UCD Centre for Precision Surgery, Mater Misericordiae University Hospital, Eccles St, Dublin 7, Ireland.
UCD School of Medicine, Belfield, Dublin 4, Ireland.
Ir J Med Sci. 2023 Jun;192(3):1009-1014. doi: 10.1007/s11845-022-03057-z. Epub 2022 Jun 22.
COVID-19 has greatly impacted medical students' clinical education. This study evaluates the usefulness of a rapidly implemented on-site simulation programme deployed to supplement our disrupted curriculum.
Students on surgical rotations received 4-hour tutor-led simulated patient sessions (involving mannikins with remote audio-visual observation) respecting hospital and public health protocols. Attitudes were questionnaire-assessed before and after. Independent, blinded, nonacademic clinicians scored students' clinical competencies by observing real patient interactions using the surgical ward assessment tool in a representative sample versus those completing same duration medicine clinical rotations without simulation (Mann-Whitney U testing, p < 0.05 denoting significance) with all students receiving the same surgical e-learning resources and didactic teaching.
A total of 220 students underwent simulation training, comprising 96 hours of scheduled direct teaching. Prior to commencement, 15 students (7% of 191 completing the survey) admitted anxiety, mainly due to clinical inexperience, with only two (1%) anxious re on-site spreading/contracting of COVID-19. A total of 66 students (30%, 38 females and 29 graduate entrants) underwent formal competency assessment by clinicians from ten specialties at two clinical sites. Those who received simulation training (n = 35) were judged significantly better at history taking (p = 0.004) and test ordering (p = 0.01) but not clinical examination, patient drug chart assessment, or differential diagnosis formulation. Of 75 students providing subsequent feedback, 88% stated simulation beneficial (notably for history taking and physical examination skills in 63%) with 83% advocating for more.
Our rapidly implemented simulation programme for undergraduate medical students helped mitigate pandemic restrictions, enabling improved competence despite necessarily reduced clinical activity encouraging further development.
COVID-19 极大地影响了医学生的临床教育。本研究评估了现场模拟项目的实施效果，该项目旨在补充我们中断的课程。
接受外科轮转的学生接受了 4 小时的导师指导模拟患者课程（涉及带有远程音频-视觉观察的人体模型），课程遵循医院和公共卫生协议。在实施前后通过问卷调查评估学生的态度。独立、盲法、非学术临床医生通过使用外科病房评估工具观察真实患者互动，对学生的临床能力进行评分，该评估工具适用于具有代表性的样本，以及未接受模拟训练的学生（Mann-Whitney U 检验，p < 0.05 表示具有统计学意义），这些学生完成了相同时长的内科临床轮转，但未接受模拟训练，所有学生都接受了相同的外科电子学习资源和教学内容。
共有 220 名学生接受了模拟培训，共计 96 小时的直接教学时间。在开始之前，有 15 名学生（191 名完成调查的学生中的 7%）承认焦虑，主要是由于临床经验不足，只有两名（1%）担心现场 COVID-19 的传播/感染。共有 66 名学生（30%，38 名女性和 29 名研究生）在两个临床地点由来自十个专业的临床医生进行了正式的能力评估。接受模拟培训的学生（n = 35）在病史采集（p = 0.004）和检查申请（p = 0.01）方面的表现明显更好，但在临床检查、患者药物图表评估或鉴别诊断方面的表现没有差异。在提供后续反馈的 75 名学生中，88%表示模拟训练有益（特别是在病史采集和体检技能方面，有 63%的学生认为如此），83%的学生主张增加模拟训练。
我们为本科医学生快速实施的模拟项目有助于缓解疫情限制，尽管临床活动减少，但仍能提高学生的能力，这鼓励了进一步的发展。
