Role of Sim-Man in teaching clinical skills to preclinical medical students

Abstract

Introduction: After a GMC report on Tomorrow’s Doctors (2003) was published, there has been more emphasis on clinical skills training in undergraduate medical education1. It is challenging for pre-clinical medical students to learn and develop clinical skills systematically, which are appropriate to working in a clinical environment. At Newcastle University Laerdal Sim-Man 3G, a high fidelity simulator, was used 1) To ascertain if Sim-man could be used as an adjunct to facilitate student’s ability to acquire clinical skills in their pre-clinical years by determining the effect of Sim-Man on the confidence levels and knowledge of pre-clinical medical students during clinical skills sessions. 2) To bridge the gap between the pre-clinical and clinical setting with an opportunity to experience differentiating between normal and abnormal signs. Methodology: 24 first year graduate entry (preclinical) medical students had previously been taught the generic clinical skill of chest examination on each other. They were divided into 2 groups (AC and BD). A pre-test was conducted where the students of both groups completed a questionnaire on knowledge and confidence (rated using a Likert scale from 1-5). Later half the students (AC group) performed chest examination on each other while the other half (BD group) used Sim-Man. Sim-Man was programmed to display abnormal signs in 4 clinical conditions based on their PBL case series. A mid-test was conducted. They then crossed over with students in AC group performing chest examination on Sim-Man while students in BD group examined each other. A post- test was carried out. Data was analyzed using Mann-Whitney test. Results: There was no difference in the test scores on knowledge questions between the two groups for pre-test and post test whereas the test scores increased significantly between the two groups for mid-test (p=0.002). A significant increase in the test scores was seen between pre-test and midtest for the BD group (p=0.01). There was a similar trend, which was not statistically significant between mid-test and post-test for the AC group (p=0.16) The mean confidence increased from pre to mid-test and then further in post-test for both groups. Their confidence increased significantly in differentiating between normal and abnormal signs [BD group, between pre-test and mid-test (2.3 to 3, p= 0.01) and AC group, between mid-test and post-test (2.8 to 3.6, p=0.01)]. Conclusion: This pilot study suggests that Sim-Man can be used as a valuable adjunct to increase knowledge and student self-confidence when acquiring clinical skills in the pre-clinical years. References: 1. Paskins Z, Kirkcaldy J, Allen M, Macdougall C, Fraser I, Peile D : Design, validation and dissemination of an undergraduate assessment tool using SimMan in simulated medical emergencies. Medical Teacher 2010, Jan 32(1): e12-e17