Teaching elliptical excision skills to novice medical students: a randomized controlled study comparing low- and high-fidelity bench models.
BACKGROUND
The search for alternative and effective forms of training simulation is needed due to ethical and medico-legal aspects involved in training surgical skills on living patients, human cadavers and living animals.


OBJECTIVE
To evaluate if the bench model fidelity interferes in the acquisition of elliptical excision skills by novice medical students.


METHODS
Forty novice medical students were randomly assigned to 5 practice conditions with instructor-directed elliptical excision skills' training (n = 8): didactic materials (control); organic bench model (low-fidelity); ethylene-vinyl acetate bench model (low-fidelity); chicken legs' skin bench model (high-fidelity); or pig foot skin bench model (high-fidelity). Pre- and post-tests were applied. Global rating scale, effect size, and self-perceived confidence based on Likert scale were used to evaluate all elliptical excision performances.


RESULTS
The analysis showed that after training, the students practicing on bench models had better performance based on Global rating scale (all P < 0.0000) and felt more confident to perform elliptical excision skills (all P < 0.0000) when compared to the control. There was no significant difference (all P > 0.05) between the groups that trained on bench models. The magnitude of the effect (basic cutaneous surgery skills' training) was considered large (>0.80) in all measurements.


CONCLUSIONS
The acquisition of elliptical excision skills after instructor-directed training on low-fidelity bench models was similar to the training on high-fidelity bench models; and there was a more substantial increase in elliptical excision performances of students that trained on all simulators compared to the learning on didactic materials.
Department of Surgery, Botucatu Medical School, University of the State of São Paulo, Botucatu, Brazil ; Institute of Plastic and Craniofacial Surgery, Brazilian Society of Research and Assistance to Craniofacial Rehabilitation Hospital, Campinas, Brazil.
Rafael
R
Denadai
Department of Statistics, Faculty of Technology, São Paulo State Technological Colleges, Marilia, SP, Brazil.
Marie
M
Oshiiwa
Department of Surgery, Botucatu Medical School, University of the State of São Paulo, Botucatu, Brazil.
Rogério
R
Saad-Hossne
Cutaneous surgery; elliptical excision; excisional biopsy; medical education; medical student; teaching