Abstract：
OBJECTIVE: To evaluate the effect of high-fidelity simulation of pediatric emergencies compared to case-based discussion on the development of self-confidence, theoretical knowledge, clinical reasoning, communication, attitude, and leadership in undergraduate medical students.
METHODS: 33 medical students were allocated to two teaching methods: high-fidelity simulation (HFS, n = 18) or case-based discussion (CBD, n = 15). Self-confidence and knowledge tests were applied before and after the interventions and the effect of HFS on both outcomes was estimated with mixed-effect models. An Objective Structured Clinical Examination activity was conducted after the interventions, while two independent raters used specific simulation checklists to assess clinical reasoning, communication, attitude, and leadership. The effect of HFS on these outcomes was estimated with linear and logistic regressions. The effect size was estimated with the Hedge\'s g.
RESULTS: Both groups had an increase in self-confidence (HFS 59.1 × 93.6, p < 0.001; CDB 50.5 × 88.2, p < 0.001) and knowledge scores over time (HFS 45.1 × 63.2, p = 0.001; CDB 43.5 × 56.7, p-value < 0.01), but no difference was observed between groups (group*time effect in the mixed effect models adjusted for the student ranking) for both tests (p = 0.6565 and p = 0.3331, respectively). The simulation checklist scores of the HFS group were higher than those of the CBD group, with large effect sizes in all domains (Hedges g 1.15 to 2.20).
CONCLUSIONS: HFS performed better than CBD in developing clinical reasoning, communication, attitude, and leadership in undergraduate medical students in pediatric emergency care, but no significant difference was observed in self-confidence and theoretical knowledge.
METHODS: 33 medical students were allocated to two teaching methods: high-fidelity simulation (HFS, n = 18) or case-based discussion (CBD, n = 15). Self-confidence and knowledge tests were applied before and after the interventions and the effect of HFS on both outcomes was estimated with mixed-effect models. An Objective Structured Clinical Examination activity was conducted after the interventions, while two independent raters used specific simulation checklists to assess clinical reasoning, communication, attitude, and leadership. The effect of HFS on these outcomes was estimated with linear and logistic regressions. The effect size was estimated with the Hedge\'s g.
RESULTS: Both groups had an increase in self-confidence (HFS 59.1 × 93.6, p < 0.001; CDB 50.5 × 88.2, p < 0.001) and knowledge scores over time (HFS 45.1 × 63.2, p = 0.001; CDB 43.5 × 56.7, p-value < 0.01), but no difference was observed between groups (group*time effect in the mixed effect models adjusted for the student ranking) for both tests (p = 0.6565 and p = 0.3331, respectively). The simulation checklist scores of the HFS group were higher than those of the CBD group, with large effect sizes in all domains (Hedges g 1.15 to 2.20).
CONCLUSIONS: HFS performed better than CBD in developing clinical reasoning, communication, attitude, and leadership in undergraduate medical students in pediatric emergency care, but no significant difference was observed in self-confidence and theoretical knowledge.
摘要：
目的：评估与基于病例的讨论相比，高保真模拟儿科紧急情况对自信心发展的影响，理论知识,临床推理，通信,态度,和领导本科医学生。
方法：33名医学生被分配到两种教学方法中：高保真模拟（HFS，n=18)或基于案例的讨论(CBD，n=15)。在干预前后应用自信心和知识测试，并使用混合效应模型估计HFS对两种结果的影响。在干预措施之后，进行了客观的结构化临床检查活动，虽然两个独立的评估者使用特定的模拟检查表来评估临床推理，通信,态度,和领导力。用线性和逻辑回归估计HFS对这些结果的影响。结果：两组的自信心（HFS59.1×93.6，p<0.001；CDB50.5×88.2，p<0.001）和知识得分（HFS45.1×63.2，p=0.001；CDB43.5×56.7，p值<0.01）均增加。但两组测试(分别为p=0.6565和p=0.3331)之间没有观察到差异(根据学生排名调整的混合效应模型中的组*时间效应).HFS组的模拟检查表得分高于CBD组，在所有域中具有较大的效果大小(对冲g1.15至2.20)。
结论：HFS在开发临床推理方面比CBD表现更好，通信,态度,以及在儿科急诊护理本科医学生中的领导力，但在自信心和理论知识方面没有观察到显著差异。
方法：33名医学生被分配到两种教学方法中：高保真模拟（HFS，n=18)或基于案例的讨论(CBD，n=15)。在干预前后应用自信心和知识测试，并使用混合效应模型估计HFS对两种结果的影响。在干预措施之后，进行了客观的结构化临床检查活动，虽然两个独立的评估者使用特定的模拟检查表来评估临床推理，通信,态度,和领导力。用线性和逻辑回归估计HFS对这些结果的影响。结果：两组的自信心（HFS59.1×93.6，p<0.001；CDB50.5×88.2，p<0.001）和知识得分（HFS45.1×63.2，p=0.001；CDB43.5×56.7，p值<0.01）均增加。但两组测试(分别为p=0.6565和p=0.3331)之间没有观察到差异(根据学生排名调整的混合效应模型中的组*时间效应).HFS组的模拟检查表得分高于CBD组，在所有域中具有较大的效果大小(对冲g1.15至2.20)。
结论：HFS在开发临床推理方面比CBD表现更好，通信,态度,以及在儿科急诊护理本科医学生中的领导力，但在自信心和理论知识方面没有观察到显著差异。
