Clinical trial NCT05895799: Whole-task Hybrid Simulation Improves Medical Student Competence in Cardiology Clerkship
Official title: Assessing the Utility of Hybrid Simulation With Wearable Technology and Repeated Peer Assessment on Medical Student Learning and Performance in Cardiology Long Case Examinations - the ASSIMILATE ExCELLENCE Study
Study type: INTERVENTIONAL
Overall status: COMPLETED
Phase: NA
Conditions: Valvular Heart Disease
Keywords: Hybrid simulation
Cardiology clerkship
Peer assessment
Whole-task learning
Standardized patient
Wearable technology
Lead sponsor: Royal College of Surgeons, Ireland
Sponsor class: OTHER
Collaborators: name: Connolly Hospital Blanchardstown
First posted: 2023-06-09
Enrollment: 77
Sex: ALL
Minimum age (years): 18
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: yes
Allocation: RANDOMIZED
Intervention model: CROSSOVER
Intervention model description: Randomized controlled waitlist design
Primary purpose: OTHER

Brief summary: The goal of this randomized controlled waitlist trial is to assess the utility of expert tuition with hybrid simulation and repeated peer grading on medical student learning and performance in cardiology long-case examinations. The primary aim of this research is to assess the effects of time, individual teaching with an expert trainer, and repeated peer assessment on students' performance scores in sequential formative long-case examinations in cardiology. The secondary aims are: (a) to assess to what degree performance scores change over time with respect to the intervention group, and (b) to assess for any change in the level of inter-observer variability over time.

Participants will be randomized into two groups and undertake three formative long-case examinations in cardiology with a hybrid patient. Each group will have tuition from an expert trainer in a randomized controlled waitlist design. The investigators will compare groups to see if the tuition from a clinical expert has an effect on participants' performance.

Detailed description: The long case examination in medicine is regarded as an authentic test of clinical competence; however, it has been shown to have low reliability and validity due to the variability in the patients used and subjective examiner grading. In this study, the investigators hypothesized that expert tuition with hybrid simulation using a standardized patient wearing a novel auscultation vest, i.e., a hybrid patient, and repeated peer grading would improve student learning and performance in sequential cardiology long case examinations. Furthermore, they hypothesized that the format's validity would improve through the use of less subjective quantitative scoring checklists.

Scripted histories and scoring checklists for three clinical scenarios in cardiology were co-created and refined through iterative consensus by a panel of clinical experts; these were then paired with recordings of auscultatory findings from three real patients with known valvular heart disease. A wearable vest with embedded pressure-sensitive panel speakers was developed to transmit these recordings when examined at the anatomically standard auscultation points. Students in the Graduate Entry Medicine degree program at RCSI were invited to enroll in the study and undertake a series of three long case examinations in cardiology (LC1 - LC3) using hybrid simulation. Each participant's performance was recorded and graded using the novel scoring checklist by two peer participants and two RCSI examiners. In addition, participants were randomized into two groups: Group 1 received individual and small-group teaching with a hybrid patient from an expert trainer between LC1 and LC2; those in Group 2 received the same intervention between LC2 and LC3 (a randomized controlled waitlist design). Participants completed a pre- and post-study questionnaire. Data are presented as number (%), mean ± standard deviation, or median (interquartile range). Group comparisons were made using either the unpaired t-test or the chi-squared (χ2) test. A p-value \< .05 was considered statistically significant. Multivariate analysis was undertaken using general linear mixed modeling and multiple logistic regression. Inter-observer variability was assessed using the Intraclass Correlation Coefficient (ICC).

Eligibility criteria: Inclusion Criteria:

1. were in either Year 2 of the Graduate Entry Medicine (GEM) program (equivalent to Year 3/5 of the Direct Entry Medical Degree Programme), or Year 1 of the Senior Cycle, i.e., Year 4/5 of the Direct Entry Medical Degree Programme, having completed Year 2 of the GEM program in the preceding year; and
2. had successfully completed the standard RCSI module in Clinical Cardiology.

Exclusion Criteria:

None

Primary outcomes:
measure: Students' total scores in sequential cardiology long case examinations
timeFrame: Within 6 months of study completion
Secondary outcomes:
measure: Students' total scores categorized by intervention group in sequential cardiology long case examinations
timeFrame: Within 6 months of study completion
measure: Variability in students' performance scores in sequential cardiology long case examinations as assessed by peer and faculty graders
timeFrame: Within 6 months of study completion
Other outcomes:
Locations:
city: Dublin
country: Ireland
facility: Royal College of Surgeons in Ireland
Study officials:
affiliation: RCSI
name: Claire Condron, PhD
role: STUDY_DIRECTOR
References: