Simulation training improves diagnostic performance on a real patient with similar clinical findings.
BACKGROUND
Training on a cardiopulmonary simulator improves subsequent diagnostic performance on the same simulator. But data are lacking on transfer of learning. The objective of this study was to determine whether training on a cardiorespiratory simulator improves diagnostic performance on a real patient.


METHODS
We randomly allocated first-year medical students at the University of Calgary to simulator training in one of three clinical scenarios of acute-onset chest pain: pulmonary embolism with right ventricular strain but no murmur, symptomatic aortic stenosis, or myocardial ischemia causing mitral regurgitation. Simulation sessions ran for 20 min, after which participants had a standardized debriefing session and reviewed the physical findings. Immediately following the training sessions, students assessed the auscultatory findings of a real patient with mitral regurgitation. Our outcome measures were accuracy of identifying abnormal auscultatory findings and diagnosing the underlying cardiac abnormality (mitral regurgitation).


RESULTS
Eighty-six students participated in the study. Students trained on mitral regurgitation were more likely to identify and diagnose these findings on a real patient with mitral regurgitation than those who had trained on aortic stenosis or a scenario with no cardiac murmur. The accuracy (SD) of identifying clinical features of mitral regurgitation for these three groups was 74.0 (36.4) vs 56.2 (34.3) vs 36.8 (33.1), respectively (P = .0005), and for diagnosing mitral regurgitation, the accuracy was 68.0 (45.4) vs 51.6 (50.0) vs 29.9 (40.7), respectively (P = .01).


CONCLUSIONS
Simulator training on mitral regurgitation increases the likelihood of diagnosing this abnormality on a real patient.
Fraser
Kristin
K
Department of Medicine, University of Calgary, Calgary, AB, Canada.
Wright
Bruce
B
Department of Family Medicine, University of Calgary, Calgary, AB, Canada; Office of Undergraduate Medical Education, University of Calgary, Calgary, AB, Canada.
Girard
Louis
L
Department of Medicine, University of Calgary, Calgary, AB, Canada.
Tworek
Janet
J
Office of Undergraduate Medical Education, University of Calgary, Calgary, AB, Canada.
Paget
Mike
M
Office of Undergraduate Medical Education, University of Calgary, Calgary, AB, Canada.
Welikovich
Lisa
L
Department of Medicine, University of Calgary, Calgary, AB, Canada.
McLaughlin
Kevin
K
Department of Medicine, University of Calgary, Calgary, AB, Canada; Office of Undergraduate Medical Education, University of Calgary, Calgary, AB, Canada. Electronic address: kmclaugh@ucalgary.ca.
D000328:Adult; D000704:Analysis of Variance; D001018:Aortic Diseases / Q000150:complications / Q000175:diagnosis*; D001314:Auscultation; D002637:Chest Pain / Q000175:diagnosis* / Q000209:etiology; D002983:Clinical Competence; D004504:Education, Medical, Undergraduate / Q000379:methods*; D004521:Educational Measurement; D005260:Female; D006801:Humans; D008297:Male; D008944:Mitral Valve Insufficiency / Q000150:complications / Q000175:diagnosis*; D016544:Patient Simulation; D011446:Prospective Studies