gms | German Medical Science

Background: Simulation-based learning (SBL) has become an important part of medical education. SBL is defined as an artificial representation of a real-world process to achieve educational goals through experimental learning, feedback, and reflection. Based on similarity to real-life situations, simulators can be divided into three categories: low, moderate, and high-fidelity simulators. Generally, SBL was found to be successful in advancing several clinical skills competencies, among them physical examination, procedural, decision-making, and problem-solving skills [1], [2].

Recently, Abdominal Examination Trainer (AET), a moderate-fidelity simulator, was implemented into our Clinical Skills Laboratory. The aim of this study was to evaluate whether use of AET significantly improved abdominal examination as well as clinical reasoning skills.

Materials and methods: Performance of clinical examination of the abdomen on AET was tested during elective subject course. Twenty-one third year medical students were included in the study.

Performance was evaluated using OSCE (Objective Structural Clinical Examination) checklists where each item was scored as performed correctly, not performed, and not performed correctly. Points were assigned according to the correctness of the performance. Eight minutes were allocated for the examination performance.

Chi-squared test was used to identify differences in examination performance. Statistical significance was set at p <0.05.

Results: Both groups performed the examination of the abdomen in the allocated time. AET group achieved significantly higher results compared to non-AET group (86.7±10.0% vs. 73.5±14.4%, p=0.036). Analysis of protocol items showed that AET group performed an item “palpation of the abdomen” significantly better compared to non-AET group (p=0.001). Contrary, significantly worse performance was found in items “determination of the liver span” (p=0.035) and “determination of fullness of the bladder” (p=0.017).

Conclusion: Results from this study suggest that AET is a successful tool to enhance abdominal examination skills learning. Generally, students who underwent practical training on AET achieved significantly better results compared to non-AET group where especially palpation of the abdomen was significantly improved. Significantly worse results in items “determination of liver span” and “determination of fullness of the bladder” in AET group could be explained with the briefing structure, where non-AET group covered theoretical background of those items, whereas AET group might skip them due to lack of time. Additionally, stringency-leniency effect of the OSCE assessors and small group sample could have contributed to the deviation of the findings [3]. Clinical reasoning skills were not significantly different between the groups. Both groups achieved ≥90% points in clinical reasoning skills items.