Journal of Advances in Medical Education & Professionalism
Volume:12 Issue: 2, Apr 2024

Simulation-based education (SBE) is an instructional approach that aims to accurately recreate real-life scenarios and engage learners in the practical application of lesson content. By replicating critical elements of clinical situations, SBE facilitates a deeper understanding and better preparation for managing such conditions in actual clinical practice. SBE offers promising prospects for improving medical education and patient care in various settings,such as outpatient clinics. Therefore, this scoping review aims to determine to what extent the most effective components and standards of the simulation have been considered in outpatient education.

The present scoping review adheres to the guidelines outlined in the “Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMAScR) checklist” and the “Joanna Briggs Institute (JBI) Reviewers’ Manual”. This review focused on articles that specifically focused on the use of simulation in outpatient education. Google Scholar, PubMed, Scopus, Embase, and ERIC were searched for keywords related to simulation, ambulatory care, outpatient clinics, and medical education from January 1, 2001, to August 12, 2023.

The search indicated 513 articles, which were narrowed down by title and abstract relatedness. Twenty-nine articles entered the study’s second phase, and after reviewing their full text, nine articles that explicitly reported simulation use in outpatient education remained. Based on the findings of eligible articles, the ten most frequent components of SBE that should be considered and followed discussed. These features were training facilitators, pre-briefing sessions, the type of simulation techniques, the site of simulation participation, the simulation duration, unit of participation, extent of direct participation, Simulation fidelity, feedback, and debriefing and reflection.

SBE is a contemporary method of practical training for medical students that involves realistic modeling or simulation of clinical situations. It enhances learning effectiveness andprovides a safe, educational atmosphere for teaching and learning. Designing simulations adhering to established standards and carefully considering essential components improves efficiencyand effectiveness.

The objective of this research is to evaluate the effect of teaching professionalism by real lifetime scenario to undergraduate MBBS medical students.

This comparative quasi-experimental trial was conducted in OBS/GYN department from May 2019 to Jan 2020. The final year MBBS students of Shalamar Medical and Dental College, Lahore, who attended the clinical rotation of Gynae OBS were enrolled in the study using consecutive sampling. Each batch consists of 15 students. The first two batches were taken as active control, whereas the third batch was taken as an interventional group. The certified faculty in medical education assessed professionalism by using P-MEX at the start and end of the rotation in the gynae ward. P-MEX data are presented as mean and standard deviation. The comparison between the two groups was done using independent sample t-test, and pre- and post-comparison within group was done by paired sample t-test. P-value less than 0.05 was considered as significant.

Among the 45 students, 28 (62.22%) were male and 17 (37.78%) were female. Age and gender were statistically similar in both groups. The average total score, at the start of the rotation of the intervention group was 1.95±0.294, whereas the active control group was 2.23±0.31. At the end of the rotation, the average total score of the intervention group was 3.22±0.48 and active control was 2.56±0.53. Pre- and post P-MEX score was statistically significant with P<0.001.

This research showed that the teaching of professionalism using real lifetime scenarios led to statistically significant improvement of professionalism in the form of P-MEXmean score among final MBBS students.t of Shalamar Medical & Dental College( SMDC) from May 2019 to Jan,2020. Final year MBBS students of SMDC who attended the clinical rotation of OBGY were enrolled for study. The students in first two batches were taken as control and assessed for professionalism by using P-MEX at the start and end of rotation with the traditional teaching being taught. The third batch was taken as interventional group & were assessed in the start of rotation. Then professionalism was taught in the teaching session of 2 hours by lifetime scenario ,twice at interval of one week. Then they were evaluated at the end of rotation by using P-MEX. The comparison between the two groups was done by entering data in SPSS version 24. Data presented as mean and standard deviation. Comparison between two groups was done through independent sample t test. Result showed the statistically significant improvement in doctor patient relationship, reflective skills, and time management & interprofessional skills. The P-MEX score remained “below expectation” in control group whereas improved to “met expectation” in intervention group.

This nonrandomized controlled educational trial showed the teaching of professionalism using real lifetime scenarios lead to improvement of professionalism among final MBBS students from the level of below expectation to level of met expectation as assessed by P-MEX.

While medical students are expected to learn procedural skills during their training, there is no consensus on their level of learning. Further, the most essential procedural skillsacross medical curricula which need to be taught during their III-year clinical posting are often not considered. The purpose of this study was to identify the core procedural skills needed to be taught during the III-year undergraduate medical students clinical posting. A three-round, online Modified Delphi method was used to identify consensus on selecting the most essential procedural skills prescribed in National Medical Commission(NMC) curriculum 2019. In Round 1, a list of 54 procedural skills from the National Medical Commission's (NMC) Graduate Medical Education Regulations (GMER) 2019 curriculum wasdistributed to 22 experts in pre-clinical medical education and multidisciplinary clinicians. They rated the skills in terms of importance. In Round 2, the skills that received consensus in Round 1 were presented, resulting in 13 skills for evaluation. Round 3 further narrowed down the skills to a final consensus of 6. An interclass correlation coefficient of 0.767 among experts indicates a substantial level of reliability. Consensus was achieved for six procedural skills, each demonstrating over 80% agreement among the experts. These skills include basic life support, intravenous cannulation, urinary catheterization for both male and female patients, nasogastric tube insertion, oxygen administration, and basic suturing. Notably, all these skills received the highest level of agreement, surpassing 90% consensus. The results of the modified Delphi study offer crucial insights into the procedural skills that should be included in the curriculum for third-year undergraduate medical students during their clinical rotations in a tertiary care teaching hospital. Faculty members at these institutions differ in their opinions regarding the importance of teaching specific procedural skills, influenced by their teaching background and the student cohorts they instruct. From a comprehensive list, six skills have been pinpointed as the most vital through the modified Delphi technique. Moreover, the Delphi technique is acknowledged as a valuable method for achieving aconsensus on prioritizing the training of certifiable skills.

Health professions education is challenging in terms of developing ways to construct and assess the amalgamation of knowledge, skills and attitudes that result in novice graduatesto be self aware and confident to practice without supervision. Currently, the Physiotherapy internship program in India does not have a comprehensive competency-based framework. Withthe current batch of interns facing the wrath of the COVID-19 pandemic during their undergraduate training, it is a matter of concern to ensure they have developed the required competencies to treat patients independently. This is a single-group interventional study using convenience sampling. A competency framework inclusive of a comprehensive assessment and training module was developed and introduced to 27 physiotherapy interns. Every intern underwent 10 training sessions along with 8 competency assessments during 6 months of internship training. A pre-post indigenous questionnaire was used to assess their self-perceived competency along with feedback questionnaire taken at the end of the module. Implementation of the competency framework revealed a statistically significant difference in the self-perceived competency (pre=84.36±10.98, post=98.55±8.74, P≤0.000). Having uniformity in assessment techniques among the faculty, being exposed to challenging cases during assessment, having training module at the beginning of the internship were some of the suggestions given by the participants. Competency based education offers to be an effective technique in health professional program. Incorporating a competency-based training would help the learners tounderstand their strengths and weaknesses that would go a long way to develop competent health-care professionals. Developing such framework in curriculum will emphasize standardization of learning outcomes, thereby resulting in quality education, furtherenhancing patient care, and improving the health outcomes worldwide.

Applying new technologies in teaching has led to the phenomenon of blended learning (BL), which is currently flourishing as a specific requirement for higher self-efficacyand success in increasingly complex healthcare environments. Although various forms of novel education are on the rise worldwide, the effects of electronic learning (EL), combined withcollaborative learning (CL) and lecture-based teaching (LBT) approaches, have not yet been validated on academic self-efficacy among undergraduate nursing students. Utilizing a pre-/post-test comparison-group design, this quasi-experimental study was conducted on 70 undergraduate nursing students of Urmia University of Medical Sciences, Urmia, Iran, selected by the census sampling technique in 2020. The eligible participants were allocated to intervention groups, viz., the EL+LBT group (n=34) and the EL+CL group (n=36). A learning management system (LMS) was used for both intervention groups along with the LBT approach, and then 10 steps were integrated into the CL approach during 14 sessions, lasting 150 minutes. Afterward, a demographic information form and the College Academic Self-Efficacy Scale (CASES) were administered to collect the data. The data were analyzed using descriptive statistics, Chi-square test, independent-samples t-test, and analysis of covariance (ANCOVA).
No significant difference was observed in the CASE scores between the students were taught using the EL+LBT (113.76±16.98) and the EL+CL approaches (107.66±16.70) beforethe interventions (P=0.136). However, the CL+EL approaches resulted in the highest changes in the CASE scores at the pre-(107.66±16.70) and post-test (119.08±25.49) stages (P=0.019). Moreover, the female students attending the CL+EL classrooms experienced significantly positive differences in their CASE scores (127.12±30.34), compared to the males (112.65±19.30) (P=0.011). Blending the EL and CL approaches significantly promoted CASE among the undergraduate nursing students in this study by providing sufficient collaboration, essential educational equipment, and better technical support.

Direct Observation of Practical Skills (DOPS) tests is a valuable method for clinical assessment. This study aimed to implement the DOPS test to assess the procedural skills ofcommunity dentistry courses and its effects on mastery learning and satisfaction of professors and students at Tabriz faculty of dentistry in 2021-2022. In a quasi-experimental study, 60 dentistry students of a class were assigned into two study (n=30) and control (n=30) groups by Permuted block randomization. In the case group, theskills were related to Fluoride therapy, fissure sealant therapy, and health education evaluated by DOPS. In the control group, these skills were evaluated by traditional evaluation methods. Each test was repeated three times. Finally, the satisfaction of students in the case group was assessed by a questionnaire. The chi-square test was used to compare qualitative variables. Repeated measure ANOVA test was used to compare the mean scores in three stages and two groups. P-value less than 0.05 was considered significant. Data were analyzed using SPSS 16 software. A significant difference in the mean score of Fluoride therapy, pit and fissure sealant therapy, and health education was seen between the case and control groups (P<0.001).Also a significant increase in these skills in the third stage of assessment in the case group was observed (P<0.001). The professors and students’ satisfaction was considerably high onthe DOPS test. The DOPS method had more impact on Fluoride therapy, pit and fissure sealant therapy, and health education's learning process in dentistry students than the conventionalevaluation. The professors and students’ satisfaction level was high regarding DOPS. The advantages of the DOPS method are student-centeredness, objectivity, and appropriate feedback.

Over the past years, the evaluation and accountability of universities and higher education institutions in regard to the realization of their goals and the implementation of the expected performance have turned into a major issue, and those who benefit from or are relevant to the higher education system have placed a special emphasis on the use of evaluationmechanisms. The current study aimed to determine the quality of the medical curriculum approved in 2017 based on the Kano model. The study used cross-sectional and descriptive survey designs. The statistical population included all students of medicine at Tabriz University of Medical Sciences in the academic year2022/2023. Based on Morgan’s table, 240 students were selected using convenience sampling method. Field data collection and researcher-made questionnaires were used to collect data. Thequestionnaires were presented to interested and available students in person and online through a link. To analyze the data, paired one-sample t test was used with the help of SPSS 16.0 softwareand Kano’s matrix. The findings of the study showed that students’expectations in the elements of Aker were more than their perceptions, and this difference was more in the elements of logic with the Mean±Standard Deviation of (16,09±2,02; 8,53±2,18), content with Mean±SD (19,62±2,46; 9,47±2,00), teaching and learning strategies with Mean±SD of (15,85±2,14; 7,36±1,89),teaching and learning activities with Mean±SD of (23,38±3,10; 11,50±2,68), and time and place of learning with Mean±SD (12,09±1,53; 5,46±1,43). Also, after examining the Kano matrix, it was found that the most felt needs of the students in the classification of the Kano model were among the mandatory needs. Therefore, it can be concluded that the curriculum of medicine in implementation (perception) stage does not accord with the expectations of the students, and it is necessary to pay attention to the needs and expectations of the students.

We have observed inconsistencies in residents’experiences regarding important procedures and tasks necessary for patient care. We aimed to improve individual motivation tolearn and become facile with specific practices earlier in the timeline of the internship years.

Intern Bingo was implemented in a single general surgery residency. Two sites, both tertiary care centers with institutional practices, were utilized. Twenty-four procedures/tasks important to clinical practice were identified, including but not limited to Nasogastric Tube placement, IV insertion, incision and drainage, laceration repair, vascular doppler exam, andclinical documentation. Bingo cards were randomly generated. To assess comprehension, interns taught back necessary components to a senior resident or attending to complete each bingo square; including indications, supplies, steps, troubleshooting techniques, and complications. First, the residents were awarded prizes to complete a row and a full card (a cloth scrub cap and portable pulse-oximeter, respectively). A Likert-scale survey assessing satisfaction was administered following the completion of the internship period.

The first row was completed in two weeks and the first full card at four weeks. All participants finished the cards within 8 weeks. 54% of the participants returned the survey and100% reported positive experiences. 50% felt that bingo created a healthy learning environment with improved teaching, and the remaining 50% were neutral. 75% reported that Bingo positivelyinfluenced decisions to seek out opportunities. 100% conveyed a desire to repeat Bingo as mentors. Feedback from the attendings was gathered, with positive assessments of the interns’ skills and confidence.

Bingo is a simple and easily implemented educational tool that works to alleviate variations in experience early in the internship period. It represents a novel and effective way tomotivate the interns to learn important procedures and tasks within the first two months of residency. Cards may be effortlessly tailored to a variety of residency programs and rotations.