title: Simulation training improves diagnostic performance on a real patient with similar clinical findings.
abstract: 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.
authors.affiliation: Department of Medicine, University of Calgary, Calgary, AB, Canada.
authors.forename: Kristin
authors.initials: K
authors.lastname: Fraser
authors.affiliation: Department of Family Medicine, University of Calgary, Calgary, AB, Canada; Office of Undergraduate Medical Education, University of Calgary, Calgary, AB, Canada.
authors.forename: Bruce
authors.initials: B
authors.lastname: Wright
authors.affiliation: Department of Medicine, University of Calgary, Calgary, AB, Canada.
authors.forename: Louis
authors.initials: L
authors.lastname: Girard
authors.affiliation: Office of Undergraduate Medical Education, University of Calgary, Calgary, AB, Canada.
authors.forename: Janet
authors.initials: J
authors.lastname: Tworek
authors.affiliation: Office of Undergraduate Medical Education, University of Calgary, Calgary, AB, Canada.
authors.forename: Mike
authors.initials: M
authors.lastname: Paget
authors.affiliation: Department of Medicine, University of Calgary, Calgary, AB, Canada.
authors.forename: Lisa
authors.initials: L
authors.lastname: Welikovich
authors.affiliation: 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.
authors.forename: Kevin
authors.initials: K
authors.lastname: McLaughlin
mesh_terms: 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