title: A study to investigate the effectiveness of SimMan® as an adjunct in teaching preclinical skills to medical students.
abstract: BACKGROUND
  Following the GMC's report on Tomorrow's Doctors, greater emphasis has been placed on training in clinical skills, and the integration of clinical and basic sciences within the curriculum to promote the development of effective doctors. The use of simulation in the learning environment has the potential to support the development of clinical skills in preclinical medical students whilst in a 'safe' environment, but currently there is little evidence on its effectiveness.
  
  
  METHODS
  Seventy nine year one medical students were divided into two groups. A pre-test was conducted by both groups, after which one group performed chest examination on their peers whilst the other group examined the SimMan® manikin. Both groups subsequently performed a mid-test and crossed over so that the group that conducted peer examination examined the manikin and vice-versa. Finally a post-test was conducted. The students were scored for formative feedback whilst performing examinations. Students completed a feedback questionnaire at the end of the session. Data were analysed using a one-way ANOVA, independent t-test and 2- proportion Z test.
  
  
  RESULTS
  When the two groups were compared, there was no significant difference in their pre-test and post-test knowledge scores, whereas mid-test knowledge scores increased significantly (P < 0.001), with the group using SimMan® initially scoring higher. A significant increase in the test scores was seen in both groups after using SimMan® (P < 0.001). Students' confidence increased significantly in differentiating between normal and abnormal signs (P < 0.001). Students highly valued the use of the manikin in the session with 96% of students reporting that it enhanced their learning experience.
  
  
  CONCLUSIONS
  The study demonstrated a significant improvement in the students' knowledge after examining the manikin and students also reported an increase in their confidence. Students' feedback was generally very positive and they perceived the incorporation of manikin-based examinations useful to prepare them for future patient contact. The use of simulation in this context supports an integrated learning approach when used as an adjunct to peer examination, and can benefit the acquisition of clinical skills in preclinical medical students.
authors.affiliation: School of Medicine, Pharmacy and Health, Holliday Building, Durham University, Queen's Campus, University Boulevard, Stockton on Tees TS17 6BH, UK. meenakshi.swamy@durham.ac.uk.
authors.forename: Meenakshi
authors.initials: M
authors.lastname: Swamy
authors.forename: Marina
authors.initials: M
authors.lastname: Sawdon
authors.forename: Andrew
authors.initials: A
authors.lastname: Chaytor
authors.forename: David
authors.initials: D
authors.lastname: Cox
authors.forename: Judith
authors.initials: J
authors.lastname: Barbaro-Brown
authors.forename: John
authors.initials: J
authors.lastname: McLachlan
mesh_terms: D000328:Adult; D000704:Analysis of Variance; D002983:Clinical Competence; D015331:Cohort Studies; D018592:Cross-Over Studies; D004504:Education, Medical, Undergraduate / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008348:Manikins; D016544:Patient Simulation; D010808:Physical Examination / Q000379:methods*; D018794:Problem-Based Learning; D013337:Students, Medical; D013647:Task Performance and Analysis