Nassif Joseph, Sleiman Abdul-Karim, Nassar Anwar H, Naamani Sima, Sharara-Chami Rana
Department of Obstetrics and Gynecology, American University of Beirut Medical Center, Beirut, Lebanon.
Simulation Program, Faculty of Medicine, American University of Beirut, Beirut, Lebanon.
J Cancer Educ. 2019 Feb;34(1):194-200. doi: 10.1007/s13187-017-1287-3.
Clinical breast examination (CBE) is traditionally taught to third-year medical students using a lecture and a tabletop breast model. The opportunity to clinically practice CBE depends on patient availability and willingness to be examined by students, especially in culturally sensitive environments. We propose the use of a hybrid simulation model consisting of a standardized patient (SP) wearing a silicone breast simulator jacket and hypothesize that this, compared to traditional teaching methods, would result in improved learning. Consenting third-year medical students (N = 82) at a university-affiliated tertiary care center were cluster-randomized into two groups: hybrid simulation (breast jacket + SP) and control (tabletop breast model). Students received the standard lecture by instructors blinded to the randomization, followed by randomization group-based learning and practice sessions. Two weeks later, participants were assessed in an Objective Structured Clinical Examination (OSCE), which included three stations with SPs blinded to the intervention. The SPs graded the students on CBE completeness, and students completed a self-assessment of their performance and confidence during the examination. CBE completeness scores did not differ between the two groups (p = 0.889). Hybrid simulation improved lesion identification grades (p < 0.001) without increasing false positives. Hybrid simulation relieved the fear of missing a lesion on CBE (p = 0.043) and increased satisfaction with the teaching method among students (p = 0.002). As a novel educational tool, hybrid simulation improves the sensitivity of CBE performed by medical students without affecting its specificity. Hybrid simulation may play a role in increasing the confidence of medical students during CBE.
传统上，临床乳腺检查（CBE）是通过讲座和桌面乳腺模型向三年级医学生传授的。临床实践CBE的机会取决于患者的可及性以及患者是否愿意接受学生检查，尤其是在文化敏感环境中。我们建议使用一种混合模拟模型，该模型由一名穿着硅胶乳房模拟器夹克的标准化病人（SP）组成，并假设与传统教学方法相比，这种模型将提高学习效果。一所大学附属三级护理中心的82名同意参与的三年级医学生被整群随机分为两组：混合模拟组（乳房夹克+标准化病人）和对照组（桌面乳腺模型）。学生们接受了由对随机分组不知情的教员进行的标准讲座，随后进行基于随机分组的学习和实践课程。两周后，参与者在客观结构化临床考试（OSCE）中接受评估，该考试包括三个站点，由对干预不知情的标准化病人进行检查。标准化病人对学生的CBE完整性进行评分，学生们对自己在检查过程中的表现和信心进行自我评估。两组之间的CBE完整性得分没有差异（p=0.889）。混合模拟提高了病变识别等级（p<0.001），且未增加假阳性。混合模拟减轻了对在CBE中漏诊病变的恐惧（p=0.043），并提高了学生对教学方法的满意度（p=0.002）。作为一种新型教育工具，混合模拟提高了医学生进行CBE的敏感性，而不影响其特异性。混合模拟可能在增强医学生在CBE过程中的信心方面发挥作用。
