Effectiveness of simulation based education of clinical psychomotor skill of cardiovascular and respiratory auscultation in medical undergraduates: A prospective interventional study

Effective teaching of psychomotor skills is the benchmark of medical education in present scenario of advancing medical technologies , academics and research. A medical undergraduate needs to be trained holistically to be competent in not only cognitive skills but psychomotor skills also. Medical education  is challenging for every undergraduate as they are assimilating new knowledge along with learning of necessary psychomotor skills. Teaching clinical skills to first year medical undergraduates is an exigent task for faculty facilitators as they need to appreciate the balance between knowledge and clinical practice. Looking forward on understanding and learning of psychomotor skills it was seen in gap analysis that first year medical students felt a strong need for better understanding and learning of psychomotor skill of auscultation in cardiovascular system and respiratory system. Simulation based learning of psychomotor skills provides real time experience for medical undergraduates to learn vital skills like cardiac and respiratory auscultation in safe environment. It is an effective tool for training students in respiratory care education.(1) This simulated clinical environment helps medical student to have in-depth learning of essential clinical skills and prepare them clinically for accurate differential diagnosis in their forthcoming clinical posting. It was seen that training of cardiac auscultation significantly improved auscultatory skills in students in which 89.7% students were able to recognize mitral regurgitation on the simulated patient.(2) Students who are trained with simulation based tutoring shows better skill performance and confidence to identify lung sounds as compared to students who were just tutored without simulation. (3)Thus simulation based education also helps learner to have diverse exposure to auscultatory abnormalities that can be encountered in a patient. It gives opportunity and access to undergraduates to simulated patients in institution where exposure to real patients is less. Simulation based learning also ensures patient safety as student can learn and rehearse on patient simulator. In a study done on residents of cardiology specialty school it was seen that residents trained by simulation based education were having better auscultatory skills then residents who were trained in conventional manner.(4) Assessment on simulators will provide clinical scenario to the medical student which will help expand their cognitive clinical skills.(5) This study will therefore enhance their clinical skills and help us to understand effectiveness of simulation based education among medical students in auscultatory psychomotor skills in cardiovascular and respiratory system.

Rationale and Justification: Simulation based education will provide Indian medical graduates a state of the art platform for learning vital clinical skills which is a must know to do clinical practice. Simulation based learning is a real time learning where students can practice and rehearse to learn and polish their clinical psychomotor skills. It will help them interpret auscultator abnormalities and enhance clinical cognitive skills, thus promoting patient safety. Novelty of the study includes scenario based learning and assessment on simulators.

AIM:

To study effectiveness of simulation based learning of auscultatory skills in cardiovascular and respiratory system among first year medical undergraduate students.

Objectives:

1.     To assess efficacy of simulation based learning of auscultation in cardiovascular system

2.     To assess efficacy of simulation based learning of auscultation in respiratory system

Methodology:

Study type: prospective interventional study

Study settings: Study will be conducted in Department of Physiology , AIIMS Bathinda  among medical undergraduates.

Study Duration : 6 months

Study Population: Purposive sampling (all first year medical undergraduates)

Inclusion criteria: All students who will give the consent and attend training and assessment sessions.

Exclusion criteria: students who will be absent and non consenting students.

Study Intervention:

At the level of Faculty: Sensitization session on simulation based training of auscultation in respiratory and cardiac examinations will be conducted among medical faculty of Department of Physiology. Faculty will be appraised of Peyton’s 4 step approach to teach clinical skills in small group.

At the level of Students: All students will be given pre requisite knowledge in an interactive lecture in large group, in two separate classes of cardio vascular system regarding heart sounds and respiratory system examination. Large group teaching will be followed by demonstration and training of both the psychomotor skills in small groups. Small group training of the skills will be done using Peyton’s 4 step teaching approach. Pre-test will be conducted and assessment of clinical skills will be done by giving scenario based problems.

Students will be divided equally in two groups (Group A & Group B). Simulation based training of respiratory auscultation will be given to group A and Simulation based training of heart sound auscultation will be given to group B in small groups of 5 students in each group. Post test and assessment will be conducted after simulation based training and feedback will be collected in the form of questionnaire. In next session simulation based training of cardiac auscultation will be done in Group A and respiratory auscultation will be done in Group B. Post-test and assessment will be conducted and clinical skills will be evaluated on validated checklist.

Data collection: Data will be collected as validated Pre and post test checklists and scenario based assessment on simulators. Feedback will be collected from students in form of questionnaire and feedback from faculty will be taken in focused group discussions.

Data Analysis: Statistical analysis of quantitative data will be done by comparing pre and post test scores using SPSS 26th version. Qualitative data will be analyzed by thematic analysis.

Short term outcomes: First year medical students will be competent in respiratory auscultation and cardiac auscultation. Medical students will be more confident in performing auscultatory examination of respiratory and cardiovascular system on patients. Medical students will show enhanced psychomotor and cognitive skills.

Long term outcomes: Medical students will be competent to perform clinical examination and interpretation of auscultatory abnormalities independently as physician of primary contact.