating on its effectiveness but requires further validation for medical students. We aimed to evaluate the effectiveness of a single-day optional teaching program in psychiatry by simulation for medical students and validate a scale measuring Confidence in Psychiatric Clinical Skills (CPCQ), as part of the assessment. Methods This was a controlled study in a French University that compared (using paired-sample Student t-tests) knowledge and attitudes (university grades and CPCQ scores) before, just after teaching with simulated patients, and 2 months later. Satisfaction with the program (including the quality of the debriefing) was also investigated. The CPCQ scale was validated by assessing the factor structure, internal consistency, and test-retest reliability. Finally, a comparison was run with a control group who received the usual psychiatric instruction using covariance analyses. Results Twenty-four medical students were included in the simulation group and 76 in the control group. Just after the simulation, knowledge and attitudes increased significantly in the simulation group. Satisfaction with the training and debriefing was very high. The CPCQ scale showed good psychometric properties: a single-factor structure, acceptable internal consistency (α = 0.73 [0.65–0.85]), and good test-retest reliability (ICC = 0.71 [0.35–0.88]). Two months after the simulation, knowledge and attitudes were significantly higher in the simulation group than the control group, despite a lack of difference in knowledge before the simulation. Conclusions Adding a simulation program in psychiatry to the usual teaching improved the knowledge and confidence of medical students. The CPCQ scale could be used for the evaluation of educational programs.

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Clinical examinations for medical students during the COVID-19 outbreak: a simulated patient programme perspective

BMJ Simulation and Technology Enhanced Learning ◽

10.1136/bmjstel-2020-000693 ◽

2020 ◽

pp. bmjstel-2020-000693

Author(s):

Nicola Ngiam ◽

Geena Yasol ◽

Denise Li-Meng Goh

Keyword(s):

Medical Students ◽

Simulated Patient ◽

Control Measures ◽

Open Communication ◽

High Stakes ◽

Effective Response ◽

Infectious Disease Outbreak ◽

Infection Control Measures ◽

Medical Undergraduate ◽

Real Patients

BackgroundThe COVID-19 pandemic had a profound impact on how our university had to administer the high stakes, final year medical undergraduate clinical examinations without real patients, while maintaining its validity and rigour.Method11 out of the 21 stations of the medical, surgical and orthopaedic clinical examinations needed to be converted to simulated patient (SP)-based or task-based stations. Cases were developed based on an assessment blueprint, with consideration for SP demographics and availability of equipment. Infection control measures were strictly enforced to avoid transmission of COVID-19. Planning had to include consideration for physical distancing, cohorting and segregation of students and examiners. Student and SP anxiety had to be addressed.ResultsThe examination was executed successfully for 300 medical students. Everyone worked professionally and dealt with the changes and precautions that were required with flexibility.DiscussionAn infectious disease outbreak can derail plans for major clinical examinations. Factors that facilitated a rapid and effective response included decisive leadership, open communication, willingness to collaborate, mobilising resources, adaptability and flexibility. Our school managed uncertainty by erring on the side of caution. This experience may serve as a reference for others in similar situations, particularly when COVID-19 restrictions start to be lifted.

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