title: Use of breast simulators compared with standardized patients in teaching the clinical breast examination to medical students.
abstract: OBJECTIVE
  Simulators have replaced some standardized patients in medical student teaching, and their use seems to decrease anxiety related to the clinical breast examination (CBE). We compared learning the CBE on a breast palpation simulator with learning on a standardized patient with respect to skill acquisition and comfort level.
  
  
  METHODS
  At Penn State College of Medicine, the class of 2008 (historical control group, n = 113) learned the CBE on a standardized patient, whereas the class of 2009 (experimental group, n = 131) learned on the breast palpation simulator. We used measures of the process (conducting the CBE) and measures of the outcome (examination scores and detection of abnormal findings). During their third-year surgical clerkship, students in both groups completed a questionnaire reporting the number of CBEs performed and confidence in performing the CBE. The students then performed an observed examination on the simulator, and the number of positive findings detected was recorded. The mean number of positive findings was compared between groups, and an economic analysis was conducted.
  
  
  RESULTS
  The experimental group had a significantly higher mean examination score than the historical control. In subgroups, this difference was significant for those who reported performing 0-5 clinical examinations but for not those who had performed >6 examinations. On individual items, the experimental group scored significantly higher in examining for neck nodes, nipple retraction, skin changes, and axillary evaluation. The 2 groups did not differ significantly in the mean number of positive findings detected or in ratings of comfort level.
  
  
  CONCLUSIONS
  Medical students who learned the CBE on breast palpation simulators performed as well or better than those who learned on standardized patients; however, a subgroup analysis revealed that the benefit was limited to students with less clinical experience.
authors.affiliation: Department of Surgery, Penn State College of Medicine, Hershey, Pennsylvania 17033, USA. jschubart@hmc.psu.edu
authors.forename: Jane R
authors.initials: JR
authors.lastname: Schubart
authors.forename: Lillian
authors.initials: L
authors.lastname: Erdahl
authors.forename: J Stanley
authors.initials: JS
authors.lastname: Smith
authors.forename: Heather
authors.initials: H
authors.lastname: Purichia
authors.forename: Gordon L
authors.initials: GL
authors.lastname: Kauffman
authors.forename: Rena B
authors.initials: RB
authors.lastname: Kass
mesh_terms: D001941:Breast Diseases / Q000175:diagnosis*; D002982:Clinical Clerkship / Q000706:statistics & numerical data; D002983:Clinical Competence; D003198:Computer Simulation; D016001:Confidence Intervals; D004504:Education, Medical, Undergraduate / Q000458:organization & administration; D005260:Female; D006801:Humans; D008297:Male; D016017:Odds Ratio; D010173:Palpation; D016544:Patient Simulation; D010808:Physical Examination / Q000379:methods*; D013337:Students, Medical / Q000706:statistics & numerical data; D055815:Young Adult