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OBJETIVO. Construir y validar un Caso Clínico Simulado-Online (CCS-Online) como herramienta de evaluación de Habilidades Clínicas de Comunicación (HCC) y Razonamiento Clínico (RC) en un Examen de Competencias Objetivamente Estructurado (ECOE) dirigido a estudiantes de medicina de la asignatura de Ginecología. MATERIAL Y MÉTODOS. Estudio cuantitativo descriptivo, en una prueba piloto se puso a consideración de jueces expertos y estudiantes un Caso Clínico Simulado-Online (CCS-Online) con 3 componentes básicos del diseño de Casos Clínicos Simulados con fines evaluativos: 1) Correlación entre objetivos de la evaluación y la herramienta evaluativa, 2) Coherencia interna de los elementos que conforman el CCS y 3) Fidelidad del Escenario Simulado, todos ellos recogidos en un cuestionario estructurado de 16 elementos, con asignación de rangos ordinales del 1 al 5 en una escala de Likert. Se utilizó el coeficiente Kappa de Fleiss y la escala de Landis para determinar el grado de acuerdo y la fuerza de concordancia entre los expertos consultados; y el test U de Mann-Whitney para comparar diferencias entre grupos. RESULTADOS. Jueces expertos y estudiantes concuerdan que el instrumento CCS-Online contiene en su diseño componentes y elementos que permiten evaluar las competencias de RC y HCC en un escenario virtual (Kappa 0,688 /0,757 p<0,001). La valoración media global fue de 4,65/5 y 4,41/5, para jueces y estudiantes respectivamente. CONCLUSION. Jueces expertos y estudiantes calificaron al CCSOnline como una herramienta de evaluación que cumple con un buen nivel los criterios de diseño necesarios para evaluar las competencias de Habilidades Clínicas de Comunicación (HCC) y el Razonamiento Clínico (RC) en el área de Ginecología.
OBJECTIVE. Build and validate a Simulated Clinical Case-Online (SCC-Online) as an evaluation tool for Clinical Communication Skills (CCS) and Clinical Reasoning (CR) in medical students of Gynecology, in an Objectively Structured Competency Examination (OSCE). Material and methods. Quantitative descriptive study, in a pilot test a Simulated Clinical Case-Online (SCC-Online) was submitted to the judment of a group of expert judges and students, the following 3 basic components of the design of Simulated Clinical Cases were presented 1) Correlation between the evaluation objectives and the evaluation tool, 2) Internal coherence of the elements that make up the SCC and 3) Fidelity of the Simulated Scenario, all of them collected in a structured questionnaire of 16 elements, with assignment in an ordinal ranks from 1 to 5 on a Likert scale. The Fleiss Kappa coefficient and the Landis scale were used to determine the degree of agreement and the strength of concordance between the experts consulted; and the Mann-Whitney U test to compare differences between groups. RESULTS. Expert judges and students agree that the SCC-Online is an instrument that contains in its design components and elements that allow the evaluation of CR and CCS competencies in a virtual scenario (Kappa 0.688 /0.757 p<0.001). The overall mean score was 4.65/5 and 4.41/5, for judges and students, respectively. CONCLUSION. Expert judges and students qualified the SCC Online as a good level evaluation tool, that meets the necessary design criteria to evaluate Clinical Communication Skills and Clinical Reasoning competences in the area of Gynecology.
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Simulation Exercise , StudentsABSTRACT
Background: Clinical skills simulation (CSS) is an important tool in teaching and learning. The literature review showed a scarcity of research data regarding the use of CSS,in teaching, especially in dentistry. The use of CSS in dental teaching was found restricted to the use of low fidelity typhodonts fitted to phantom heads used in teaching cavity preparation and crown cutting. Aim: The aim of the study was to determine the efficacy of CSS using standardized patient in teaching behavior management and modification skills to dental undergraduate students. Settings and Design: This double-blinded, randomized controlled trial was undertaken among 3rd year dental undergraduate students, and the study was undertaken at the Department of Pediatric and Preventive Dentistry. Materials and Methods: Fifty, 3rd year BDS students were randomly allotted to simulation and nonsimulation groups. Baseline data regarding their knowledge in the behavior management of child patients were assessed. Simulation group was further divided into group of six students and underwent CSS with standardized patient. Pretest and posttest knowledge regarding behavior management was assessed in the simulation group using questionnaires approved by an expert committee. The results were analyzed to see if there is any improvement in their knowledge after CSS. Students in simulation and nonsimulation groups were assessed for their behavior management skills during patient management, by an independent observer, using a checklist. Statistical Analysis: Mean, standard deviation (SD), and unpaired student t-test were done to assess the baseline knowledge of students who participated in the study. Mean, SD, and paired t-test were used to compare the pretest and posttest score of students who underwent simulation. Mean, SD, and unpaired t-test were used to compare the behavior management skills of both groups of students. Results and Conclusions: The knowledge of students in both groups before the study was comparable with no statistically significant differences. There was a statistically significant improvement in the knowledge of students who underwent CSS regarding behavior management of child patients. The unpaired Student's t-test showed a significant difference in the behavior management skill of dental undergraduate students when treating a child patient. The students who underwent CSS fared better compared to students who were taught behavior management methods by traditional methods only. Clinical skill simulation using standardized patient is an effective adjunct to be used along with traditional method of teaching while teaching behavior management and modification skills to dental undergraduate students.
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Introduction: This study aims at investigating what dental hygienists learned through training with a simulated patient and how they applied their learning in practice. Method: Open-ended questionnaire surveys on their perceptions and experiences of health communication were undertaken by 21 dental hygienists before and after communication trainings. Result: Before the training, they felt it difficult to cope with patients’ negative responses to their communication. However, after the training, they deeply considered how they should be as health professional through reflection on their own communication style. In their practice, they tried to communicate while considering the patient’s situation. Discussion: Participants’ critical reflection, which was encouraged in this training, resulted in application of their learning to clinical practice.
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Purpose: To clarify the contents of nursing students’ feedback after they participated in a terminal care simulation. Method: Free description type answer sentences were analyzed qualitatively using Berelson’s content analysis. Results: Participants were 39 students. Feedback contents were divided into 334 recording units. As the result of analysis, 13 categories, including “acquisition of knowledge on communication,” “evaluation on method of implementation,” “self-understanding on nursing,” “self-positive-prospect on nursing,” “acquisition of knowledge on terminal care,” “evaluation on simulation ambience,” “acquisition of learning opportunities,” “self-positive-changing on nursing,” “effect of debriefing,” “effect of experience,” “feeling of reality,” “acquisition of knowledge on nursing” and “evaluation on faculty’s intervention” were formed. Conclusion: It was suggested that simulated patients contributed to making end of life clinical settings because the realism of the simulation had been apparent from the results. To make the terminal care simulation more developed, future studies should investigate how to give a briefing, and so on.
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Introducción: La simulación se ha empleado como herramienta de aprendizaje en diferentes disciplinas y profesiones, como la medicina y sus especialidades. Su utilidad está directamente relacionada con la integración a los objetivos, contenidos, metodologías y recursos específicos en cada área del conocimiento. Objetivo: Describir el desarrollo de una experiencia pedagógica implementada en la Pontificia Universidad Javeriana Cali con los estudiantes de Conducta Humana II del programa de Medicina entre 2012 y 2013. Dicha experiencia se apoyó en la participación de pacientes simulados por actores del grupo representativo Altergesto, que fueron entrevistados por los estudiantes con la supervisión de los psiquiatras docentes de la materia, utilizando el Hospital Simulado de la Universidad. Métodos: Recuento histórico del desarrollo de la secuencia didáctica desde el primer semestre de 2012 hasta el segundo semestre de 2013, planteamiento de los objetivos pedagógicos y descripción de la estrategia de enseñanza-aprendizaje. Resultados: Se realizaron 158 entrevistas en un periodo de 2 años, en el transcurso de los cuales fue necesario plantear soluciones metodológicas para adaptar la secuencia pedagógica a los contenidos y los objetivos de la materia. Conclusiones: La simulación de alta fidelidad, integrando a actores que representan a los pacientes psiquiátricos y la tecnología del Hospital Simulado, resultó útil para lograr el cumplimiento de los objetivos propuestos en el curso de Conducta Humana II del programa de Medicina de la Pontificia Universidad Javeriana Cali. Paralelamente, la construcción de la experiencia como un proyecto interdisciplinario y el enfoque práctico de esta estrategia pueden impactar en las dimensiones cognitivas, emocionales y conductuales de los significativo. Es necesario construir una base de datos de fácil acceso con el material recopilado y estudiar los efectos de esta estrategia en la formación de los estudiantes a largo plazo.
Introduction: Simulation has been used as a learning tool in different disciplines and pro-Simulation scenario fessions, including medicine and its specialties. Its usefulness is directly related to the Psychiatric interview integration of objectives, contents, methodologies and specific resources in each area of Simulated patient actor knowledge. Objective: To describe the development of an educational experience implemented in the Pontificia Universidad Javeriana Cali (Cali, Colombia) with medical students of Human Behavior II program, between 2012 and 2013. This experience was performed with simulated patients played by actors of the Altergesto theater group, that were interviewed by students under the supervision of psychiatrists and teachers of the subject, using the Simulated Hospital of the University. Methods: A historical development recall of the teaching sequence was made from the first half of 2012 to the second half of 2013, a statement of pedagogical objectives, and a description of the teaching-learning strategies. Results: 158 interviews were conducted over a period of two years during which it was necessary to raise methodological solutions to adapt this teaching sequence to the content and objectives of the subject. Conclusions: The high-fidelity simulation, integrating actors who represent psychiatric patients mixed with the technology of a Simulated Hospital was useful to achieve compliance with the objectives proposed in the course of Human Behavior II, as a part of the program of Medicine at the Pontificia Universidad Javeriana Cali. In parallel, the construction of experience as an interdisciplinary project and the practical approach of this strategy may impact on cognitive, emotional, behavioral dimensions of the participants, encouraging meaningful learning. An easy access database for the collected material and the study of the effects of this strategy in the formation of long-term students is needed.
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Humans , Male , Female , Adult , Students, Medical , Simulation Exercise , Learning , Occupational Groups , Organization and Administration , Patients , Psychiatry , Teaching , Technology , Health Strategies , Knowledge , MethodsABSTRACT
Objective To explore the application and effectiveness of simulated patient role play in the inquiry and the medical record writing teaching.Methods Carrying out the teaching model of simulated patient role play in the Second Clinical Medical College of Southern Medical University to the undergraduate students of grade 2009 snd 2010 in diagnose inquiry and medical record writing training class.A self-designed student questionnaire mainly about atmosphere of class,study enthusiasm,Self-evaluation of learning efficiency,the effect of the medical record writing in-class training and so on was used to do the survey.On the other hand,questionnaire for teachers included students' performance,students' writing ability,etc.100 students and 50 teachers were investigated with the survey.The percentage of the options of each question on the questionnaire was calculated in order to analyze the new teaching mode.Results The random questionnaire survey showed that 85％ (85/100) of the students believe that the new teaching mode can activate classroom atmosphere and improve learning motivation.About 62％(62/100) of the students said medical record writing errors can be obtained and corrected timely in-class training.Most students in grade 2009 have better capacity in medical record writing than those students who did not contact with new teaching mode.Conclusion The teaching model of simulated patient role play in the analogue inquiry and medical record writing is efficient and feasible in medical education,which can improve students' practical ability and is expected to be applied in undergraduate medical education.
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As medical students enter the role of physician, clinical outcomes not only rely on their mastery of clinical knowledge, but also on the effectiveness in which they can communicate with patients and family members. While students typically have numerous opportunities to practice clinical communication with adult patients, such practice in pediatric settings is limited. This study examines if simulated patient (SP) encounters strengthen third-year medical students' communication skills during the pediatrics clerkship. During 2011-2013, three SP encounters (comprising 3 pediatric scenarios) were incorporated into a pediatrics clerkship at one United States medical school to give students a safe venue to practice advanced communication with observation and direct feedback. Third-year medical students engaged in the scenarios and received both written and oral feedback from an evaluator observing the encounter. With IRB approval, students' self-perceived confidence and abilities at performing the advanced communication skills were measured using an eight-item, Likert scale questionnaire administered pre and post the SP encounter. Pre- and post-questionnaires (n=215; response rate, 96%) analyzed using a Wilcoxon-matched pairs signed-rank test demonstrated statistically significant increases in students' perception of their confidence and abilities regarding their performance (P<0.05; Bonferroni correction, P<0.006). There was an increases in student confidence and self-perceived ability in: first, communicating with children and family members of young patients; second, managing confrontational situations involving parents; third, performing a thorough psychosocial history with an adolescent; and fourth, using Evidence Based Medicine to motivate parents.
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Adolescent , Adult , Child , Humans , Ethics Committees, Research , Evidence-Based Medicine , Parents , Pediatrics , Schools, Medical , Students, Medical , United States , Surveys and QuestionnairesABSTRACT
A 4–year trial of an undergraduate medical care education program for smoking cessation with the participation of simulated patients is described. Simulated medical care with the participation of simulated patients is thought to motivate medical students to learn clinical skills for smoking cessation. However, simulated medical care for smoking cessation is difficult to plan when both the medical students and the simulated patients are nonsmokers.
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1)Training elderly simulated patients (SPs) will enhance elderly persons' contribution to education. Such training will also help universities contribute to the community and help elderly persons be more productive in their activities.<br>2)Training programs for elderly SPs and follow–up seminars focusing on the display of symptoms requested by participants were held. The aim of this program was to train SPs to participate in the preclinical educational activities of the university. The participants evaluated the program to be satisfactory.
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1)The purpose of this study was to evaluate a role–playing class for informed consent with fifth–year students playing the role of physicians and first–year students playing the role of patients.<br>2)The first–year students were competent as simulated patients for the informed consent role–playing and were a worthy educational human resource.<br>3)This role–playing was effective for helping both first–year and fifth–year students understand informed consent and the mentality of patients and to motivate students to study informed consent. This joint class also allowed fifth–year students to review their progress over time and gave first–year students a chance to meet role models.
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1) Medical interview practice with simulated patients is an effective method for facilitating the learning of intervie w skills by health professionals.In particular, feedback from simulated patients is an extremely useful means for healti professionals to learn what patients are thinking.<BR>2) However, because simulated patients must have significant amounts of training and experience to provide effective feedback, many find the task challenging, difficult, and stressful.<BR>3) Therefore, we created a feedback worksheet so that simulated patient know what to keep in mind during interviews and how to share their feelings in a precise and simple manner.
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1) We visited 5 Scottish universities (the Universities of Aberdeen, St Andrews, Dundee, Glasgow, and Edinburgh) to observe and learn about simulated-patient programs and communication-skills training.<BR>2) Each medical school has developed its own approach for using simulated patients in training and for giving feedback to medical students.<BR>3) In Scotland, where all medical schools adhere to“Tomorrow's Doctors”and“the Scottish Doctor Curriculum Outcomes, ”curriculum styles vary greatly, but the differences are celebrated.The simulated-patient programs are integrated into each program in a way unique to each school.
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The objective structured clinical examination (OSCE) is expected to be used for the Japanese medical license exami-nation (Advanced OSCE). An Advanced OSCE trial was conducted at Hyogo College of Medicine. We examined 96 stu-dents in 11 areas in 1 day with 58 examiners, 5 simulated patients, 70 student volunteers, and 34 clerks. According to thequestionnaire filled out by the students and examiners, this trial was moderately or rather difficult. This trial suggeststhat the Advanced OSCE can be used for the license examination, although some aspects should be improved.
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To study the application of simulated-patient teaching in practice teaching and assessment of obstetrics and gynecology,the two groups of students were taught by simulated-patient teaching and discussed cases teaching respectively,and then they were assessed by using simulated patients for clinical skills.The result shows that simulated-patient teaching is effective in improving students' clinical skills,can act as a worthy tool of clinical teaching and assessment.
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Objectives: To investigate future directions of medical interview and physical examination practice (MIPEP) with simulated patients and to clarify its educational meaning for medical students. Design: Qualitative design using 8 focus groups before and after MIPEP with simulated patients (4 pre-MIPEP and 4 post-MIPEP). Methods: Nine simulated patients and 10 medical students participated. Four physicians served as facilitators. Each student practiced consultation, including two medical interviews and physical examinations (of one male and one female simulated patient), for 15 minutes. After every consultation, students had a 15-minute feedback session with a simulated patient and a facilitator. All simulated patients and students participated in both the pre-MIPEP and post-MIPEP focus groups. Results: Through pre-MIPEP and post-MIPEP focus groups, medical students realized that an appropriate disposition and talking with patients during physical examination are helpful. MIPEP with simulated patients helps students to gain confidence before clinical practice. Simulated patients found that the value of MIPEP with simulated patients for medical students was increased by thorough course preparation and by the simulated patient's training and motivation, which was affected by the students' attitudes to MIPEP with simulated patients. Conclusion: MIPEP with simulated patients is valuable for teaching the appropriate disposition towards patients, including making physical contact and talking with patients as fellow human beings. When the students' attitudes satisfy the simulated patients, MIPEP with simulated patients can become a powerful educational method.
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Objectives: To investigate how simulated patients perceive physical examinations. Methods: Simulated patients, who were members of the Nagoya University Simulated Patient Society, were divided into two groups according to age, one group in their 40s and one in their 60s, and interviewed about their perceptions of physical examinations. A coding scheme was used to organize the data in thematic categories and extracted concepts. Results: Both groups believed that: 1) training in physical examination is essential for medical students and 2) communication between a patient and a physician during physical examination is important. The 60s group had positive “attitudes” and less “hesitation” in terms of physical examination, whereas the opposite was true for the 40s group. As for “acceptable body parts, ” there was a greater degree of acceptance among the 60s group, whereas the “students' sex” affected the 40s group but not the 60s group. Conclusion: The results suggest that simulated patients can participate in physical examination education, providing each simulated patient's preferences are considered.
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A student's medical interview in an objective structured clinical examination (OSCE) may be assessed slightly differently by simulated patients and by the faculty. In this study, we compared three different scores given by the faculty or simulated patients in the assessment of OSCE medical interviews conducted at our department for 3 years. Scores compared were the total score and the behavior score given by the faculty and the score given by simulated patients. The total score and the behavior score given by the faculty correlated well with the score given by simulated patients. However, for students who received a poor assessment from simulated patients, the three scores were weakly correlated; in particular, the behavior score given by the faculty differed markedly from the score given by simulated patients. These results suggest that simulated patients have a different and important viewpoint on assessment of the medical interview in an OSCE.
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In the fourth-year curriculum of the Chiba University School of Medicine, suggesting changes in health behavior and informing patients of bad news were studied through lectures and small-group role-playing with simulated patients as part of an advanced course in medical interviewing. We report on the contents of the curriculum and the results of an evaluation.
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The purposes of this study were to examine scales and to assess the effects of the training in clinical interviewing for dental students. The subjects to examine validity and reliability of the scale were 11 dentists and 25 dental school students. The subjects to assess the effects of the training were 16 dental school students, and were divided into a training group that was given the training and a control group that was not given the training. Kappa statistics revealed moderate agreement. The acceptable level of Cronbach's coefficient alpha for standardized patients in each case was obtained. The significant difference was found in the scores between the dentists and the students. The scores of training group and control group were not significantly different before the training. However, the training group had significantly higher scores than the control group after the training. These results confirmed the reliability and validity of this scale, and suggested that this training using simulated patient was effective for dental school students.
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Communication training in the dental interview was conducted for 5th-year dental students through role playing and simulated patients. The purpose of this training was for students, through practicing and observing dental interviews, to acquire interviewing skills and to communicate with patients by considering the patient's point of view. A questionnaire regarding this training was administered to the students. The results revealed that the students realized the difficulty and the importance of communication with patients. The results also showed that the students learned what points they should keep in mind, how they can improve their own communication skills by communicating with patients, and the importance of understanding the patient's point of view. Moreover, students believed that this training would continue to be useful.