Department of Surgery, Penn State College of Medicine, Hershey, Pennsylvania 17033, USA.
J Surg Educ. 2012 May-Jun;69(3):416-22. doi: 10.1016/j.jsurg.2011.10.005. Epub 2011 Nov 25.
Simulators have replaced some standardized patients in medical student teaching, and their use seems to decrease anxiety related to the clinical breast examination (CBE). We compared learning the CBE on a breast palpation simulator with learning on a standardized patient with respect to skill acquisition and comfort level.
At Penn State College of Medicine, the class of 2008 (historical control group, n = 113) learned the CBE on a standardized patient, whereas the class of 2009 (experimental group, n = 131) learned on the breast palpation simulator. We used measures of the process (conducting the CBE) and measures of the outcome (examination scores and detection of abnormal findings). During their third-year surgical clerkship, students in both groups completed a questionnaire reporting the number of CBEs performed and confidence in performing the CBE. The students then performed an observed examination on the simulator, and the number of positive findings detected was recorded. The mean number of positive findings was compared between groups, and an economic analysis was conducted.
The experimental group had a significantly higher mean examination score than the historical control. In subgroups, this difference was significant for those who reported performing 0-5 clinical examinations but for not those who had performed >6 examinations. On individual items, the experimental group scored significantly higher in examining for neck nodes, nipple retraction, skin changes, and axillary evaluation. The 2 groups did not differ significantly in the mean number of positive findings detected or in ratings of comfort level.
Medical students who learned the CBE on breast palpation simulators performed as well or better than those who learned on standardized patients; however, a subgroup analysis revealed that the benefit was limited to students with less clinical experience.
模拟器已经取代了一些标准化病人在医学生教学中的作用，而且它们的使用似乎降低了与临床乳房检查（CBE）相关的焦虑。我们比较了在乳房触诊模拟器上学习 CBE 与在标准化病人上学习 CBE 在技能获取和舒适度方面的差异。
在宾夕法尼亚州立大学医学院，2008 届（历史对照组，n=113）学生在标准化病人身上学习 CBE，而 2009 届（实验组，n=131）学生在乳房触诊模拟器上学习。我们使用了过程（进行 CBE）和结果（检查分数和异常发现的检测）的测量方法。在他们的第三年外科学实习中，两组学生都完成了一份报告，报告了进行 CBE 的次数和对执行 CBE 的信心。然后，学生们在模拟器上进行了一次观察性检查，并记录了阳性发现的数量。比较了两组之间阳性发现的平均数量，并进行了经济分析。
实验组的平均考试成绩显著高于历史对照组。在亚组中，对于报告进行了 0-5 次临床检查的学生，这种差异是显著的，但对于报告进行了>6 次检查的学生，这种差异不显著。在个别项目上，实验组在检查颈部淋巴结、乳头回缩、皮肤变化和腋窝评估方面的得分显著更高。两组在阳性发现的平均数量或舒适度评分上没有显著差异。
在乳房触诊模拟器上学习 CBE 的医学生的表现与在标准化病人上学习的医学生一样好或更好；然而，一项亚组分析显示，这种益处仅限于临床经验较少的学生。
