ePoster
Abstract Title | Do Simulation and Virtual Reality Models Improve Medical Students' Learning Process?

Authors

  1. Gerardo E. Munoz-Maldonado MD. PhD FACS
  2. Oralia Barboza-Quintana MD. PhD
  3. Raquel Garza-Guajardo MD. PhD
  4. Mario Hernandez-Ordonez MD. PhD
  5. Norberto Lopez-Serna MD. PhD
  6. Angel Martinez-Ponce de Leon MD. Phd.

Theme

Simulation and Simulated Patients

Category

Simulation

INSTITUTION

Universidad Autónoma de Nuevo León. Facultad de Medicina.

Background

Clinical simulation is a teaching technique and a way to learn from mistake without the risk of damaging a real patient. This tool's success depends on the experience it presents, since, as Kolb (1984), Jarvis (1987) and Dewey (1938) state,  learning depends on experience and the interaction created between people and environment. In this line of work, we have selected some emotional aspects which promote learning and  pertain to a former study of  student characterization in the Medicine School at the UANL.

Conclusion


In our experience, including the clinical simulations models of the program has been an advantage in the student's personal learning process, promoting competencies like  knowledge retentivity and recovery, patient safety and team-work, among many others.

Feedback in individual tutorships has been enriched through the student's analysis of  mistakes made in his practice at CEVAM, increasing his self-confidence and self-esteem at the time of asking for help.

Finally, the student has found himself immersed in an ongoing evaluation process, which today, has become a part of every scheme for professional exercise in the community where he/she will practice.

Take-home Messages

As subjects of constant change through learning, the students, who, in some way, have been immersed in simulation models, as opposed to traditional models, can be in charge of their own cognitive structure and conduct, as well as the constant interaction of motivation, attention, assimilation, organization, recovery and transference inside that internal structure, and are able to respond to the semantic content of any exchange in the exercise of this profession and the meaning, interest networks, needs and aims of the culture of the Medicine School and the University Hospital. 

Summary of Work

It is an exploratory study where simulation, as a method of intensifying the learning of ATLS,  ACLS, BLS and Via Aérea Dífícil, is evaluated from a qualitative point of view, in order to be used in decision making regarding individual tutorships for students in the 6th year of *licenciatura and 1st year of  postgraduate school, in rotating internships in critical and emergency situations.

All the revised items, and data gathering instruments, were considered within the first months, after the basic training and courses given in the CEVAM at the UANL Medicine School;

Acknowledgement

Dr. med Santos Guzman Lopez

Dr. Martin Jesus Alvarez Ovalle

Dra. Luz Maria Perez Gorostieta

Dr. Carlos Augusto Lopez Acevo

Summary of Results

A higher personal safety level; elimination of fear; detailed analysis of mistakes and better knowledge of personal learning styles  are four of the results found after acquiring those learning related advantages and conveniences considered necessary to make that learning effective.

These aspects form a wide range of results in which the students are satisfied with their personal process in their transit through CEVAM, center which, since 2005, has been  the stage for courses, surgical simulations and the development of abilities in students of surgery, trauma, gastroenterology, and anesthesiology, and has been documented with data from more than 3,500 participants for analysis  in a process of educational evaluation.

References
Dewey, J. (1938). Experience and Education. New York: Collier Books.

Garcia, T., & Pintrich, P. (1991). The effects of autonomy on motivation, use of learning strategies, and performance in the college classroom. Paper presented at the annual meeting of the American Psychological Association, San Francisco, CA.

Garcia, T., & Pintrich, P. (1993). Self-schemas as goals and their role in self-regulated learning. Paper presented at the annual meeting of the American Psychological Association, Toronto, Canada.

Garcia, T., & Pintrich, P. (1995). The role of possible selves in adolescents’ perceived competence and self-regulation. Paper presented at the annual meeting of the American Educational Research Association, San Francisco, CA.
Background

Clinical simulation is a teaching technique and a way to learn from mistake without the risk of damaging a real patient. This tool's success depends on the experience it presents, since, as Kolb (1984), Jarvis (1987) and Dewey (1938) state,  learning depends on experience and the interaction created between people and environment. In this line of work, we have selected some emotional aspects which promote learning and  pertain to a former study of  student characterization in the Medicine School at the UANL. In this study a theory was built to understand the students and a metaphor was made to contemplate the various categories emerging from the description of the students who achieve what they calll “effective learning” (Pérez, L., 2008).

 

With an evident theoretical-practical interest, the study goes beyond what is assumed by the clinical simulation in the Medical Evaluation Center (CEVAM),  above all due to interest and concern for institutional efficiency, in general, and for the quality of strategies used in the learning and teaching processess of medicine in this school, in particular.

 

Former studies dealt with objectives like confirming psychological, sociological and pedagogical traits in the students (personal and functional conditions), in their conditioning of teaching and learnig processes, advancing or limiting them. From a formative point of view, it was a process evaluation. That first evaluation,  to value and identify, provided a set of student traits found in pregraduate and postgraduate schools. Traits derived from that evaluation have become indicators, quantitative and qualitative, used as reference for assessments on performance or edges and benefits in didactical strategies; that is the case with this study.

 

The learner perspective has become the focus of educational analysis and assessment for the last three years in this school, mainly due to the “Focused on learning” core of the University Educational Model  (UANL, 2008).

 

            The basic criteria was to obtain useful and effective information from the teaching activities performed as a recource for the betterment of the didactical strategies used and support and evaluation tool design.

Conclusion
Take-home Messages

As subjects of constant change through learning, the students, who, in some way, have been immersed in simulation models, as opposed to traditional models, can be in charge of their own cognitive structure and conduct, as well as the constant interaction of motivation, attention, assimilation, organization, recovery and transference inside that internal structure, and are able to respond to the semantic content of any exchange in the exercise of this profession and the meaning, interest networks, needs and aims of the culture of the Medicine School and the University Hospital. 

In this way, the didactic proposal of this study is a suggestion to organize the exchange conditions coming from an aggregate of information that a medicine professional has to process and relate through the combination of simulation models and individual tutorships programs.

Setting goals at the time of assisting people to focus their energy on things they want to improve, is a challenge every educator must face, and we call it a challenge because its aim is to reinforce every positive aspect and eliminate every negative one, considering that a healthy sense of oneself allows the person to become a reliable someone for oneself and others, someone who can be respected and looked up to. Students do not optimize their immediate condition in exams, valuing themselves as they are at the time.

Summary of Work

It is an exploratory study where simulation, as a method of intensifying the learning of ATLS,  ACLS, BLS and Via Aérea Dífícil, is evaluated from a qualitative point of view, in order to be used in decision making regarding individual tutorships for students in the 6th year of *licenciatura and 1st year of  postgraduate school, in rotating internships in critical and emergency situations.

 

All the revised items, and data gathering instruments, were considered within the first months, after the basic training and courses given in the CEVAM at the UANL Medicine School; allowing the students to be exposed to real situations and scenarios, achieving an enriching learning experience for them and the people performing this study.

 

Five courses were considered in the study; group distribution and quantity of participants are shown in Fig. 1; these courses took place in the years 2008 - 2011.

.

COURSE

GROUP QTY

TOTAL OF PARTICIPANTS

ATLS

14

448

ACLS

5

120

PALS

2

48

BLS

37

1187

Vía Aérea Difícil

3

23

Table No.1 

            In order to obtain information about the students' perception of their learning in those 61 groups and 1826 participants, a poll was conducted among those who continue their postgrade studies, since they are closer to researchers and were part of the ideal frame for the purposes of this study.

 

The data presented come from that poll and a series of interviews performed by an education expert whose work represents the theoretical frame for the study.

 

The poll had three parts: in the first part we find five sentences referring to the presence or absence of a fearful feeling during real life practice and patient safety, which could provide an answer to the question How do students perceive fear sensations regarding patient's safety?; the second block comprises five questions aiming to provide feedback on mistakes made during practice, which could clarify the role of immediate feedback after a mistake provided by fellow students or instructors; the sentences in the third part could answer the question How does the student perceives personal safety while implementing any of the procedures included in the course?

 

The various sentences were made up with words used by the students themselves in the interviews.

            Data gathering was performed through personal contact with the faculty members of  CEVAM.

            Table No. 2 presents the student quantity answering (voluntarily) the poll , we can observe that the answers obtained came from just 15 groups of the total of 61 attending these courses.

Table No. 2

Distribution of student sample

Group

Questionnaire Qty

 Percentage

ATLS -1

ATLS -5

ATLS-8

Vía Aérea Difícil-1

Vía Aérea Difícil-3

ACLS-3

ACLS-5

BLS-1

BLS-7

BLS-16

BLS-17

BLS-22

BLS-36

1

8

16

4

6

11

6

7

7

16

15

10

13

0.83

6.67

13.33

3.33

5.00

9.17

5.00

5.83

5.83

13.33

12.49

8.33

10.83

Total

120

100

 

            Now we comment on some of the answers obtained in the questionnaires.

            For the five sentences in part 1, the phrase: “I feel constantly distressed by what I am doing”, the answer distribution is quite significant since 65.57% answered this describe them  Very well, but we had no answers like  Does not describe me at all, giving  0%; compared to the answer for the second sentence after the course: “I feel responsible for the patient's safety, but I was not distressed”, where 58.10% responded that it describes them Well , leads us to conclude that some of the stress produced by the patient's safety decreased after the course, when there is control over what is done, with a distribution of 68.06% in the answer that describes them Very well.

            In this way, the various answers were compared and cross-referred to the base study categories and interviews with some students.

Acknowledgement
Summary of Results


A higher personal safety level; elimination of fear; detailed analysis of mistakes and better knowledge of personal learning styles  are four of the results found after acquiring those learning related advantages and conveniences considered necessary to make that learning effective.

These aspects form a wide range of results in which the students are satisfied with their personal process in their transit through CEVAM, center which, since 2005, has been  the stage for courses, surgical simulations and the development of abilities in students of surgery, trauma, gastroenterology, and anesthesiology, and has been documented with data from more than 3,500 participants for analysis  in a process of educational evaluation.

Any physical or emotional characteristic in the students, needs to be accepted by the individual; and that acceptance is what psychology has taught us as self-esteem (Pérez, L., 2008), needed for the mental process to get organized in terms of control and help to fix the new learning to become a customary behavior (Garcia & Pintrich, 1991,1993,1995). 

We know that every stage in the individual development demands certain experiences and we agree with Greenspan (1997), on the idea that these experiences are not only cognitive but also embrace a wide range of emotional interactions, whatever subtle they may be. 

In real educational practices inside the classrooms, forms of fast enumeration, formal classification, and utilization of such categories (for concepts or procedures) are transmmited, but no procedure is provided to assist in relating those categories to life or to the domain experience of the category in question. This is always dismissed before it shows -  and even punished when it does – avoiding in this way turning it into a learning form coming from an opportunity of trial and error for our own thinking procedures, where the source of teaching is experience and the help that, to understand it, comes from connections with the experiences of others, which is the case of cooperative learning, promoted in the clinical simulation abilities in CEVAM.


References
Dewey, J. (1938). Experience and Education. New York: Collier Books.

Garcia, T., & Pintrich, P. (1991). The effects of autonomy on motivation, use of learning strategies, and performance in the college classroom. Paper presented at the annual meeting of the American Psychological Association, San Francisco, CA.

Garcia, T., & Pintrich, P. (1993). Self-schemas as goals and their role in self-regulated learning. Paper presented at the annual meeting of the American Psychological Association, Toronto, Canada.

Garcia, T., & Pintrich, P. (1995). The role of possible selves in adolescents’ perceived competence and self-regulation. Paper presented at the annual meeting of the American Educational Research Association, San Francisco, CA.

Greenspan, S., (1997). El Crecimiento de la mente. Y los ambiguos orígenes de la inteligencia. Barcelona: Editorial Piados.
Jarvis, P. (1987). Adult Learning in the Social Context. New York: Croom Helm.

Kolb, D. A. (1984). Experiential Learning. Englewood Cliffs, New Jersey: Prentice-Hall, Inc.

Pérez, L. (2008). El aprendizaje efectivo en los estudiantes de medicina de la Universidad Autónoma de Nuevo León. Tesis doctoral. México: UANL

Universidad Autónoma de Nuevo León. (2008). Modelo Educativo de la UANL. México: Autor.
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