Hybrid Simulation in Teaching Clinical Breast Examination

Abstract

This article was migrated. The article was not marked as recommended. Problem: Clinical Breast Examination (CBE) is traditionally taught to third year medical students using a lecture and a table-top breast model. The opportunity to clinically practice CBE depends on patient availability and willingness to be examined by students, especially in culturally sensitive environments. Intervention: We employed hybrid simulation of the breast and aimed to investigate its effectiveness as an educational tool for teaching CBE to medical students. The hybrid simulation model consists of a standardized patient (SP) wearing a silicone breast simulator jacket. Context: We compared the use of this tool to the traditional method using a blinded randomized controlled design. Medical students (N=82, 48.8% male) were randomized into teaching activities: hybrid simulation and control. Both groups received didactic teaching followed by a practical session. The control group practiced on the table-top model traditionally used while the intervention group practiced on the hybrid model (SP+breast jacket). Next, all students were assessed on their technical and communication skills in an Objective Structured Clinical Examination (OSCE) that included three SP stations. SPs were trained to act according to specified cultural roles: a liberal woman, a veiled woman and a moderately modest woman. Assessment employed a variety of simulated lesions. Outcomes: The hypothesized outcomes consisted of a more complete acquisition of CBE skills, improved lesion detection and better communication skills. CBE completeness scores did not differ between the two groups (p=0.889). Hybrid simulation improved lesion identification grades (p<0.001) without increasing false positives. Communication skills were worse in the hybrid simulation group as graded by the SP (p<0.001), but not as reported by the students (p=0.346). We commented on the students' comfort during OSCE. Hybrid simulation relieved the fear of missing a lesion on CBE (p=0.043) and increased satisfaction with the teaching method among students (p=0.002). Lessons Learned: As a novel educational tool, hybrid simulation improves the sensitivity of CBE done by medical students without affecting its specificity. Although it might not necessarily improve their communication or sensitivity to cultural aspects of CBE, hybrid simulation might have a role in increasing the self-confidence of medical students during CBE.