An Effective Method of Teaching Advanced Cardiac Life Support (ACLS) Skills in Simulation-Based Training / 한국의학교육

PURPOSE: In this study, we compared the effects of constructivist and traditional teaching strategies in teaching advanced cardiac life support (ACLS) skills during simulation-based training (SBT). METHODS: A randomized, pre- and post-test control group study was designed to examine this issue in 29 third-year emergency medical technician (EMT) students. Participants received SBT through constructivist SBT (CSBT) or traditional lecture-based SBT (TSBT) teaching strategies. We evaluated the effects of the simulation training on ACLS knowledge, and performance immediately after practice and at retention. RESULTS: The knowledge and performance of the CSBT group were higher than compared with the TSBT group (mean knowledge 33.3+/-5.03 vs. 29.5+/-5.33, p=0.36; and mean performance 12.20+/-1.85 vs. 8.85+/-3.54, p=0.010). However, there was no difference between two groups in retention between groups 1 month later (mean knowledge 31.86+/-4.45 vs. 31.50+/-4.65, p=0.825; and mean performance 12.13+/-0.99 vs. 12.57+/-1.78, p=0.283). CONCLUSION: CSBT is more effective with regard to knowledge acquisition and performance than TSBT. Further studies are needed to explore ways of improving retention and transfer of knowledge from simulated to real situations with SBT.

Job Analysis of Standardized Patient Trainer / 한국의학교육

PURPOSE: Although standardized patients (SPs) have been used widely in medical education, there has been little research on SP trainers. The purpose of this study was to examine the roles SP trainers by establishing their job description and assessing the importance, frequency, and difficulty of each task element. METHODS: SP trainers' responsibilities were defined and their job descriptions were developed based on a focus group interview (FGI) of 6 panels. The validity of the duties, tasks, and task elements that were elicited from the FGI was examined by the 6 panels and a medical school professor. The data were collected using a questionnaire survey from 24 SP trainers in April 2011. The questionnaire pertained to the importance, frequency, and difficulty of the duties, tasks, and task elements that were identified in SP trainers' job descriptions. RESULTS: The job description of SP trainers consisted of 10 duties, 25 tasks, and 76 task elements. The average level of importance of the 10 duties was 4.29; "SP training" was identified as the most important duty (4.79+/-0.41). Of the 76 task elements, "providing training regarding the scoring criteria and standardizing the scoring system" had the highest levels of importance and frequency (4.83+/-0.48, 4.08+/-1.06). "Standardizing the acting abilities of SPs" was the most difficult task element (4.50+/-0.66). CONCLUSION: By analyzing the job description of SP trainers, this study is expected to help define the roles of SP trainers and facilitate their deployment.

The Change of CPX Scores according to Repeated CPXs / 한국의학교육

PURPOSE: Most medical schools have held clinical skills training programs recently. Despite these educational endeavors, few studies have attempted to address the effect of clinical skills assessments on clinical performance. This study investigated whether repeated experiences with the examination improved medical students' history-taking, physical exams, and patient-physician interactions (PPIs). METHODS: The subjects of the study were 101 4th-year medical students who participated in the clinical performance examination (CPX) 3 times. They completed their core clerkship before acquiring the first CPX scores; we tracked down the scores of three sets of CPX for 3 subdomains (history taking, physical exam, and patient-physician interaction) and investigated the changes in these scores. Additionally, we classified the research subjects into 3 groups by total CPX score-higher (upper 30%, n=30), intermediate (medium 40%, n=40), and lower (lower 30%, n=30)-and compared the curves for each group. RESULTS: Significant improvements were made on history taking and physical exam (F=130.786/237.358, p<0.01), while proficiency on the PPI declined (F=17.621, p<0.01). Additionally, scores in all levels improved continuously on history taking and physical exam, while students of the high and low levels experienced a sharp decline on the PPI (F=11.628, p<0.01). CONCLUSION: Improvement in the history-taking score reflects an accumulation of clinical knowledge and clinical exposure. Improvement on the physical exam score is affected by repeated practice on similar or identical cases and receipt of feedback. That PPI can deteriorate might be an effect of one's negative experience in a clinical clerkship.

A Systematic Review of Training That Use an Integrated Patient Simulator / 한국의학교육

The purpose of this article is to systematically review the literature that describes training and assessment that use an integrated patient simulator (IPS). We also tried to determine how to train learners with simulators, plan, and perform research on simulator-based education. Literature searches were conducted to identify articles from PubMed, EMBASE, and KMbase that were related to training and assessment that use an IPS, published from January 1999 to September 2008. Forty articles met the criteria and were analyzed. The results were as follows: Studies on IPS are the most common in graduate medical education (GME). The impact of IPS-based education is relatively greater in GME versus undergraduate medical education (UME) or continuing medical education (CME). IPS research in GME is characterized by addressing the effectiveness of clinical application, the training of procedures, and algorithms, rather than knowledge or simple skills. And research design is more elaborate in GME than UME or CME. IPS training in CME focuses mostly on specific clinical skills. Most training sessions in UME are offered to groups, but assessment is performed for a single student. Also, inter-rater reliability is checked unsatisfactorily in UME. IPS research in UME is characterized by limitations in design due to connections to the regular curriculum. According to findings above, we propose that: more detailed research design should be performed to overcome the limitations of UME research. For GME, increasing simulator-based training opportunities is desired, because its effectiveness and adaptability are relatively high.

Delivery training for undergraduate medical students using birth simulator / 대한산부인과학회지

OBJECTIVE: The aim of our study is to describe the experience of delivery training for medical students by using a birth simulator as an educational tool during obstetrical clinical clerkship. METHODS: Study participants were 35 third year medical students of K medical school in Seoul. We have developed birth simulation courses using the robot birth simulator (S555 Noelle(TM). Maternal Neonatal Simulation System. Gaumard scientific, Coral Gables, FL.). During 4 weeks clinical clerkship, clinical teacher gave 90 minutes delivery practice session to students by one-to-one basis with birth simulator. After 4 weeks clinical experience, clinical teacher assessed students' delivery performance using birth simulator. Also students completed self-reported questionnaires to assess satisfaction with the teaching process and their perceptions of the effectiveness of simulation practice. RESULTS: Most students ranked delivery training with birth simulator as an interesting and useful way of understanding labor process and getting skills in obstetrics. And they assessed that they had more confidence to perform a vaginal delivery after the training. CONCLUSION: Simulation training with birth simulator during obstetrical clinical clerkship is an effective way to bridge the gap between the theory and the practice and augment clinical experience.