Training in physical examination using a cardiac patient simulator for medical students during bedside learning

DOI IR HANDLE Web Site 15 References
  • Komatsu Hiroyuki
    Center for Medical Education, Faculty of Medicine, University of Miyazaki Clinical Training Center after Graduation, University of Miyazaki Hospital
  • Arimura Yasuji
    Clinical Training Center after Graduation, University of Miyazaki Hospital
  • Imamura Takuroh
    Circulatory and Body Fluid Regulation, Department of Internal Medicine, Faculty of Medicine, University of Miyazaki
  • Kitamura Kazuo
    Circulatory and Body Fluid Regulation, Department of Internal Medicine, Faculty of Medicine, University of Miyazaki
  • Okayama Akihiko
    Clinical Training Center after Graduation, University of Miyazaki Hospital
  • Hayashi Katsuhiro
    Center for Medical Education, Faculty of Medicine, University of Miyazaki

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Other Title
  • 卒前臨床実習における心臓病患者シミュレータを用いた診察実習
  • 探索的研究 卒前臨床実習における心臓病患者シミュレータを用いた診察実習
  • タンサクテキ ケンキュウ ソツ ゼン リンショウ ジッシュウ ニ オケル シンゾウビョウ カンジャ シミュレータ オ モチイタ シンサツ ジッシュウ

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Abstract

Cardiac patient simulators are commonly used in Japanese educational institutions; however, most institutions have not established concrete learning objectives or strategies for mastering physical examination of the circulatory system, including cardiac auscultation. In this study, we propose clear learning objectives and strategies for simulator practice for fifth-year medical students who have passed the objective structured clinical examination, and explored their educational effectiveness.<br>1)The subjects were fifth-year medical students (n=94) at the University of Miyazaki. Learning objectives were the mastery of the sequential physical examination and the ability to distinguish 6 cardiac findings, including normal status. The subjects were evaluated with a checklist before and after lectures and simulator practice.<br>2)The mean score (maximum score=14) significantly increased from before simulator practice (2.2±0.9) to after simulator practice (11.4±1.5; p<0.001). There was no difference in scores after practice among the cardiac diseases.<br>3)Before practice more than 50% of subjects could use a stethoscope on only right positions and could indicate only the maximum point of a cardiac murmur; in contrast, after practice more than 90% of the subjects could sequentially describe physical findings and accurately predict cardiac diseases.<br>4)In a questionnaire administered after practice, 83% of the subjects answered that all physicians should acquire proficiency in cardiac auscultation regardless of their specialty.<br>Simulator practice with clear learning objectives may help improve clinical examination skills when both time and human resources are limited. The reevaluation of the program's continuing educational effectiveness and the establishment of an iterative learning program will be needed.

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