Gordon James A, Brown David F M, Armstrong Elizabeth G
G.S. Beckwith Gilbert and Katharine S. Gilbert Medical Education Program in Medical Simulation, Harvard Medical School, Boston, MA, USA.
Simul Healthc. 2006 Jan;1 Spec no.:13-7. doi: 10.1097/01266021-200600010-00005.
To explore whether a simulated critical care encounter can accelerate basic science learning among preclinical medical students.
Using a high-fidelity patient simulator, we "brought to life" a paper case of a myocardial infarction among a convenience sample of first-year medical students (n=22 [intervention]). Students discussed the case as part of a routine tutorial session, and then managed the case in the simulator laboratory. Using an identical six-item test of cardiac physiology, students were evaluated immediately after the simulator session and at 1 year (n=15). Performance was compared with controls (case discussion but no simulator session) at both baseline (n=37) and 1 year (n=48).
Performance among simulator-exposed students was significantly enhanced on immediate testing (mean score 4.0 [control], 4.7 [intervention], P = .005). Gains among the simulator cohort were maintained at 1 year (mean score 4.1 [control], 4.7 [intervention], P = .045). Multivariable analysis confirmed that the intervention was a significant determinant of performance across time (P = .001).
Compared with controls in this pilot study, an additional simulation exercise improved immediate performance on a short written test of cardiovascular physiology. Enhanced performance was again seen at 1 year, raising the possibility that the extra teaching session produced accelerated and sustained learning compared with the routine teaching method. Given the preliminary nature of this investigation, further study is required to distinguish transient from lasting effects of simulation versus alternative teaching approaches in the basic medical sciences.
探讨模拟重症监护情境能否加速临床前医学生的基础科学学习。
我们使用高保真患者模拟器，让一年级医学生的便利样本（n = 22[干预组]）“体验”了一个心肌梗死的纸质病例。学生们将该病例讨论作为常规辅导课程的一部分，然后在模拟器实验室中处理该病例。使用相同的六项心脏生理学测试，在模拟器课程结束后立即对学生进行评估，并在1年后（n = 15）再次评估。将其表现与对照组（仅进行病例讨论但无模拟器课程）在基线时（n = 37）和1年后（n = 48）的表现进行比较。
在即时测试中，接触模拟器的学生表现显著提高（平均得分：对照组4.0，干预组4.7，P = 0.005）。模拟器组的成绩在1年后得以保持（平均得分：对照组4.1，干预组4.7，P = 0.045）。多变量分析证实，干预是不同时间点表现的重要决定因素（P = 0.001）。
在这项初步研究中，与对照组相比，额外的模拟练习提高了心血管生理学简短笔试的即时成绩。1年后再次观察到成绩提高，这增加了与常规教学方法相比，额外的教学课程产生了加速且持续学习的可能性。鉴于本调查的初步性质，需要进一步研究以区分模拟教学与基础医学中其他教学方法的短暂效果和持久效果之间的差异。
