Abstract：
BACKGROUND: Simulation based medical training (SBMT) is gaining traction for undergraduate learning and development. We designed, implemented, and independently assessed the impact of an SBMT programme on competency in surgical history taking and clinical examination for senior clinical students.
METHODS: With institutional ethical approval and initial pilot study of student volunteers that ensured format appropriateness, we implemented an SBMT programme weekly for ten weeks during the core surgery module of our Medicine degree programme. Groups of 5 students collaboratively undertook an observed focused history and physical examination while simultaneously directing care on a simulated surgical patient (actor) with acute abdominal pain. This was conducted in a nonclinical, standardised, tutor-supervised environment and followed by a group debriefing led by both the simulated patient and tutor discussing student interaction and competency. All students undertook Southampton Medical Assessment Tool (SMAT) on a surgical inpatient prior to (baseline) and within 2 weeks after SBMT. Students without simulation training functioned as a control group and randomized cluster sampling was utilised for group selection. Second assessments were by independent surgical academics blinded to student group. Feedback was collected via anonymous questionnaire from those who undertook SBMT.
RESULTS: One hundred students took part, fifty of whom undertook SBMT. Global mean SMAT scores were similar between the control and intervention group at baseline (p > 0.05). Scores on the second assessment were significantly higher (p = 0.0006) for those who had undertaken SBMT vs. controls; 94% of students taking SBMT reported benefit via questionnaire with 85% stating increased confidence in history-taking and 78% reporting improved abdominal examination.
CONCLUSIONS: Undergraduate simulation training at scale is feasible and positively impacts undergraduate student core task competency.
METHODS: With institutional ethical approval and initial pilot study of student volunteers that ensured format appropriateness, we implemented an SBMT programme weekly for ten weeks during the core surgery module of our Medicine degree programme. Groups of 5 students collaboratively undertook an observed focused history and physical examination while simultaneously directing care on a simulated surgical patient (actor) with acute abdominal pain. This was conducted in a nonclinical, standardised, tutor-supervised environment and followed by a group debriefing led by both the simulated patient and tutor discussing student interaction and competency. All students undertook Southampton Medical Assessment Tool (SMAT) on a surgical inpatient prior to (baseline) and within 2 weeks after SBMT. Students without simulation training functioned as a control group and randomized cluster sampling was utilised for group selection. Second assessments were by independent surgical academics blinded to student group. Feedback was collected via anonymous questionnaire from those who undertook SBMT.
RESULTS: One hundred students took part, fifty of whom undertook SBMT. Global mean SMAT scores were similar between the control and intervention group at baseline (p > 0.05). Scores on the second assessment were significantly higher (p = 0.0006) for those who had undertaken SBMT vs. controls; 94% of students taking SBMT reported benefit via questionnaire with 85% stating increased confidence in history-taking and 78% reporting improved abdominal examination.
CONCLUSIONS: Undergraduate simulation training at scale is feasible and positively impacts undergraduate student core task competency.
摘要：
背景：基于模拟的医学培训（SBMT）正在吸引本科生的学习和发展。我们设计了,已实施，并独立评估了SBMT计划对高级临床学生的外科病史采集和临床检查能力的影响。
方法：通过机构伦理批准和学生志愿者的初步试点研究，确保格式适当性，在医学学位课程的核心手术模块期间,我们每周实施一项SBMT课程,为期10周.由5名学生组成的小组合作进行了观察到的重点病史和体格检查，同时指导对患有急性腹痛的模拟手术患者（演员）的护理。这是在非临床中进行的，标准化,导师监督的环境，然后由模拟患者和导师领导的小组汇报，讨论学生的互动和能力。所有学生在SBMT之前（基线）和之后2周内对外科住院患者进行了南安普敦医学评估工具（SMAT）。没有模拟训练的学生作为对照组，随机整群抽样用于分组选择。第二次评估是由对学生群体视而不见的独立外科学者进行的。反馈是通过匿名问卷从进行SBMT的人那里收集的。
结果：一百名学生参加了，其中50人进行了SBMT。基线时，对照组和干预组的整体平均SMAT评分相似（p>0.05）。进行SBMT的人的第二次评估得分明显更高（p=0.0006）。对照组;94％的接受SBMT的学生通过问卷调查报告获益，85％的学生表示对病史的信心增加，78％的学生报告腹部检查改善。
结论：规模的本科生模拟训练是可行的，对本科生核心任务能力有积极影响。
方法：通过机构伦理批准和学生志愿者的初步试点研究，确保格式适当性，在医学学位课程的核心手术模块期间,我们每周实施一项SBMT课程,为期10周.由5名学生组成的小组合作进行了观察到的重点病史和体格检查，同时指导对患有急性腹痛的模拟手术患者（演员）的护理。这是在非临床中进行的，标准化,导师监督的环境，然后由模拟患者和导师领导的小组汇报，讨论学生的互动和能力。所有学生在SBMT之前（基线）和之后2周内对外科住院患者进行了南安普敦医学评估工具（SMAT）。没有模拟训练的学生作为对照组，随机整群抽样用于分组选择。第二次评估是由对学生群体视而不见的独立外科学者进行的。反馈是通过匿名问卷从进行SBMT的人那里收集的。
结果：一百名学生参加了，其中50人进行了SBMT。基线时，对照组和干预组的整体平均SMAT评分相似（p>0.05）。进行SBMT的人的第二次评估得分明显更高（p=0.0006）。对照组;94％的接受SBMT的学生通过问卷调查报告获益，85％的学生表示对病史的信心增加，78％的学生报告腹部检查改善。
结论：规模的本科生模拟训练是可行的，对本科生核心任务能力有积极影响。
