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Our first instalment of CDTL Brief for 2011 is all about the various Teaching Tools our educators use to engage students and stimulate their interest in the subject. Whether commercially procured or developed by the educators themselves, these tools serve to enhance their students’ understanding of abstract concepts and ultimately enrich their learning experience. We are pleased to have colleagues from the medical, science, design and environment as well as engineering faculties share their teaching experiences in this area.

June 2011, Vol. 14 No. 1 Print Ready ArticlePrint-Ready
The Use of Simulation in Paediatric Undergraduate Education
Dr Nicola Ngiam
Department of Paediatrics

The use of simulation in the aviation and nuclear power industries has set the stage for the use of these same tools in medical education. The rationale behind using simulation in teaching clinical medicine seems intuitive, given the need for rational decision-making in stressful situations.

The Department of Paediatrics has incorporated the use of simulation into teaching acute emergencies to fourth year medical students, using high fidelity patient simulators such as SimBaby and Laerdal (see Figure 1). Online lectures are available to the students prior to their encounter with these simulation tools, so as to fill any knowledge gaps that may be present. During the simulation session, students work in groups of 6 to 7 and are presented with a patient scenario, based on real cases, that they may encounter in an emergency department or on the wards when they are on call at night. The objective of this exercise is to allow students to apply what they have learnt in a safe simulated environment that reflects reality. It also provides an opportunity for students to hone their skills in working as a team. They will need to draw on prior knowledge and intervene appropriately. With each intervention, the simulator will respond and the physiological parameters will change accordingly. This should prompt further action from the students if necessary. At the end of the scenario, the facilitator will then debrief the class, utilising this opportunity to reinforce what they did correctly and to rectify mistakes that may have occurred. The debriefing session employs self-reflection and group feedback as core techniques in facilitating learning.

Figure 1. Using the SimBaby simulator during a simulated clinical scenario.

We also performed a pilot study among a group of elective students who were exposed to the same set of simulated clinical scenarios. An anonymous pre- and post-session questionnaire and a feedback form were administered. All responses were rated on a Likert scale of 1 to 5. Informed consent was obtained and participation was voluntary. Based on the pre- and post-session assessment, it was established that the students (n=26) were more confident (1=not confident at all, 5=very confident) with managing acutely ill children after the session (see Table 1).

Table 1. Results from the pre- and post-session assessments.

The mean satisfaction score for all 3 stations in the simulation exercise was ≥ 4 (1=poor, 5=excellent). All the students who participated in this exercise felt that this training better prepared them for their future job and that it should be made part of the undergraduate curriculum. Simulation-based teaching is associated with increased student confidence in managing acute problems in paediatrics as well as a high degree of student satisfaction. The results provide evidence that simulation should be used in teaching acute paediatric medicine to undergraduate students.

Student feedback from the simulation sessions was largely favourable. Students felt that simulation–based teaching reflected real-life situations in real time. These exercises reinforced their awareness of the sequence of appropriate actions that needed to be taken in such situations and helped them recognise the consequences of their actions in the changes that occurred in the simulator. My favourite quote was from a student who said: “[t]he simulator made words from the book come alive”. In addition, students felt that they were given an opportunity to practice and apply knowledge in a safe environment. The scenarios also required them to think on their feet and respond quickly to situational changes, helping them to prioritise effective management. They were appreciative of the feedback they received from the facilitators that was immediate and non-threatening. They also wanted more sessions, more time for practice and smaller student-teacher ratios.

With technology advancing at lightning speed, the possibilities for the application of simulation in medical education are endless. It is not difficult to envisage a curriculum revolving around virtual patients in various forms, electronic or standardised, in the early phases of a medical student’s education. While it is absolutely true that nothing can replace a real patient, simulation offers an excellent tool in our armamentarium of teaching methodologies and is one that makes intuitive sense. Rather than allow medical education to be dictated by chance encounters between students and patients, a well-rounded, all-encompassing curriculum can be tailored so that all students will be exposed to a more uniform educational experience. From a patient safety point of view, exposure and practice prior to real patient encounters, especially with rare or infrequent but life-threatening conditions, would certainly make a young doctor safer and more prepared for such encounters.

One of the major limitations in the use of simulation is the logistics and cost in terms of equipment and manpower. The key to successfully overcoming such limitations is to choose the appropriate level of simulation that best achieves the objectives or the learning outcomes of the session. This requires careful thought and planning. With time, it is likely that simulation will play a bigger role in medical education as well as in the assessment of clinical competence. The Department of Paediatrics hopes to be at the forefront of this paradigm shift.

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Inside this issue
Using Routine Workplace Audits as Educational Tools: Teaching Hand Hygiene to Medical Students
The Use of Simulation in Paediatric Undergraduate Education
The Examination Library Folder (ELF): A Courseware to Manage Examination Questions
Personal Experiences in Teaching Chemical Engineering Thermodynamics
Using Full-sized Construction Models to Teach Construction Technology