The standardized live patient and mechanical patient models--their roles in trauma teaching.

BACKGROUND: We have previously demonstrated improved medical student performance using standardized live patient models in the Trauma Evaluation and Management (TEAM) program. The trauma manikin has also been offered as an option for teaching trauma skills in this program. In this study, we compare performance using both models. METHODS: Final year medical students were randomly assigned to three groups: group I (n = 22) with neither model, group II (n = 24) with patient model, and group III (n = 24) with mechanical model using the same clinical scenario. All students completed pre-TEAM and post-TEAM multiple choice question (MCQ) exams and an evaluation questionnaire scoring five items on a scale of 1 to 5 with 5 being the highest. The items were objectives were met, knowledge improved, skills improved, overall satisfaction, and course should be mandatory. Students (groups II and III) then switched models, rating preferences in six categories: more challenging, more interesting, more dynamic, more enjoyable learning, more realistic, and overall better model. Scores were analyzed by ANOVA with p < 0.05 being considered statistically significant. RESULTS: All groups had similar scores (means % +/- SD)in the pretest (group I - 50.8 +/- 7.4, group II - 51.3 +/- 6.4, group III - 51.1 +/- 6.6). All groups improved their post-test scores but groups II and III scored higher than group I with no difference in scores between groups II and III (group I - 77.5 +/- 3.8, group II - 84.8 +/- 3.6, group III - 86.3 +/- 3.2). The percent of students scoring 5 in the questionnaire are as follows: objectives met - 100% for all groups; knowledge improved: group I - 91%, group II - 96%, group III - 92%; skills improved: group I - 9%, group II - 83%, group III - 96%; overall satisfaction: group I - 91%, group II - 92%, group III - 92%; should be mandatory: group I - 32%, group II - 96%, group III - 100%. Student preferences (48 students) are as follows: the mechanical model was more challenging (44 of 48); more interesting (40 of 48); more dynamic (46 of 48); more enjoyable (48 of 48); more realistic (32/48), and better overall model (42 of 48). CONCLUSIONS: Using the TEAM program, we have demonstrated that improvement in knowledge and skills are equally enhanced by using mechanical or patient models in trauma teaching. However, students overwhelmingly preferred the mechanical model.

The simulated Trauma Patient Teaching Module--does it improve student performance?

BACKGROUND: Student feedback from the old TEAM (Trauma Evaluation and Management) program prompted introduction of simulated trauma patient models in the new program. Performance after the new and old programs was compared to assess the impact of the simulated patient models. METHODS: Final year medical students randomly assigned to control and experimental groups completed a 20-item trauma multiple choice questionnaire examination (MCQE). The experimental groups attended the old or new TEAM program before completing a second MCQE and the control groups completed the same post-test without the TEAM programs. We used paired t tests for within and unpaired t tests for between group comparisons of the control and experimental groups' performances on the MCQ pre- and post-tests. On a 1 to 5 scale, students graded if objectives were met; trauma knowledge improved; trauma skills improved; overall satisfaction; and if TEAM should be mandatory. RESULTS: Post-test scores increased significantly after both the old and new programs but the increase was statistically significantly greater after the new program. In the old TEAM, 51.6% rated improvement in trauma skills at 4 or greater compared with 97.3% in the new program. A large percentage of students in the old program requested more hands-on teaching. Of students, 85% scored honors pass mark after completion of the new TEAM format, and no honors pass marks were achieved after completion of the old TEAM format. CONCLUSION: Simulated trauma patient models were rated highly and improved both trauma skills and knowledge. Wider application of these teaching models is suggested.

Healthy-year equivalents in major joint replacement. Can patients provide meaningful responses?

OBJECTIVES: Healthy-years equivalents (HYEs) have been proposed as an evaluative measure with advantages over quality-adjusted life-years (QALYs). The main purpose was to assess the feasibility of eliciting HYEs from patients who have undergone major joint replacement; a secondary objective was to examine relationships with postsurgical health status. METHODS: Pre- and postsurgical reports of perceived comorbidity and current arthritic burden were obtained from 194 patients, using a comorbidity checklist, summary scores from the Western Ontario/McMaster Osteoarthritis Questionnaire (WOMAC), summary scores derived from six Likert scales, and holistic utility scores for the same attributes. After surgery, HYEs for the full across-time health profile were also elicited. RESULTS: All measures of arthritic burden were sensitive to pre/postsurgical changes (p = .0001), and comorbidity scores were stable. Two HYE subgroups emerged. An HYE-invariant subgroup ascribed full HYEs to their profiles, while reporting higher Likert (t = 2.1309; p = .0344) and utility (s = 4.1504; p = .0001) scores for their postsurgical health state. An HYE-variant subgroup reported HYEs that were weakly but significantly (p < .009) correlated with Likert (r = .30), utility (rs = .25), and comorbidity (r = -.26) scores for their postsurgical state. CONCLUSIONS: Our results indicate that patients can understand the HYE assessment procedures and provide interpretable responses. However, a significant proportion reports invariant HYEs that could inflate estimates of the overall mean HYE. Further exploration of the HYEs reported by different clinical and attitudinal populations is needed before widespread adoption of this measure.