Clinical trial NCT02125487: Hybrid Simulation in Teaching Clinical Breast Examination
Official title: The Use of Hybrid Simulation (HS) of the Breast in Teaching Clinical Breast Examination (CBE) to Medical Students.
Study type: INTERVENTIONAL
Overall status: COMPLETED
Phase: NA
Conditions: Medical Education
Clinical Breast Examination
Medical Simulation
Standardized Patient
Keywords: Clinical Breast Examination
Breast Cancer detection
Breast Simulator
Hybrid Simulation
Patient Simulation
Standardized Patient
Medical student education
Health Communication
Communication Barriers
Cultural competency
Cultural
Middle East
Lebanon
Lead sponsor: American University of Beirut Medical Center
Sponsor class: OTHER
First posted: 2014-04-29
Enrollment: 82
Sex: ALL
Standard ages: CHILD
ADULT
OLDER_ADULT
Accepts healthy volunteers: yes
Allocation: RANDOMIZED
Intervention model: PARALLEL

Brief summary: 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: 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.

Eligibility criteria: 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

Primary outcomes:
measure: CBE completeness (in OSCE)
timeFrame: Each participant will be assessed once, after an average of 2-3 weeks following the intervention (teaching activity)
Secondary outcomes:
measure: Student's attitude about the teaching activity
timeFrame: Each participant will be assessed once, after an average of 2-3 weeks following the intervention (teaching activity)
measure: Cultural communication skills (in OSCE)
timeFrame: Each participant will be assessed once, after an average of 2-3 weeks following the intervention (teaching activity)
measure: Student's attitude about the assessment activity (OSCE)
timeFrame: On the day of the assessment activity, after an average of 2-3 weeks following the intervention (teaching activity)
Other outcomes:
Locations:
city: Beirut
country: Lebanon
facility: American University of Beirut Medical Center
Study officials:
affiliation: American University of Beirut Medical Center
name: Abdul Karim Sleiman, MD
role: STUDY_DIRECTOR
affiliation: American University of Beirut Medical Center
name: Rana Sharara-Chami, MD
role: PRINCIPAL_INVESTIGATOR
References:
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citation: Pugh CM, Salud LH; Association for Surgical Education. Fear of missing a lesion: use of simulated breast models to decrease student anxiety when learning clinical breast examinations. Am J Surg. 2007 Jun;193(6):766-70. doi: 10.1016/j.amjsurg.2006.12.033.
citation: Schubart JR, Erdahl L, Smith JS Jr, Purichia H, Kauffman GL, Kass RB. Use of breast simulators compared with standardized patients in teaching the clinical breast examination to medical students. J Surg Educ. 2012 May-Jun;69(3):416-22. doi: 10.1016/j.jsurg.2011.10.005. Epub 2011 Nov 25.
citation: Nassif J, Sleiman AK, Nassar AH, Naamani S, Sharara-Chami R. Hybrid Simulation in Teaching Clinical Breast Examination to Medical Students. J Cancer Educ. 2019 Feb;34(1):194-200. doi: 10.1007/s13187-017-1287-3.