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PubMed1977

Gaming-simulation and health education an overview.

Simulation entails abstraction and representation from a larger system in terms of process as well as structure. Central features are identified and simplified, less important elements are omitted from the model. In medical and health education, simulation enables learners to practice in an environment where mistakes are not costly, such as with simulated patients. Gaming-simulation incorporates role-playing into a defined system of interaction simulating a real world system and is characterized by the degree of structure of the roles and the focus on role interactions. Employment of gaming-simulation is embryonic in health education. Examples included in this Monograph concern problems of aging, hemophiliacs, and the dying; teaching interpersonal skills in psychiatric nursing; interactions of health care systems with their communities; and several other topics. Evaluation is discussed in a separate paper. A variety of health care gaming resources are described.

Game Theory↗

PubMedDate not supplied

Videotape analyses of medical students' interviewing skills.

This research project investigates medical students' interviewing skills before and after a six-week clerkship in family and community medicine. Male and female medical students participating in a clerkship in family and community medicine were asked to conduct a pre- and post-videotape interview with a simulated patient. After the pre-test videotape, the student received feedback from the simulated patient and from a faculty member. Students than participated in a six-week clerkship with a family physician. Multivariate and univariate analyses of variance of pre- and post-test interviews showed significant pre-post differences on seven of ten interviewing skills and focal areas. Significant differences relating to students' year in medical school were also found.

Clinical Clerkship↗

PubMed1977

Initial pelvic examination instruction: the effectiveness of three contemporary approaches.

Initial pelvic examination skills were taught to 38 second-year medical students who were assigned to one of three study groups. The cognitive posttest scores of all groups were nearly identical, but the students who had received training from professional simulated patients rated significantly better in psychomotor and interpersonal skills than did those who received simulated outpatient instruction by a gynecologist. Thirty-five per cent of the psychomotor and interpersonal ratings attained by the latter and 5 per cent of those attained by the former were marginal or inadequate. It was concluded that a program involving professional simulated patients is an effective method of teaching pelvic examination skills to beginning students.

Adult↗

PubMed1987

Relations between physicians' behaviors and analogue patients' satisfaction, recall, and impressions.

This paper investigates associations between physicians' task-oriented and socioemotional behaviors, on the one hand, and analogue patients' satisfaction, recall of information, and global impressions. The study is based on role-playing subjects' responses to interactions between physicians and simulated patients. Audiotapes of two standardized patient cases presented by trained patient simulators to 43 primary care physicians were rated by role-playing patients (N = 258), and electronically filtered excerpts from the encounters were rated for vocal affect by 37 independent judges. Content analysis was made of the visits' transcripts to assess interaction process and to identify all medical information communicated. Finally, speech error rate was calculated from a combination of audiotape and transcript. Findings revealed that role-playing patients clearly distinguished task from socioemotional behaviors of the physicians, and a consistent pattern of association emerged between physicians' task behaviors and role-playing patients' satisfaction, recall, and impressions. Within the task domain, patient-centered skills (i.e., giving information and counseling) were consistently related to patient effects in a positive direction, but physician-centered behaviors (i.e., giving directions and asking questions) demonstrated the opposite relationship. A negative pattern of association was also evident between physicians' socioemotional behaviors and patient effects.

Affect↗

PubMed1988

Evaluation of a communication skills course for second-year medical students.

A five-year evaluation and redesign of the communication skills component of the Introduction to Clinical Medicine course was undertaken at the State University of New York Health Science Center at Syracuse College of Medicine. The objectives of the evaluation were to determine the effectiveness of the component in teaching communication skills, identify areas of the component in need of change, and monitor the effectiveness of previous changes. In the first three years, the evaluation focused on the students' perceptions of the importance of communication skills in their training as physicians. Based on the evaluations for those three years, the component was modified substantially. One of the changes was the introduction in years four and five of simulated patients for practicing interviewing skills. The evaluations in years four and five focused on the effectiveness of using the simulated patients and the students' perceptions of how well the course objectives were met.

Communication↗

PubMed1988

A course component to teach interviewing skills in informing and motivating patients.

In the present study, the authors implemented and evaluated a course component to teach three types of interviewing skills: giving information to patients, handling emotions on the part of patients, and motivating patients. The authors developed a seven-week course for second-year students that included identification and demonstration of explicit interviewing skills, practice with simulated patients, and feedback in a small-group setting. Thirty of the 104 students in the course were randomly selected for evaluation before and after the course. They showed statistically significant increases in their interviewing skills, based on ratings of videotaped interviews with simulated patients after the course, but did not change significantly in self-assessment of their level of confidence in aspects of conducting the interviews.

Education, Medical, Undergraduate↗

PubMed1991

Iliad training enhances medical students' diagnostic skills.

Iliad is a computerized, expert system for internal medical diagnosis. The system is designed to teach diagnostic skills by means of simulated patient case presentations. We report the results of a controlled trial in which junior students were randomly assigned to received Iliad training on one of two different simulated case mixes. Each group was subsequently tested in both their "trained" and "untrained" case domain. The testing consisted of computerized, simulated patient cases for which no training feedback was provided. Outcome variables were designed to measure the students' performance on these test cases. The results indicate that students made fewer diagnostic errors and more conclusively confirmed their diagnostic hypotheses when they were tested in their trained domain. We conclude that expert systems such as Iliad can effectively teach diagnostic skills by supplementing trainees' actual case experience with computerized simulations.

Clinical Clerkship↗

PubMed1987

A comprehensive performance-based assessment of fourth-year students' clinical skills.

Written examinations are widely used for assessment in clinical clerkships and for licensure and specialty board certification, as opposed to assessment based on actual performance with patients. This reliance on written examinations is due to their ease of use and perceived objectivity and occurs despite the fact that the examinations assess few components of clinical competence. Simulated patients can standardize the presentation of a patient problem; and, if the patients are employed in an assessment in a manner parallel to the design of written test items, the assessment can have an objectivity similar to that enjoyed by written tests. Such an assessment allows the major components of clinical competence to be tested. The results and feasibility of using simulated patients in a multiple-station assessment of an entire senior class in January 1986 are described. A second assessment was administered to a different senior class in December 1986. This latter assessment was designed in collaboration with another medical school that administered the same assessment to its senior students in March 1987.

Clinical Clerkship↗

PubMed1989

Development and construction of a fetal monitoring simulator.

Maximizing learning from a patient simulator requires a high degree of authenticity. This paper describes a new fetal monitoring simulator developed to improve the anatomical accuracy, tactile and procedural realism, and visual aesthetics of existing fetal monitoring simulators. Several new materials and techniques are discussed.

Fetal Monitoring↗

PubMed1988

Evaluation of a self-instructional method for improving doctor-patient communication.

The purpose of the project reported here was to develop and evaluate an educational intervention to improve the interviewing skills learned in medical school. Sixty fourth-year medical students in a required ambulatory care rotation were randomly selected and randomly assigned to one of four conditions. All students interviewed a simulated patient who presented with one of five main complaints, and the interview was videotaped. Students were assigned to a control group or to one of three intervention groups: viewing a self-instruction videotape, viewing and critiquing a videotape of their interview, or both of these activities. The students assigned to the control group did not participate in any educational interventions. At the end of the intervention period, the students again interviewed a simulated patient and were videotaped. The 120 videotaped interviews were reliably rated by a scoring system developed by the project team. The postintervention interviews conducted by students in the two groups that used the self-instruction videotape received significantly higher ratings than those in the control group. These results suggest that this self-instruction intervention can improve the interviewing skills of senior medical students.

Ambulatory Care↗

PubMed1977

An experimental comparison of three courses in history-taking skills for medical students.

Since clinical training often fails to equip medical students with essential history-taking skills, more effective teaching methods required to be developed. As previous work had suggested that training which included televised demonstrations of history-taking and practice with simulated patients might be superior to traditional methods, it was decided to evaluate this experimentally. Thirty students beginning the Oxford Clinical Course were randomly selected and allocated to a traditional or one of two experimental courses. Both experimental courses used television and simulation but differed in the way the history-taking demonstrations were presented. After completing these courses, each student was asked to take a history from a simulated patient. Rating of the videotapes of these interviews showed that the two experimental groups obtained much more information and used many more of the required skills than students assigned to the traditional course. The experimental students were also rated more favourably by the simulators and recorded more data in their case histories. It is concluded that these short courses were practical, very effective, and could be augmented by a self-teaching programme in history-taking skills.

Clinical Competence↗

PubMed1992

Educational computer simulation of malignant hyperthermia.

An educational graphic simulator was developed to provide an interactive learning environment to practice the diagnosis and treatment of malignant hyperthermia. The program incorporates a set of dynamically interacting models to present the physiologic changes associated with malignant hyperthermia and the simulated patient's response to management. Cardiovascular, respiratory, and temperature changes are presented through a graphic display of the operating room monitors. Mouse-driven input is used to manage the airway, control ventilation, manage cardiovascular and rhythm disturbances, and control fluids, electrolytes, and temperature. Medications, including dantrolene, antidysrhythmics, diuretics, and sodium bicarbonate, can be administered. Four simulated patients with different presentations of malignant hyperthermia are included to illustrate variations in the syndrome. Two of these patients are described in detail.

Adult↗

PubMed1991

What value is given to quality of life assessment by health professionals considering response to palliative chemotherapy for advanced cancer?

A study was designed to obtain information on the importance of quality of life assessment (QL) during palliative chemotherapy. A questionnaire was answered by 542 health professionals (392 general practitioners, 20 specialist oncologists, and 130 oncology nurses). In both simulated patient situations and multiple-choice questions, all groups rated QL higher than other standard methods of assessment. General practitioners and oncologists appeared to weight the assessment criteria more equally than nurses who gave strong emphasis to QL. In the simulated patient situation, there was a small degree of interaction between QL and other assessment criteria. However, the analysis showed that QL was regarded as an independent variable and was considered to be the most important objective of palliative chemotherapy for advanced cancer.

Aged↗

PubMed1985

Evaluation of clinical skills for nutrition counseling.

This report describes the procedures for and feasibility of an evaluation program that provides a direct assessment of the use of specific clinical skills during an interview with a simulated patient. The specific aims of this evaluation were to assess untrained graduate students in nutrition on their application of a set of 31 specific clinical skills for resolving dietary adherence problems. Each student conducted two interviews with each of two different simulated patients with hyperlipidemia presenting typical problems following a diet low in saturated fat and cholestrol. The evaluation program provided analyses that identified the strengths and deficits of each student and the performance of the entire group. It is suggested that the evaluation program offers a practical, objective method for examining the entry-level clinical skills of students in training and may be useful in other educational programs (eg, in-service, continuing education workshops).

Cholesterol, Dietary↗

PubMedDate not supplied

Simulated versus actual patients in teaching medical interviewing.

This research project investigates the value of using simulated v. real patients in teaching interviewing skills to third- and fourth-year medical students on a clerkship in family and community medicine. Sixty-four medical students (38 males, 28 females) were asked to make a videotaped patient interview at the beginning of the clerkship. Forty-one of the students interviewed trained, simulated patients and 22 interviewed real patients at their clerkship site. Students received feedback and faculty teaching of interviewing skills after the first interview. All students made another videotaped interview with a simulated patient at the conclusion of the clerkship. All interviews, pre- and post-clerkship, were scored for interviewing skills, focal areas, and nonverbal language. Multivariate and univariate analyses of pre- and post-interviews found simulated patients to be of most value in teaching medical students verbal interviewing skills and real patients to be of most value in teaching the focal content areas of the interview. Recommendations were made to include use of both simulated and real patients in the teaching of medical interviewing.

Analysis of Variance↗

PubMed1986

Small-volume resuscitation with hypertonic saline dextran solution.

Small-volume hypertonic resuscitation has been proposed as an effective means for restoration of cardiovascular function after hemorrhage at the scene of an accident. We evaluated the cardiovascular, metabolic, and neurohumoral response of resuscitation after hemorrhage using 200 ml of 2400 mosm sodium chloride, 6% dextran 70. Unanesthetized adult sheep were bled to maintain mean arterial pressure at 50 mm Hg for 3 hours, shed blood volume = 42 +/- 7 ml/kg. The sheep were then treated with a single bolus infusion of hypertonic saline dextran (n = 7) or normal saline solution (control group, n = 7) and then observed for a 30-minute period of simulated patient transport during which no additional fluid was given. Hypertonic saline dextran caused rapid restoration of blood pressure and cardiac output within 2 minutes of infusion. Cardiac output remained at or above baseline level, while both O2 consumption and urine output increased to above baseline level during the 30 minutes of simulated patient transport. By comparison 200 ml of normal saline solution caused only a small increase in blood pressure and no improvement in cardiac output or oxygen consumption. After this 30-minute period, both groups were given lactated Ringer's solution as needed to return and maintain cardiac output at its baseline value. The volume of lactated Ringer's solution required to maintain cardiac output was less in the hypertonic group, 371 +/- 168 ml, only one sixth that of the control group, 2200 +/- 814 ml. In summary after 3 hours of hypovolemia, a small volume of hypertonic saline dextran, about 4 ml/kg, fully restored cardiovascular and metabolic function for at least 30 minutes and significantly lowered the total volume requirements of resuscitation.

Animals↗

PubMed1978

Measuring clinical competence of medical students.

Evidence of clinical competence for medical students entering the clinical clerkships at the University of Kansas College of Health Sciences is established by passing two different examinations: a 100 item multiple choice examination and a videotaped history and physical examination by each student of a simulated patient, being rated by that patient and two examiners. In 1976 the class of 196 medical students took an average 1.85 written examinations per student. With 70% or better constituting a passing score, 30.6% passed on the first attempt, 55.6% the second, 11.2% the third and 2.5% the fourth. Each student passed the televised practical examination and had the opportunity to review his or her videotape with a critiqued data base and the examiners' and simulated patient's evaluations in hand. Correlation coefficients for all 196 students between scores of written examinations, medicine tutors, examiners and professional patients revealed weak but significant correlations between the assessments of examiners and medical tutors and assessments of examiners and written examination scores, but not between other evaluations. This scheme of proof of competence appears to be objective and direct, and serves the convenience of both students and teaching staff.

Clinical Competence↗

PubMed1989

The effects of storage and shaking on the settling properties of phenytoin suspension.

Phenytoin suspension (PHY-S) is reported to settle, resulting in uneven drug distribution and variable patient dosing. We designed this study to determine the rate of settling and the amount of agitation needed to resuspend the preparation. To determine the rate of settling, we thoroughly shook three bottles of PHY-S and then left them undisturbed. We took samples from the top and bottom of each bottle with a microsyringe at 15 minutes, 1, 6, 12, 24, 48, and 72 hours, and 1, 2, 3, 4, and 5 weeks. We simulated patient administration with daily doses that were measured under good, fair, and poor shaking techniques. We analyzed samples after every tenth dose. After complete resuspension the active ingredient in PHY-S settles at a very slow rate. We found no differences in concentration between the top and bottom until the fifth week in the bottles thoroughly shaken and left undisturbed. Minimal agitation is required to resuspend PHY-S. The well-shaken and poorly shaken bottles in the patient simulation phase exhibited no differences in concentrations whereas the unshaken bottle had differences throughout the study period. Problems thought to be associated with PHY-S may be related to compliance and inaccurate measuring devices.

Drug Storage↗