Ajab Shereen, Pearson Emma, Dumont Steven, Mitchell Alicia, Kastelik Jack, Balaji Packianathaswamy, Hepburn David
Hull York Medical School, Hull University Teaching Hospitals NHS Trust, Hull, United Kingdom.
JMIR Med Educ. 2022 May 9;8(2):e33565. doi: 10.2196/33565.
Bedside teaching is integral to medical education and has been highlighted to improve clinical and communication skills, as well as clinical reasoning. Despite the significant advantages of bedside teaching, its usage within medical education has been declining, and COVID-19 has added additional challenges. The pandemic has resulted in a significant reduction in opportunities to deliver bedside teaching due to risk of viral exposure, patients declining student interactions, and ward closures. Educators have therefore been required to be innovative in their teaching methods, leading to the use of online learning, social media platforms, and simulation. Simulation-based education allows for learning in a low-risk environment and affords the opportunity for deliberated repeated practice with case standardization. The results demonstrate that simulation-based training can increase students' confidence, increase the rates of correct clinical diagnoses, and improve retention of skills and knowledge when compared with traditional teaching methods.
To mitigate the impact of COVID-19 upon bedside teaching for third year students at Hull York Medical School amid closure of the cardiorespiratory wards, a high-fidelity simulation-based model of traditional bedside teaching was designed and implemented. The objectives of the teaching session were to enable students to perform history taking and a focused cardiorespiratory clinical examination in a COVID-19-safe environment using SimMan 3G.
Four clinical teaching fellows with experience of simulation-based medical education scripted histories for 2 common cardiorespiratory cases, which were asthma and aortic stenosis. The simulation sessions were designed for students to take a focused cardiorespiratory history and clinical examination using SimMan 3G. All cases involved dynamic vital signs, and the simulator allowed for auscultation of an ejection systolic murmur and wheezing in accordance with the cases chosen. Key aspects of the pathologies, including epidemiology, differential diagnoses, investigations, and management, were summarized using an interactive PowerPoint presentation, followed by a debriefing session.
In total, 12 third year medical students undertook the sessions, and overall feedback was highly positive. Of the 10 students who completed the feedback questionnaires, 90% (n=9) felt more confident in their clinical examination skills following the teaching; 100% (n=10) of the students responded that they would recommend the session to a colleague; and implementation of regular simulation was frequently requested on feedback. These results are in keeping with the current literature.
Bedside teaching continues to face ongoing challenges from the COVID-19 pandemic as well as declining patient recruitment and fluctuations in clinical findings. The support for simulation-based medical education is derived from high-quality studies; however, studies describing the use of this technology for bedside teaching in the undergraduate curriculum are limited. The authors describe a highly effective teaching session amid the pandemic, which allowed for maintenance of staff and student safety alongside continued education during a challenging time for educators globally.
床边教学是医学教育不可或缺的一部分，一直被强调有助于提高临床技能、沟通技巧以及临床推理能力。尽管床边教学有诸多显著优势，但在医学教育中的应用却呈下降趋势，而新冠疫情更是带来了额外挑战。由于存在病毒暴露风险、患者拒绝与学生互动以及病房关闭等原因，床边教学的机会大幅减少。因此，教育工作者需要在教学方法上进行创新，从而催生了在线学习、社交媒体平台和模拟教学的应用。基于模拟的教育能够在低风险环境中进行学习，并提供了按照病例标准化进行深思熟虑的反复练习的机会。结果表明，与传统教学方法相比，基于模拟的培训可以增强学生的信心，提高正确临床诊断率，并改善技能和知识的留存率。
为减轻新冠疫情对赫尔约克医学院三年级学生床边教学的影响，在心肺病房关闭期间，设计并实施了一种基于高保真模拟的传统床边教学模式。教学课程的目标是让学生在使用SimMan 3G的新冠安全环境中进行病史采集和重点心肺临床检查。
四名具有基于模拟的医学教育经验的临床教学人员为两个常见的心肺病例编写了病史，分别是哮喘和主动脉瓣狭窄。模拟课程旨在让学生使用SimMan 3G进行重点心肺病史采集和临床检查。所有病例都涉及动态生命体征，模拟器可根据所选病例听诊喷射性收缩期杂音和哮鸣音。使用交互式PowerPoint演示文稿总结了疾病的关键方面，包括流行病学、鉴别诊断、检查和管理，随后进行了总结汇报环节。
共有12名三年级医学生参加了这些课程，总体反馈非常积极。在10名完成反馈问卷的学生中，90%（n = 9）表示在教学后对自己的临床检查技能更有信心；100%（n = 10）的学生表示会向同事推荐该课程；并且在反馈中经常有人要求定期开展模拟教学。这些结果与当前文献一致。
床边教学继续面临来自新冠疫情的持续挑战，以及患者招募减少和临床发现波动的问题。对基于模拟的医学教育的支持源于高质量研究；然而，描述该技术在本科课程床边教学中应用的研究有限。作者描述了在疫情期间一次非常有效的教学课程，在全球教育工作者面临挑战的时期，该课程在保障工作人员和学生安全的同时实现了继续教育。
