Hybrid Simulation in Teaching Clinical Breast Examination

Abstract

Problem: Clinical Breast Examination (CBE) is traditionally taught to third year medical students using a lecture and a table-top breast model. The opportunity to clinically practice CBE depends on patient availability and willingness to be examined by students, especially in culturally sensitive environments. Intervention:We employed hybrid simulation of the breast and aimed to investigate its effectiveness as an educational tool for teaching CBE to medical students. The hybrid simulation model consists of a standardized patient (SP) wearing a silicone breast simulator jacket. Context:We compared the use of this tool to the traditional method using a blinded randomized controlled design. Medical students (N=82, 48.8% male) were randomized into teaching activities: hybrid simulation and control. Both groups received didactic teaching followed by a practical session. The control group practiced on the table-top model traditionally used while the intervention group practiced on the hybrid model (SP+breast jacket). Next, all students were assessed on their technical and communication skills in an Objective Structured Clinical Examination (OSCE) that included three SP stations. SPs were trained to act according to specified cultural roles: a liberal woman, a veiled woman and a moderately modest woman. Assessment employed a variety of simulated lesions. Outcomes:The hypothesized outcomes consisted of a more complete acquisition of CBE skills, improved lesion detection and better communication skills. CBE completeness scores did not differ between the two groups (p=0.889). Hybrid simulation improved lesion identification grades (p<0.001) without increasing false positives. Communication skills were worse in the hybrid simulation group as graded by the SP (p<0.001), but not as reported by the students (p=0.346). We commented on the students' comfort during OSCE. Hybrid simulation relieved the fear of missing a lesion on CBE (p=0.043) and increased satisfaction with the teaching method among students (p=0.002).Lessons Learned: As a novel educational tool, hybrid simulation improves the sensitivity of CBE done by medical Nassif J, Sleiman A, Nassar A, Naamani S, Sharara-Chami R MedEdPublish https://doi.org/10. 15694/mep.2016.000115 Page | 2 students without affecting its specificity. Although it might not necessarily improve their communication or sensitivity to cultural aspects of CBE, hybrid simulation might have a role in increasing the self-confidence of medical students during CBE.

Hybrid simulation for teaching clinical breast examination (CBE) for physicians in training

“…Currently, there is no evidence in the literature on the effectiveness of hybrid simulation in teaching CBE to residents, nor studies that focus on assessing the educational experience of residents while performing CBE. A similar study [8] was conducted by the principle investigator which found that hybrid simulation improved lesion identification (p<0.001) and relieved the fear of missing a lesion on CBE (p=0.043) and increased satisfaction with the teaching method among medical students (p=0.002) [8]. This study is the first of its kind to use modern techniques to elevate the proficiency of residents' CBE skills and make the teaching of CBE to residents, and potentially the detection of breast cancer lesions, more rounded and even more effective.…”

“…We employed hybrid simulation with standardized patients wearing breast jackets for residents to learn and practice CBE. Unlike with medical students [8], the simulation did not impart clinical knowledge, yet residents positively rated the teaching experience, and all agreed that it offered an opportunity to practice and improve their skills. Their recommendations for the inclusion of hybrid simulation in curricula shows their appreciation of the added value of this exercise to practice a sensitive yet important clinical examination, knowing patient encounters are not guaranteed, even during residency.…”

“…At the end of each encounter, the SP was also trained on how to evaluate the participant's CBE performance by scoring a checklist on CBE completeness. For quality assurance, the same SPs were used as during the previous study performed by the same group on students [8]; during that study, the investigators randomly audited the OSCE sessions to make sure that SPs were evaluating properly and correctly. The checklist included items on the technique of examination in both its visual inspection and palpation aspects.…”