The Big Bang: A Virtual Subarachnoid Hemorrhage Simulation for Preclinical Medical Students

Abstract

Simulation-based learning is important for rare, high mortality cases, which are unlikely to be witnessed during clinical rotations but are likely to be encountered during future practice such as a subarachnoid hemorrhage. Neurology case simulations, especially those targeted at preclinical learners, are underrepresented in simulation pedagogy, and preclinical learners are underrepresented in a meta-analysis of the efficacy of simulation-based medical education. We designed a virtual simulation of subarachnoid hemorrhage for preclinical medical students, which can be implemented during restricted access to clinical learning. The simulation is 15 minutes long and requires only one standardized patient and one evaluator, which makes this simulation accessible to institutions with limited simulation resources. We adapted the validated questions from the “Simulation Evaluation Tool - Modified” for our post-simulation survey, which will detect the students’ level of confidence and their perceived learning post-simulation. The analysis of student experiences using this validated tool will contribute to the literature base surrounding the efficacy of virtual simulation as a training tool for preclinical learners.

Neurological semiology learning and technological-digital perspectives: a scoping review

“…However, neurological simulations are used to demonstrate the clinical signs and medical history of patients because the diagnosis depends on the correct interpretation of the history and parts of the neurological physical examination, such as speech, visual fields, pupil symmetry, facial weakness, and coordination, which can be presented through games and simulations. (13) Simulations can also improve the coordination and door--to-needle (DTN) time of neurology residents in stroke care because the integration of simulation-based medical education for stroke was associated with a 9.64-minute reduction in DTN time. (14) Finally, the 14% improvement in long-term retention of the medical students' knowledge, and late recovery of neurological semiology from students who received "The Move" training, which simulates neurological syndromes, compared to students who did not receive the training (12) shows that the use of games, simulations, and nontraditional teaching methods, such as problem-solving, can increase academic satisfaction and bring better results when analyzing not only short-term memory but also long-term knowledge retention, besides decreasing the time to diagnosis of neurological syndromes.…”

“…In this sense, using a card game for teaching neurological semiology was classified as productive and fun, and aided in the learning of the students submitted to the study, causing a relevant impact on their medical training. (3) Furthermore, virtual simulation of a scenario in which the student must diagnose a subarachnoid hemorrhage can increase the retention and confidence of future physicians in the management of pathologies with high mortality and/or difficult diagnosis (13) . Furthermore, a study that analyzed the association between practical simulated teaching as a booster for theoretical classes obtained positive results for a group that received only traditional passive theory training.…”

“…It showed a benefit in short-term memorization but was not able to prove its efficacy in long-term memory. (16) And, "Neuropoly" is a board game to enhance the neurological semiology abilities of neurology residents, although it is a viable and inexpensive approach to target neurophobia (17) , all the games we found in this review are, except for the virtual simulation for the diagnosis of subarachnoid hemorrhage (13) , in person and made of physical materials. Hence, we found a lack of technological and digital solutions to aid in traditional neurological semiology teaching.…”

“…(11,14) The potential of introducing technology in learning neurological semiology has not yet been extensively evaluated, but the initial sampling is considered promising. (13) According to the articles analyzed, technological tools come into play to complement the foundation already provided by traditional medical education, strengthening theoretical and practical concepts that have already been approached conventionally. In summary, technology can strengthen and facilitate learning while providing a greater chance for students to retain knowledge through repetition and simulation.…”

“…(18) Digital methods bring content closer to medical students, a strategy that could help overcome the problems of neurophobia. (13) Thus, with students closer to the subject, their knowledge of neurological semiology would be better understood and established. (18) This would facilitate an understanding of the key concepts of neurology that are necessary for the formation of physicians.…”