Hybrid Simulation in Teaching Clinical Breast Examination

Study Overview
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Brief Summary
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The purpose of this study is to determine whether the use of hybrid simulation of the breast are more effective in teaching CBE technique and culturally sensitive doctor-patient communication skills to medical students than the traditional method.

Detailed Description
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Breast cancer is a Lebanese national problem. Campaigns for mammography screening are effective but recommendations on breast examinations screening for breast tumors are lacking. On one hand, the Lebanese population is culturally diverse, with women's beliefs ranging from liberal to extremely conservative. On the other hand, Clinical Breast Examination (CBE) is traditionally taught to medicine III students in a lecture, followed by practice on a low-fidelity breast model. The opportunity to clinically practice CBE depends on patient availability and her willingness to be examined by students. This is further limited by some Lebanese women's cultural and religious beliefs. Little is known about the effect of patient cultural practices on the efficacy of CBE. In this project, we focus on the need for an effective educational tool for teaching CBE to physicians-in-training. The proposed teaching method in this study is hybrid simulation: breast model jacket (simulator) worn by a trained actress (standardized patient, SP). In this study, we compare this standardized educational tool to the traditional teaching method which consists of a lecture and training on a low-fidelity (unrealistic) breast model on a desk (no SP). We hypothesize that the use of this hybrid simulation tool, as compared to the traditional teaching method, will result in a more complete CBE, better lesion detection and improved culturally sensitive communication skills in terms of awareness of, and ability to deal with, cultural differences related to breast examination. In order to do so, we will evaluate medical students' performance and examine their attitudes and cultural competencies when they perform CBEs on 3 culturally different standardized patients using hybrid simulation scenarios. Through an experimental design that minimizes biases related to selection of students (randomized controlled), we will compare hybrid simulation (intervention) with low-fidelity simulation (control) in teaching CBE. Medicine-III students rotating in the Obstetrics and Gynecology department at the American University of Beirut Medical Center (AUBMC) will be asked to participate; they are free to refuse without any effect on their grades in the rotation. The students will be assessed in an Objective Structured Clinical Examination (OSCE) setting similar to their usual oral clinical exams but not contributory to their academic evaluation in the Faculty of Medicine. The OSCE setting will include encounters with 3 culturally different Standardized Patients (1 outgoing woman, 1 with chador, and 1 moderately conservative woman). The assessment tools are questionnaires that are either objective (filled by SP) or self-reporting (filled by students) about (1) met learning objectives, (2) student's attitude, and (3) clinical cultural competency.

Official Title
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The Use of Hybrid Simulation (HS) of the Breast in Teaching Clinical Breast Examination (CBE) to Medical Students.

Conditions
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Medical Education, Clinical Breast Examination, Medical Simulation, Standardized Patient

Intervention / Treatment
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* Behavioral: Teaching using Hybrid Simulation of breast examination
* Behavioral: Teaching using traditional method


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Third year medical students (Med III) at the American University of Beirut Rotating in the Obstetrics and Gynecology department at the American University of Beirut Medical Center Exclusion Criteria: None
Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: Low-Fidelity Simulation<br>Teaching using traditional method | Behavioral: Teaching using traditional method<br>* Students in the control group will receive the regular lecture given at the American University of Beirut and will attend the usual simulation lab teaching activities (single breast silicone model without any actors). The only new introduction to the curriculum is an educational video on the technique of CBE.<br>* Other names: Lecture with low-fidelity breast model;|
| Experimental: Hybrid Simulation<br>Teaching using Hybrid Simulation of breast examination | Behavioral: Teaching using Hybrid Simulation of breast examination<br>* Students in the intervention/experimental group will receive the regular lecture given at the American University of Beirut and will attend a screening of an educational video on the technique of CBE, in addition to the hybrid simulation teaching activities in the simulation lab (standardized patient wearing breast examination simulator jackets)<br>* Other names: Standardized Patient wearing breast jacket;|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| CBE completeness (in OSCE) | SPs will be objectively grading the students on a scoring sheet | Each participant will be assessed once, after an average of 2-3 weeks following the intervention (teaching activity) | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Student's attitude about the teaching activity | Self-reported questionnaires | Each participant will be assessed once, after an average of 2-3 weeks following the intervention (teaching activity) | 
| Cultural communication skills (in OSCE) | SPs will be objectively grading the students on a scoring sheet | Each participant will be assessed once, after an average of 2-3 weeks following the intervention (teaching activity) | 
| Student's attitude about the assessment activity (OSCE) | Self-reported questionnaires | On the day of the assessment activity, after an average of 2-3 weeks following the intervention (teaching activity) | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Breast Cancer detection, Breast Simulator, Hybrid Simulation, Patient Simulation, Standardized Patient, Medical student education, Health Communication, Communication Barriers, Cultural competency, Cultural, Middle East, Clinical Breast Examination, Lebanon