Case-Based Teaching: Does the Addition of High-Fidelity Simulation Make a Difference in Medical Students' Clinical Reasoning Skills?

Autor: Mutter MK; Department of Emergency Medicine, University of Virginia School of Medicine, PO Box 800699, Charlottesville, VA 22908-0699 USA., Martindale JR; University of Virginia School of Medicine, Box 800866 Suite 2008 Pinn Hall, Charlottesville, VA 22908-0866 USA., Shah N; Division of Gastroenterology and Hepatology, University of Virginia School of Medicine, Box 800708, GI West Complex - 2nd Floor, Charlottesville, VA 22908 USA., Gusic ME; University of Virginia School of Medicine, Box 800866 Suite 2008 Pinn Hall, Charlottesville, VA 22908-0866 USA., Wolf SJ; Department of Emergency Medicine, Denver Health Medical Center, University of Colorado School of Medicine, Denver Health Medical Center, 777 Bannock St., Pavilion A, Denver, CO 80204 USA.
Jazyk: angličtina
Zdroj: Medical science educator [Med Sci Educ] 2020 Jan 10; Vol. 30 (1), pp. 307-313. Date of Electronic Publication: 2020 Jan 10 (Print Publication: 2020).
DOI: 10.1007/s40670-019-00904-0
Abstrakt: Context: Situativity theory posits that learning and the development of clinical reasoning skills are grounded in context. In case-based teaching, this context comes from recreating the clinical environment, through emulation, as with manikins, or description. In this study, we sought to understand the difference in student clinical reasoning abilities after facilitated patient case scenarios with or without a manikin.
Methods: Fourth-year medical students in an internship readiness course were randomized into patient case scenarios without manikin (control group) and with manikin (intervention group) for a chest pain session. The control and intervention groups had identical student-led case progression and faculty debriefing objectives. Clinical reasoning skills were assessed after the session using a 64-question script concordance test (SCT). The test was developed and piloted prior to administration. Hospitalist and emergency medicine faculty responses on the test items served as the expert standard for scoring.
Results: Ninety-six students were randomized to case-based sessions with ( n  = 48) or without ( n  = 48) manikin. Ninety students completed the SCT (with manikin n  = 45, without manikin n  = 45). A statistically significant mean difference on test performance between the two groups was found ( t  = 3.059, df = 88, p  = .003), with the manikin group achieving higher SCT scores.
Conclusion: Use of a manikin in simulated patient case discussion significantly improves students' clinical reasoning skills, as measured by SCT. These results suggest that using a manikin to simulate a patient scenario situates learning, thereby enhancing skill development.
Competing Interests: Conflict of InterestThe authors declare that they have no conflict of interest.
(© International Association of Medical Science Educators 2020.)
Databáze: MEDLINE
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