Effects of Using an Abdominal Simulator to Develop Palpatory Competencies in 3rd Year Medical Students.

Background. US medical students seldom practice enough on patients to master the palpation skills of the physical examination of the abdomen. We evaluated the impact of extended practice with an abdominal simulator which provides concurrent and summative feedback on the appropriate depth of palpation and coverage of relevant areas. Methods. All third-year medical students were given the opportunity to study with the AbSim simulator during the family medicine rotation. The competence of those who studied with the simulator was measured by its sensors, before and after a training session that included visual feedback regarding the depth and coverage of the student’s manual pressure. Additionally, they reported their confidence in their abdominal examination skill at the beginning and end of the rotation. Results. 119 (86.9%) of 137 students filled out the initial questionnaire, and 73 (61.3%) studied the tutorial. Pre-training competence was predictable by gender, but not by month of third year nor by previous surgery or internal medicine rotations. There was little relation between students’ confidence in their abdominal examination skills and their measured competence. The simulator training had a highly significant effect, improving overall competence (4 measures, all p’s < 0.001). Conclusions. A tutorial using an abdominal simulator increased medical students’ competency examining the abdomen, both the depth of palpation and the thoroughness of coverage. Interpretation of changes in confidence are uncertain, because confidence was unrelated to objectively measured competence, although low initial confidence did influence student choice to study with the abdominal simulator.

Increased competency of dietitian nutritionists’ physical examination skill after a simulation-based education in the United States

Purpose: This study aimed to translate simulation-based dietitian nutritionist education to clinical competency attainment in a group of practicing Registered Dietitian Nutritionists (RDNs). Using a standardized instrument to measure performance on the newly-required clinical skill, Nutrition Focused Physical Exam (NFPE), competence was measured both before and after a simulation-based education (SBE) session. Methods: Total 18 practicing RDNs were recruited by their employer Spectrum Health system. Following a pre-brief session, participants completed an initial 10-minute encounter, performing NFPE on a standardized patient (SP). Next, participants completed a 90-minute SBE training session on skills within NFPE, including hands-on practice and role play, followed by a post-training SP encounter. Video recordings of the SP encounters were scored to assess competence on seven skill areas within the NFPE. Scores were for initial competence and change in competence.. Results: Initial competence rates ranged from 0- 44% of participants across the seven skills assessed. The only competency where participants scored in the “meets expectations” range initially was “approach to the patient(. When raw competence scores were assessed for change from pre- to post-SBE training, a paired t-test indicated significant increased in all seven competency areas following the simulation-based training (P< .001). Conclusion: This study showed the effectiveness of a SBE training for increased competence scores of practicing dietitian nutritionist on a defined clinical skill.

67. HIPPOCRATES APPRENTICES ON EARTH: MEDICAL STUDENTS EXPERIENCES AND CONSENT FOR VAGINAL EXAMINATIONS OF ANAESTHETISED PATIENTS

Vaginal examinations (VEs) are an essential sexual health examination skill. Reports of students having difficulties getting experience with VEs are matched by reports of patients being examined without consent. This study prospectively aimed to find out what was happening when medical students sought consent for VEs of anaesthetised patients. All 66 2005 5th year medical students at OU, WSM & HS were asked to prospectively complete a 14 item questionnaire about their experience at gynaecology operating sessions. Chi-squared test determined result significance. Student response rate was 78%. 141/184 patients were asked if the student could attend the operation. Students asked 101 patients. Consultants were more likely ask on the student's behalf for males than females. p > 0.0010. All male students sought consent within 2 hours of operations. Some female students sought consent 5 or more hours beforehand; a significant gender difference (p > 0.0001). Five patients declined student attendance at their operation. When asked 96 patients (86.6%/-3.4%) agreed and 16 (13.3% +/-3.4%) declined permission for the student conducting a VE under anaesthesia; with no statistical gender difference in refusal rate. VEs were done on 82 patients; including 2 without consent. In 19 instances a student had consent but no examination was done. Eleven students (3 male, 6 female) did no examinations. The value of the examination for student learning was rated 4/5 by 73% students; with no statistical difference by gender or age. The implications of these findings for teaching sexual health skills to medical students are discussed.