3.3 Questionnaire results
A total of 45 questionnaires were distributed and 45 were recovered. Hence, the recovery rate was 100%. The questionnaires were analyzed by 2 doctors participating in the training. The results showed that 93.3% of participants had not been involved in similar training before, 100% were satisfied with the training method and believed it was necessary to set up such a course, 95.6% believed it was beneficial to their future learning and work, and 100% believed that such training improved clinical practice and teamwork. Participants also believed that the training helped enhance their 1st aid awareness and improved interest in learning, comprehensive 1st aid, clinical thinking, theory-practice combination, and doctor-patient communication (Table 3).
Traditional clinical skill training, which is dominated by the pattern of “teaching and single skill practice,” mainly seeks to improve individual clinical operation skills. However, when entering the clinical field, medical students must address many complicated conditions requiring the integrated application of clinical skills. Although medical students master the basic operation steps in training, they often feel apprehensive in clinical operations due to the lack of 1st aid scene training, particularly in critical scenarios. Working in the ICU requires the integration of strong theoretical, practical, and applicable multi-disciplinary knowledge and skills; hence, clinicians should be armed with solid basic theoretical knowledge, relatively strong operation skills, and comprehensive analytic skills. The rapid development of critical care medicine has influenced greater requirements for doctors in the ICU and further improvement in clinical 1st aid skills and teamwork awareness.[5–6] In recent years, the state has carried out standardized training for resident physicians to improve their professional ability and operation skills. Medical students often show inadequate ability and experience in clinical practice and addressing the particularities of critical patients during the transitional period between medical training and clinical practice. Standardized training residents whose 1st aid skills and clinical thinking ability require further improvement rarely have the opportunity to participate in 1st aid treatment. Thus, high-fidelity patient simulators such as SimMan may be utilized in ICU physician training to address such deficiencies.
While intelligent integrated simulation technology is undergoing rapid development, medical teaching based on intelligent integrated simulation is playing an increasingly important role in clinical skill training for medical students. Meta-analysis indicates that medical students and staff who participate in skill training based on high-fidelity patient simulators can achieve an improvement in their medical knowledge, skill operation ability, medical behavior, and care quality. SimMan is a simulated adult male with explicit anatomical traits, realistic shape, easy operation and positioning, full voice prompts, and text prompts. It exhibits the following characteristics: life characteristic simulation including liquid crystal pupil scaling and carotid pulsation changes; simulated ECG display that responds to a pressing operation and successful rescue; full electronic monitoring of pressing position, pressing depth, and blowing volume; and student management including playback of the operation process, transcript saving, and printing. SimMan can simulate different psychological and pathological characteristics of patients as well as potential responses to different operations carried out by the trainees. The self-equipped monitoring equipment of SimMan can display changes in a timely manner and create a full-featured simulated teaching environment for comprehensive 1st aid.[8–9] SimMan can also simulate real clinical cases to provide lifelike operation environments and practical experiences for standardized training physicians. The preparation and simulation of clinical 1st aid cases and adoption of a new teaching model (an integrated practice of basic theory teaching, itemized skill practice, comprehensive simulation drilling, and recording, analysis and summarization) may influence standardized training physicians to take an active part in skill training, problem solving, developing critical thinking, and bridging the gap between classroom teaching and clinical practice.[10–11]
In this study, the standardized training residents’ comprehensive 1st aid skills were assessed before and after training using SimMan. Results show statistically significant differences in pre- and post-test scores, indicated by overall improvement in qualification rate, average score, and average 1st aid duration,. After the standardized training, the residents achieved a more accurate judgment of critical conditions and diseases, as well as an improvement in such aspects as 1st aid awareness, 1st aid efficiency, commanding ability, communication ability with the patient's family members, 1st aid equipment use, clinical thinking ability, and learning initiative and teamwork awareness. They also became more experienced in management of comprehensive 1st aid and application of special operation skills. All improvements fully embody the advantages of high-fidelity advanced patient simulator integration in clinical 1st aid skill training and the benefits of simulated teaching in improving practical operation ability and the clinical comprehensive treatment ability of the trained residents.[12–13] The questionnaire results show that the trained residents took great interest in novel training methods and expect more opportunities of involvement in similar training courses. They also believed that the training could help improve the judgment and treatment of critical conditions, improve clinical operation and comprehensive 1st aid abilities, stimulate interest in learning, cultivate teamwork skills, and enhance doctor-patient communication. At the same time, participants became aware of their problems, such as insufficient recognition of the critical patient's potential condition changes, insufficient familiarity with the 1st aid process, insufficient recognition of the potential disease risk, insufficient diagnosis/differential diagnosis when the disease condition changes, and non-standard 1st aid operations. All these insufficiencies should be continuously resolved through similar training programs in the future.
SimMan, which can improve the clinical EMT skills of standardized training physicians, is an effective way to bridge the gap between theory and clinical practice. However, the use of virtual patients creates a gap between the simulated clinical scenario and clinical practice. Therefore, SimMan should still be combined with practical clinical teaching, and standardized training physicians still need to continue learning, acquiring wider ranges of experience, and improving their clinical comprehensive 1st aid skills in their future clinical work.
Thanks to the Clinical Skills and Experiment Center for providing SimMan.
Conceptualization: yanshu zhang, lei zhang, gang wang, litao guo.
Data curation: yu liu, yanshu zhang, lei zhang, gang wang, litao guo.
Formal analysis: yanshu zhang, litao guo.
Investigation: yu liu, yanshu zhang, hongliang bai, gang wang, litao guo.
Methodology: yu liu, yanshu zhang, lei zhang, hongliang bai, gang wang, litao guo.
Project administration: yu liu, lei zhang, hongliang bai, gang wang, litao guo.
Resources: yu liu, hongliang bai, gang wang.
Software: yu liu, gang wang, litao guo.
Supervision: hongliang bai, litao guo.
Validation: lei zhang, gang wang, litao guo.
Visualization: yu liu.
Writing – original draft: litao guo.
Writing – review & editing: yu liu, yanshu zhang, lei zhang, gang wang, litao guo.
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Keywords:Copyright © 2019 The Authors. Published by Wolters Kluwer Health, Inc. All rights reserved.
EMT skills; SimMan; Standardized Training Resident