In the virtual bronchoscopy simulator, there was representation of airway structures on a computer screen. This interactive model provides tactile feedback. We used available programming with specific tasks and patient scenarios, Dr. Deutsch said.
Explore This IssueJanuary 2009
For the standardized patient portion, the residents and faculty role-played as the endoscopist and family members of the patient. They had to obtain informed consent and delivered bad news.
In 2007, the residents rated everything as wonderful, with scores greater than 4 out of 5 for developing cognitive and psychomotor skills, for the affective impact of the experience, for understanding normal and abnormal conditions and complications, and for developing endoscopy skills and team process skills, Dr. Deutsch said. Overall realism and a realistic feel were also rated highly.
For 2008, we really stressed to our participants that we wanted to assess the learning attributes and limitations in a more discriminatory fashion. The scores had more of a broad range, she said. We saw, in psychomotor skills, that the animal laboratory had the highest mean score for psychomotor skill development and the standardized patient had the lowest mean score, which shows the students were better able to distinguish the qualities of the learning modalities.
When we compared the modalities, we saw that mannequins have value for dealing with complications because you aren’t putting a real patient or an animal at risk. The animal laboratory did well as far as being realistic.
Choosing the Modalities
Dr. Deutsch said the impetus to incorporate various modalities in simulation education is based on technological advances, better understanding of adult learning processes, and the successes of simulation in other high-risk fields.
We have to choose our tools and techniques thoughtfully, she said. The current availability of this variety of learning modalities during this course allowed a unique opportunity for comparison. Some of the results were expected; others were surprises.
We expected that the lectures would be rated highly for development of cognitive skills, but we were a little surprised that they were rated highly for endoscopy skills also. I like to think that is a mature appreciation of the need to integrate cognitive information to inform psychomotor skills, she said.
On the other hand, Dr. Deutsch said the standardized patient scores were a little disappointing and may have reflected our implementation rather than the inherent value of the modality. Other modalities allowed practice until comfortable, but this was variously achieved in the standardized patient sessions. This was the only modality in which residents were confronted with personal hostility, meaning that the situation itself may have been unpleasant.