Combining simulated patients and simulators: pilot study of hybrid simulation in teaching cardiac auscultation

Abstract

Auscultation torsos are widely used to teach position-dependent heart sounds and murmurs. To provide a more realistic teaching experience, both whole body auscultation mannequins and torsos have been used in clinical examination skills training at the Medical Faculty of the University of Muenster since the winter term of 2008-2009. This training has since been extended by simulated patients, which are normal, healthy subjects who have undergone attachment of the electronic components of the auscultation mannequins to their chests to mimic pathophysiological conditions ("hybrid models"). The acceptance of this new learning method was examined in the present pilot study. In total, 143 students in their second preclinical year who were participating in auscultation training were randomized into an intervention group (hybrid models) and a control group (auscultation mannequins). One hundred forty-two (99.3%) of these students completed a self-assessment Likert-scale questionnaire regarding different teaching approaches (where 1 = "very poor" to 100 = "very good"). The questionnaire focused on the "value of learning" of different teaching approaches. Direct comparison showed that students evaluated the hybrid models to be significantly more effective than the auscultation mannequins (median: 83 vs. 64, P < 0.001). The cardiac auscultation training was generally assessed positively (median: 88). Additionally, verbal feedback was obtained from simulated patients and tutors (trained students who had successfully passed the course a few semesters earlier). Personal feedback showed high satisfaction from student tutors and simulated patients. Hybrid simulators for teaching cardiac auscultation elucidated positive responses from students, tutors, and simulated patients.

The 2019 WACEM expert document on hybrid simulation for transforming health-care simulation through “mixing and matching”

“…In this context, HS should also not be used in isolation but linked to other modalities such as pre-learning through reading, video use, and even flipped classroom modeling. [1314151617] Even with virtual reality (VR) simulation, educators must develop realistic interfaces with the clinical environment. Synthetic models, combined with VR can help bridge gaps in learning through integration of the real and the virtual world.…”

“…In the process of combining modalities, it is important to consider the acuity of the scenarios and its impact on learners at the various levels, the level of interaction, and the hands-on opportunities being offered. [91011121314151617] Considering the desired learning outcomes is also important. The consideration of context too is important as it will help enhance the authenticity of the scenarios for learners.…”

“…Even with SPs, usually normal sounds are easy to teach, unless the SP is known to have some condition with the appropriate signs. [9161718]…”

Developing a CTG simulator app: theory and practice

“…Hybrid simulation, where an actor works in combination with a task‐trainer or simulated patient monitor offers a solution to some resource issues associated with whole‐patient simulation. Additional benefits include increased fidelity and an emphasis on interpersonal skills . Furthermore, scenarios can be run ad hoc, when the labour ward is not unduly busy.…”

“…Additional benefi ts include increased fi delity and an emphasis on interpersonal skills. 6,7 Furthermore, scenarios can be run ad hoc, when the labour ward is not unduly busy. We therefore hoped to introduce this simulation method to our practice, but existing CTG simulators were only available packaged with hardware and proved prohibitively expensive.…”