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      Simulación clínica de alto realismo: una experiencia en el pregrado Translated title: Realistic clinical simulation: an experience with undergraduate medical students

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          Abstract

          Introducción. La simulación con modelos de alto realismo se utiliza a menudo en la formación de los profesionales sanitarios. Sin embargo, son escasas las experiencias en el pregrado. El objetivo de este trabajo fue conocer la factibilidad y la aceptación de su aplicación con estudiantes de sexto curso de la licenciatura de Medicina. Materiales y métodos. Se diseñaron ocho escenarios que simulaban problemas clínicos frecuentes para su desarrollo con maniquíes de alto realismo. Los estudiantes se dividieron en grupos de 6-8 sujetos, cada uno de los cuales atendió dos casos durante 30 minutos. Posteriormente se llevó a cabo un análisis reflexivo durante 25-40 minutos. La actividad se repitió en dos años consecutivos. Al final se recabó la opinión de los estudiantes mediante encuestas anónimas. Resultados. La actividad fue valorada muy positivamente por los estudiantes, quienes la consideraron como "útil" (4,8 y 4,9 puntos sobre 5) e "interesante" (4,9 y 4,9 puntos). El tiempo preciso para preparar cada escenario fue de unas 3 horas. Fueron necesarias una jornada completa de un profesor, un técnico y un enfermero para que un colectivo de unos 40 estudiantes se expusiera a dos casos clínicos. Conclusiones. Esta experiencia piloto sugiere que la simulación de alto realismo es factible en el pregrado, supone un consumo razonable de recursos y tiene una elevada aceptación por parte de los estudiantes. No obstante, se necesitan otros estudios que confirmen la impresión subjetiva de que resulta útil para potenciar el aprendizaje de los alumnos y su competencia clínica.

          Translated abstract

          Introduction. Realistic clinical simulation is commonly used with physicians and other health professionals. However it has been rarely used with undergraduate students. The aim of this study was to explore its feasibility and acceptance with medical students. Materials and methods. Eight clinical scenarios representing common acute problems in medical practice were designed and implemented using a realistic manikin. In two consecutive years, groups of 6-8 students attended two cases during 30 min, followed by a 25-40 period for assessment and feedback. Students opinion was obtained by anonymous questionnaires. Results. Students considered the activity both "useful" (4.8 and 4.9 points in a 5-point scale) and "interesting" (4.9 and 4.9 points). Designing each scenario required about 3 hours. During a work day of a teacher, a nurse and a technician, 40 students were exposed to two scenarios. Conclusions. This pilot study suggest that realistic clinical simulations is both feasible and well-accepted by medical students, with reasonable resource requirements. Nevertheless, other studies are needed to confirm their usefulness to improve student learning and clinical performance.

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          Most cited references23

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          To Err Is Human : Building a Safer Health System

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            A systematic review of skills transfer after surgical simulation training.

            To determine whether skills acquired by simulation-based training transfer to the operative setting. The fundamental assumption of simulation-based training is that skills acquired in simulated settings are directly transferable to the operating room, yet little evidence has focused on correlating simulated performance with actual surgical performance. A systematic search strategy was used to retrieve relevant studies. Inclusion of articles was determined using a predetermined protocol, independent assessment by 2 reviewers, and a final consensus decision. Only studies that reported on the use of simulation-based training for surgical skills training, and the transferability of these skills to the operative setting, were included. Ten randomized controlled trials and 1 nonrandomized comparative study were included in this review. In most cases, simulation-based training was in addition to normal training programs. Only 1 study compared simulation-based training with patient-based training. For laparoscopic cholecystectomy and colonoscopy/sigmoidoscopy, participants who received simulation-based training before undergoing patient-based assessment performed better than their counterparts who did not receive previous simulation training, but improvement was not demonstrated for all measured parameters. Skills acquired by simulation-based training seem to be transferable to the operative setting. The studies included in this review were of variable quality and did not use comparable simulation-based training methodologies, which limited the strength of the conclusions. More studies are required to strengthen the evidence base and to provide the evidence needed to determine the extent to which simulation should become a part of surgical training programs.
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              Lessons for continuing medical education from simulation research in undergraduate and graduate medical education: effectiveness of continuing medical education: American College of Chest Physicians Evidence-Based Educational Guidelines.

              Simulation technology is widely used in undergraduate and graduate medical education as well as for personnel training and evaluation in other healthcare professions. Simulation provides safe and effective opportunities for learners at all levels to practice and acquire clinical skills needed for patient care. A growing body of research evidence documents the utility of simulation technology for educating healthcare professionals. However, simulation has not been widely endorsed or used for continuing medical education (CME). This article reviews and evaluates evidence from studies on simulation technology in undergraduate and graduate medical education and addresses its implications for CME. The Agency for Healthcare Research and Quality Evidence Report suggests that simulation training is effective, especially for psychomotor and communication skills, but that the strength of the evidence is low. In another review, the Best Evidence Medical Education collaboration supported the use of simulation technology, focusing on high-fidelity medical simulations under specific conditions. Other studies enumerate best practices that include mastery learning, deliberate practice, and recognition and attention to cultural barriers within the medical profession that present obstacles to wider use of this technology. Simulation technology is a powerful tool for the education of physicians and other healthcare professionals at all levels. Its educational effectiveness depends on informed use for trainees, including providing feedback, engaging learners in deliberate practice, integrating simulation into an overall curriculum, as well as on the instruction and competence of faculty in its use. Medical simulation complements, but does not replace, educational activities based on real patient-care experiences.
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                Author and article information

                Contributors
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Journal
                edu
                Educación Médica
                Educ. méd.
                Fundación Educación Médica (, , Spain )
                1575-1813
                June 2012
                : 15
                : 2
                : 109-115
                Affiliations
                [02] orgnameHospital Universitario Marqués de Valdecilla orgdiv1Servicio de Medicina Interna
                [04] orgnameHospital Virtual Valdecilla
                [01] orgnameHospital Universitario Marqués de Valdecilla orgdiv1Servicio de Neurología
                [05] Santander orgnameUniversidad de Cantabria orgdiv1Departamento de Medicina y Psiquiatría España
                [03] orgnameHospital Universitario Marqués de Valdecilla
                Article
                S1575-18132012000200009
                10.4321/s1575-18132012000200009
                3125d3a8-cef3-484a-96d9-f42c8fe13278

                This work is licensed under a Creative Commons Attribution-NonCommercial 3.0 International License.

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                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 16, Pages: 7
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                SciELO Spain


                Clínica médica,Medicina clínica,Pregrado,Simulación,Clinical medicine,Medical students,Simulation,Undergraduate

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