Friday, August 7, 2015

Does Cardiac Physical Exam Teaching using a Cardiac Simulator Improve Medical Students’ Diagnostic Skills

Nadine Gauthier, MD, FRCPC, MEd
University of Ottawa

Background : Challenges in clinical bedside teaching has led to a decrease of quality and quantity of cardiac physical skills of medical trainees. Simulation using high-fidelity simulators can provide a realistic alternative for the teaching of cardiac physical examination.

Aims : The purpose of this study was to measure the ability of medical students at performing a cardiac physical exam and making the correct clinical diagnosis after a learning module on a standardized Simulated Patients (SP) with real cardiac findings in comparison to a cardiac simulator (Harvey).

Methods : After a pretest MCQ test on Harvey, 32 first-year medical students were randomized to a one-hour teaching module on either an SP or Harvey. Their performance and ability to make the correct diagnosis of three cardiac conditions (Aortic stenosis, Mitral regurgitation, Normal Findings) were evaluated during a videotaped posttest Objective Structured Clinical Examination (OSCE) on real patients.

Results: No difference in the mean OSCE score was observed between the two groups (SP group: M=62.1% vs. Harvey group: M =59.1% (p = 0.32). The SP group obtained a higher frequency of correct diagnosis (M = 61%) than the Harvey group (M = 21%), p = 0.03. Feedback on teaching showed that Harvey offered significantly superior clinical findings. However, 34.4% of students requested a combination of both teaching modalities as opposed to Harvey alone (9.4%) or SP alone (6.2%).

Conclusions: The medical students’ ability to perform a cardiac physical exam did not vary when taught on SP vs. Harvey. Teaching on SP did lead to better performance in correctly diagnosing cardiac conditions. The standardized findings of the high-fidelity simulator, Harvey were preferred but a combined teaching program using both SP and Harvey would be the ideal method of teaching to attain transferability to patients.