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Mechanical Simulators Versus Patient Actors: Addressing the Content Validity Question
Journal of Surgical Research 168, 177–178 (2011) doi:10.1016/j.jss.2010.05.009
COMMENTARY Mechanical Simulators Versus Patient Actors: Addressing the Content Validity Question Submitted for publication May 3, 2010
Patient actors (standardized patients) have been used successfully in medical education for over 45 years [1, 2]. In this study, the authors compared the use of live patient actors with mechanical simulators during the initial assessment station of the Advanced Trauma Life Support (ATLS) course [3]. The overall goal was to assess content validity of the mechanical simulator compared with live patient actors. Study participants included ATLS faculty (n ¼ 32) and ATLS students (n ¼ 64) who were randomly selected from a local ATLS database. The final participants represent an 80% response rate for faculty who were asked to participate and a 91% response rate for students. All participants had previous experience with live patient actors in previous courses. To compare content validity, participants were asked to review a DVD recording of four healthcare professionals providing care for a blunt trauma patient who had sustained head, thoracic, abdominal, and lower extremity injuries. The patient was in shock on presentation. The blunt trauma patient in the DVD was a full body mechanical simulator, SimMan Universal Patient Simulator (Laerdal Medical, Stavanger, Norway). After reviewing the video, participants completed a survey assessing which learning modality was more challenging, interesting, dynamic, enjoyable, realistic, and better overall. The authors appropriately acknowledge the subjective nature of these six variables. The results overwhelmingly show that faculty and students chose the mechanical simulator over the patient actor in all six areas. For students, the range of agreement in favor of the mechanical simulator was 97%– 100% for the six variables. For faculty, the range of agreement in favor of the mechanical simulator was 94%–100%. Factors that appear to affect participant’s decisions were the level and type of interaction possible with the mechanical simulator. In contrast to live patient actors, use of the mechanical simulator allowed for the performance of chest decompression, airway manipulation, bladder and gastric catheterization, rectal examination as well as response to painful stimuli. In addition, changes in the patient’s physiologic status happened in a relatively seamless, dynamic fashion. Physiologic changes using patient actors have to be verbally communicated by ATLS instructors to students. Despite the subjective nature of the study, the results are in line with other studies that have found content validity weaknesses in patient actors compared with manikin-based simulators [4, 5]. The advent of manikin-based simulators and virtual reality trainers has enabled the
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0022-4804/$36.00 Ó 2011 Elsevier Inc. All rights reserved.
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JOURNAL OF SURGICAL RESEARCH: VOL. 168, NO. 2, JUNE 15, 2011
introduction of clinical variation during simulation-based training and assessment [6]. It is this capability that is one of the most important factors affecting content validity of patient actors compared with manikin and virtual reality based simulation. In support of patient actors, one of the most powerful capabilities supporting their broad use has been communication. As such, when choosing one learning modality versus the other, it is always best to start with the learning objectives [7]. While the learning objectives were not explicitly stated in this study, the authors indirectly placed value on student’s ability to make decisions and perform procedures during a dynamically changing trauma situation. Hence, it is clear why the mechanical simulator was felt to be a better learning modality. Carla M. Pugh, M.D., Ph.D. Director of the Center for Advanced Surgical Education Department of Surgery Northwestern University School of Medicine 676 North St. Clair, Suite 650 Chicago, IL 60611 E-mail: [email protected]
REFERENCES 1. Barrows H. An overview of the uses of standardized patients for teaching and evaluating clinical skills. Acad Med 1993;68:443. 2. Stillman PL, Regan MB, Philbin M, et al. Results of a survey on the use of standardized patients to teach and evaluate clinical skills. Acad Med 1990;65:288. 3. Ali J, Dunn J, Eason M, Drumm J. Comparing the standardized live trauma patient and the mechanical simulator models in the ATLS initial assessment station. J Surg Res 2010;162:7. 4. Hatala R, Cole G, Kassen BO, et al. Does physical examination competence correlate with bedside diagnostic acumen? An observational study. Med Teach 2007;29:199. 5. Chalabian J, Dunnington G. Do our current assessments assure competency in clinical breast evaluation skills? Am J Surg 1998;175:497. 6. Cooper JB, Taqueti VR. A brief history of the development of mannequin simulators for clinical education and training. Qual Saf Health Care 2004;13(Suppl 1):i11. 7. Collins JP, Harden RM. The use of real patients, simulated patients, and simulators in clinical examinations. AMEE Medical Education Guide No 13. (2004). http://www.medev.ac.uk/ resources/features/AMEE_summaries/Guide13summaryMay04.pdf. Last accessed May 1, 2010.
COMMENTARY Mechanical Simulators Versus Patient Actors: Addressing the Content Validity Question Submitted for publication May 3, 2010
Patient actors (standardized patients) have been used successfully in medical education for over 45 years [1, 2]. In this study, the authors compared the use of live patient actors with mechanical simulators during the initial assessment station of the Advanced Trauma Life Support (ATLS) course [3]. The overall goal was to assess content validity of the mechanical simulator compared with live patient actors. Study participants included ATLS faculty (n ¼ 32) and ATLS students (n ¼ 64) who were randomly selected from a local ATLS database. The final participants represent an 80% response rate for faculty who were asked to participate and a 91% response rate for students. All participants had previous experience with live patient actors in previous courses. To compare content validity, participants were asked to review a DVD recording of four healthcare professionals providing care for a blunt trauma patient who had sustained head, thoracic, abdominal, and lower extremity injuries. The patient was in shock on presentation. The blunt trauma patient in the DVD was a full body mechanical simulator, SimMan Universal Patient Simulator (Laerdal Medical, Stavanger, Norway). After reviewing the video, participants completed a survey assessing which learning modality was more challenging, interesting, dynamic, enjoyable, realistic, and better overall. The authors appropriately acknowledge the subjective nature of these six variables. The results overwhelmingly show that faculty and students chose the mechanical simulator over the patient actor in all six areas. For students, the range of agreement in favor of the mechanical simulator was 97%– 100% for the six variables. For faculty, the range of agreement in favor of the mechanical simulator was 94%–100%. Factors that appear to affect participant’s decisions were the level and type of interaction possible with the mechanical simulator. In contrast to live patient actors, use of the mechanical simulator allowed for the performance of chest decompression, airway manipulation, bladder and gastric catheterization, rectal examination as well as response to painful stimuli. In addition, changes in the patient’s physiologic status happened in a relatively seamless, dynamic fashion. Physiologic changes using patient actors have to be verbally communicated by ATLS instructors to students. Despite the subjective nature of the study, the results are in line with other studies that have found content validity weaknesses in patient actors compared with manikin-based simulators [4, 5]. The advent of manikin-based simulators and virtual reality trainers has enabled the
177
0022-4804/$36.00 Ó 2011 Elsevier Inc. All rights reserved.
178
JOURNAL OF SURGICAL RESEARCH: VOL. 168, NO. 2, JUNE 15, 2011
introduction of clinical variation during simulation-based training and assessment [6]. It is this capability that is one of the most important factors affecting content validity of patient actors compared with manikin and virtual reality based simulation. In support of patient actors, one of the most powerful capabilities supporting their broad use has been communication. As such, when choosing one learning modality versus the other, it is always best to start with the learning objectives [7]. While the learning objectives were not explicitly stated in this study, the authors indirectly placed value on student’s ability to make decisions and perform procedures during a dynamically changing trauma situation. Hence, it is clear why the mechanical simulator was felt to be a better learning modality. Carla M. Pugh, M.D., Ph.D. Director of the Center for Advanced Surgical Education Department of Surgery Northwestern University School of Medicine 676 North St. Clair, Suite 650 Chicago, IL 60611 E-mail: [email protected]
REFERENCES 1. Barrows H. An overview of the uses of standardized patients for teaching and evaluating clinical skills. Acad Med 1993;68:443. 2. Stillman PL, Regan MB, Philbin M, et al. Results of a survey on the use of standardized patients to teach and evaluate clinical skills. Acad Med 1990;65:288. 3. Ali J, Dunn J, Eason M, Drumm J. Comparing the standardized live trauma patient and the mechanical simulator models in the ATLS initial assessment station. J Surg Res 2010;162:7. 4. Hatala R, Cole G, Kassen BO, et al. Does physical examination competence correlate with bedside diagnostic acumen? An observational study. Med Teach 2007;29:199. 5. Chalabian J, Dunnington G. Do our current assessments assure competency in clinical breast evaluation skills? Am J Surg 1998;175:497. 6. Cooper JB, Taqueti VR. A brief history of the development of mannequin simulators for clinical education and training. Qual Saf Health Care 2004;13(Suppl 1):i11. 7. Collins JP, Harden RM. The use of real patients, simulated patients, and simulators in clinical examinations. AMEE Medical Education Guide No 13. (2004). http://www.medev.ac.uk/ resources/features/AMEE_summaries/Guide13summaryMay04.pdf. Last accessed May 1, 2010.