Javascript is currently disabled in your browser. When javascript is disabled, some functions of this website will not work.
Open access for scientific and medical research
From submission to the first editing decision.
From editor acceptance to publication.
The above percentage of manuscripts have been rejected in the past 12 months.
Open access to peer-reviewed scientific and medical journals.
Dove Medical Press is a member of OAI.
Batch reprints for the pharmaceutical industry.
We provide real benefits for authors, including fast processing of papers.
Register your specific details and specific drugs of interest, and we will match the information you provide with articles in our extensive database and send you a PDF copy via email in a timely manner.
Back to Journal »Advances in Medical Education and Practice» Volume 11
Integrate high-fidelity simulation into the medical cardiovascular physiology curriculum
Author Zheng Jie, Lapu R, Khalid H
The 2020 volume will be published on January 15, 2020: 11 pages 41-50
DOI https://doi.org/10.2147/AMEP.S230084
Single anonymous peer review
Editor who approved for publication: Dr. Md Anwarul Azim Majumder
Jinjie Zheng, 1 Rigobert Lapu, 2 Hammad Khalid 3 1 Department of Medical Education, Morehouse Medical School, Atlanta, Georgia, USA; 2 Department of Medicine, Morehouse Medical College, Atlanta, Georgia, USA; Morehouse Medical College, Atlanta, Georgia, USA 3MD project mailing address: Jinjie Zheng Morehouse School of Medicine, 720 Westview Drive, SW, Atlanta, GA 30310, USA Phone +1404 752 1565 Fax +1404 752 1064 Email [email protection] Introduction: The challenge of transitioning from basic science to clerical staff It is well recognized in medical education. High-fidelity simulation has established a record of improving clinical reasoning and clinical skills, and has been proposed as a viable way to bridge the gap between basic science and clerks. However, little is known about the results of using simulation to resolve this gap. Method: In 2018, Morehouse Medical College strengthened the first-year cardiovascular physiology curriculum, integrating the high-fidelity simulation iStan into the cardiovascular physiology curriculum, aiming at early clinical exposure, grasping cardiovascular concepts, and increasing clinical relevance. The integration includes three structural design elements: (a) simulated clinical case introduction; (b) simulated clinical case development; (c) student-led clinical case study. Results: The first-year medical (MD1) students’ performance in cardiovascular physiology was significantly improved compared with the MD1 students in the first two cohorts, and the test-taking time of the students was significantly reduced compared with the performance of the first two counterpart cohorts. Students report Said that they are more involved in simulated enhanced cardiovascular physiology courses. Conclusion: The research results provide preliminary evidence that the structural integration of high-fidelity simulations in the cardiovascular physiology curriculum has proven successful in students' learning experience and learning outcomes. The three core elements of high-fidelity simulation integration can provide information for future efforts, as a structural solution that effectively bridges the gap between basic scientific concepts and clinical reasoning through the use of high-fidelity simulation. Keywords: high-fidelity simulation, pre-clinical curriculum integration, evaluation, simulation case development
The ongoing redesign of the national medical curriculum is characterized by the creative use of various teaching methods and the most advanced technology to narrow the gap in medical care capabilities. 1-3 Successful knowledge transfer from basic science concepts to clinical reasoning to clinical skills has been identified as a challenging field that can benefit from this endeavor. 4-6 Specifically, high-fidelity simulation has been proposed as a feasible method to enhance basic scientific concepts and clinical reasoning skills in the early stages of medical student training, and has proven the validity of the evidence. 4,7,8
Existing research and teaching literature provides promising evidence in this regard: High-fidelity simulation has been described as a way to educate third-year clerk and resident medical students by providing a low-risk, safe learning environment. 9,10,11 A variety of group activities aim to integrate simulation into the cardiovascular physiology curriculum, provide students with hands-on simulation experience and improve clinical reasoning skills. 12,13 The effective integration of high-fidelity simulation in lecture hall-based preclinical research requires reliable data-driven evidence from different methods to establish and inform practice. 14 Many research reports on this topic were published about ten years ago. Some limiting factors may lead to a lack of continuous literature in this field: for example, overwhelming design and implementation decisions and execution, juggling choices of multiple teaching methods, group simulation scheduling conflicts in the first few years of clinical practice, and the relationship between learning results and time and energy Return on investment.
This article studies the results of structured integration of high-fidelity simulations in the cardiovascular physiology curriculum. Specifically, we purposefully integrated three structural elements into the cardiovascular physiology curriculum: simulated clinical case introduction; simulated clinical case development; and student-centered group case studies. In this article, we introduced in detail the decision-making of clinical case revision, step-by-step high-fidelity simulation integration methods, and students' learning experience and learning outcomes. By detailing the reproducible steps and providing a framework for this simulation integration, we hope to provide information for future practice and encourage renewed discussions on the use of high-fidelity simulations to close the capability gap between basic science and clinical relevance.
The study was approved by the Institutional Review Board (IRB) of Morehouse Medical School as a Category IV exemption in 2018. The study used a historically controlled non-experimental cohort study. The 101 first-year medical (MD1) students in the 2018 cohort participated in the simulation-integrated cardiovascular physiology course as a convenient sample. The results of their course learning were compared with students who had experienced traditional lecture-style courses in 2017 and 2016. Participating students answered the simulated integration course survey anonymously. The study attempts to answer two research questions: First, what is the result of integrating high-fidelity simulation into the cardiovascular physiology curriculum compared to the unintegrated curriculum? Second, what is the feedback and learning experience of students on the integrated simulation course?
The purpose of the integration is threefold: to familiarize students with the clinical environment as soon as possible; to improve the grasp of the concepts of cardiovascular physiology; and to improve the clinical reasoning ability. Through many planning and design links, the following three structural elements have been specially designed and integrated into the curriculum. Figure 1 illustrates the details of these three elements, and then describes each element in detail. Figure 1 Flow chart of our step-by-step high-fidelity simulation integration method (simulation-based learning and problem-based learning).
Figure 1 Flow chart of our step-by-step high-fidelity simulation integration method (simulation-based learning and problem-based learning).
The cardiovascular physiology course requires eight 90-minute lectures in a 4-week span. We implemented element A in the second cardiovascular physiology lecture, when simulated patient cases were introduced to first-year medical (MD1) students via a real-time TV stream from the simulation center to the lecture hall. The Physician Instructor (RL) introduced the case and simulated real-time vital signs and electrocardiogram (ECG) of the high-fidelity simulator (iStan) in the lecture, which is designed to depict hypertension (hypertension) and subsequently develop myocardial infarction. Element B requires a 90-minute interactive, problem-based problem-solving lecture hall session during class 7 of the cardiovascular physiology course. Lecturers (RL) use three pre-designed iStan interactive videos to present and model simulated standardized patient visits, clinical case presentations, and case development, as clinical triggers for problem-based learning courses in large classroom lectures. Element C, composed of a student-led group case study, concludes the cardiovascular physiology course. Each element is explained further below.
The initial iStan clinical case presentation was carried out through real-time streaming from the simulation center to the lecture hall, aiming to create a real learning environment and bring the "immediacy" and "realistic" emotions of clinical cases into the classroom. End of introduction After the lecture goal, the lecturer introduced the use of the simulation center, and then dialed the simulation center phone from the classroom in real time. The scene of the clinical scene is presented through the classroom projector through the clinical skill teaching software called "learning space". The physician simulation supervisor showed iStan patient cases, as well as the vital signs of baseline vital signs, high-risk patient cases, and case scenarios of interest (shock). After the introduction of the iStan case, the first integration event is over. There are three reasons for choosing the iStan high-fidelity simulator: (1) iStan is equipped with a physiological model and responds to abnormal physiology for teaching purposes; (2) iStan has a wireless microphone to simulate a doctor-patient encounter, and (3) iStan is placed In one room, there is a two-way mirror in the room for the director of the simulator center to conveniently role-play the patient's verbal encounter.
The purpose of element B is to use iStan: (a) As part of the clinical development case presentation process, taking the standardized patient visit process as an example; (b) presenting the vital signs of case development; (c) providing instant problem-solving process for students Feedback of clinical reasoning results. This time, the iStan course integration was achieved by integrating three pre-designed and pre-recorded videos into a complete 90-minute lecturer-led problem-solving meeting. These three videos are quoted below to further clarify the key steps in the teaching process: Initial standardized simulation patient encounter video A standardized patient vital signs/ECG video B Electric shock simulation interested patient vital signs/ECG video C
The following teaching process introduces the following step-by-step methods: simulation video integration; patient encounter report; comprehensive review of cardiovascular physiology concepts in the context of clinical case development; and interactive questioning. Recall the patient case in the last simulation center. Invite students to review simulated patient cases as doctors. Students watch the meeting between the instructor and the standardized patient simulator, and the patient simulator introduces the case development and main complaint (Video A). The lecturer guides the students to analyze simulated standardized patient encounters. A summary of the patient simulation experience. The lecturer interactively guides students to explore the medical history, case development and screening process. Teachers use basic scientific concepts to conduct clinical reasoning and ask students questions in an interactive way. A simulated patient’s baseline vital signs/ECG is shown to confirm the clinical reasoning process (Video B). Instruct teachers to use basic science concepts to ask students questions to solve the clinical prediction problem of case development. The vital signs/ECG display of a simulated shock case confirmed the validity of the clinical reasoning process (Video C). The lecturer reviewed the basic scientific concepts and clinical reasoning process involved in the development of simulated patient cases. The lecturer provided an additional PowerPoint presentation describing the use of the same clinical reasoning process for other clinical cases. The clinical relevance integration meeting is over, and the cardiovascular physiology team's student-centered clinical case studies will be connected (introduced), as discussed briefly below.
The purpose of this modified case scenario is to help students apply the basic cardiovascular principles they have learned from previous courses to the clinical environment, as shown below: (1) Concept: long-term/poorly controlled blood pressure (BP) or Hypertension (HTN) and the related effects of increased afterload (that is, increased aortic pressure) on the heart (that is, the pressure-volume loop of the ventricle). We discussed that afterload is the pressure at which the heart ventricles must eject blood. The afterload of the left ventricle is the aortic pressure. To open the aortic valve and eject blood, the left ventricular pressure must be increased to a level higher than the aortic pressure. Therefore, if the afterload increases, as in the case of this patient with long-term HTN, the left ventricle must work harder than usual to overcome this higher pressure. This leads to a reduction in stroke volume (SV), cardiac output (CO), ejection fraction (EF), and end-systolic volume (ESV). (2) A clear reasoning: ↑BP → ↑AFTERLOAD → ↑Myocardium, a condition called left ventricular hypertrophy (LVH) → Myocardial hypoxia due to imbalance of supply and demand → Myocardial ischemia/infarction → Myocardial death → Impaired cardiac contraction As a pump [↓ Contractility → ↓SV/CO/EF → ↓BP].
Our report covers the medical history of patients with acute chest pain syndrome who are at increased risk of multiple cardiac complications, including repetitive ischemia. In the case study described here, a patient with poor blood pressure/HTN and LVH control had a heart attack (ie myocardial infarction) accompanied by repeated/repeated myocardial ischemia, which ultimately resulted in impaired hemodynamics and Cardiogenic shock. This patient has a left ventricular wall infarction secondary to myocardial ischemia. This damage to the left ventricle impairs its function as a pump. The left ventricle can no longer produce enough pressure to eject blood normally. We discussed the conventional high-risk factors of this patient with acute chest pain that are susceptible to atherosclerotic cardiovascular disease (CVD), including older age and uncontrolled HTN [as in our case study]. The resulting myocardial changes (ie, LVH) are the most critical predisposing factor for heart attacks (ie, myocardial infarction). Other risk factors we discussed include smoking, obesity, and related lipid abnormalities, such as low HDL cholesterol.
Element C's student-led group case study concludes the cardiovascular physiology course. Each case study group consists of eight students and two faculty counselors (a basic scientist and a clinician). The purpose of student-led group case studies is to help students transition from a teacher-led problem-solving process to an independent problem-solving process. During this process, students completed two activities. First, students complete case study questions individually and submit their answers through the online discussion board on Canvas (the school’s e-learning management system). Then, they participated in a group case study meeting. The student-led case study meeting lasted for 45 minutes, during which the student group took the lead in solving clinical cases. During this period, the teacher facilitator is instructed not to interfere or teach the problem-solving process, but to observe, guide, and ask thought-provoking questions, and re-direct the conversation when it loses focus. Choose a different student leader for each group meeting to facilitate the progress of the case study.
There are four sources of research data: (1) students' test scores at the end of the course; (2) students' test time; (3) students' final course scores in the basic principles of human biology in the MD course, and (4) ) Students’ survey feedback on the experience and perceived value of simulation integration. The test scores, test time, final results of the basic principles and the first two cohorts of the students participating in 2018 are all retrieved from the school safety test system Examsoft (www.examsoft.com) and the 2018 MD1 student survey. The response data is retrieved through the school Collected by learning management system canvas (www.instructure.com). The cardiovascular physiology test consists of 10 questions, covering 10 interesting cardiovascular physiology concepts. At the end of the cardiovascular physiology course, a set of test questions with the same concepts for the 2016, 2017, and 2018 1st grade MD students was managed, which allowed consistent measurement of the learning outcomes of the three groups of students.
A post-simulation evaluation survey containing 15 items was conducted to measure the learning experience of students and their perceived value of the simulated comprehensive curriculum. Specifically, the three dimensions of the perceived value of the simulated integrated curriculum were asked: perceived learning experience, including related aspects such as motivation, enjoyment, and participation; perceived value in medical learning, including retention, conceptual understanding, communication, and clinical reasoning, etc. Aspect; and overall perceived value. The research project is first brainstormed by the research team to determine the original intention of the simulation integration and the desired classroom experience. The survey was externally reviewed by the Director of Simulation and the Director of the Organ System II Course before implementation, and went through two rounds of revision. Students rated each Likert scale survey item from very disagree (1 point) to very agree (5 points). The survey was conducted at the end of the 2018 fall semester, 2 months after the end of the simulated integrated cardiovascular physiology course, with the purpose of measuring the students' more lasting experience feedback and perceived value.
By comparing the test results of the 2018 cohort students this year with the test results of the first two student cohorts (the 2016 and 2017 cohorts), the impact of the integration of this simulation into the cardiovascular physiology curriculum was evaluated, and the basic principles were controlled Course grades in. Human biology. The collected data will be tabulated and imported into SPSS 23 for statistical analysis. Calculate the regression model after testing and satisfying the statistical assumptions of each model. The survey results are descriptively reported based on the average score of each survey item.
This study analyzed the test data of 294 students, including 101 students in the 2018 cohort, 101 students in the 2017 cohort, and 92 students in the 2016 cohort. The research results are reported from three aspects: (1) students' grasp of cardiovascular physiology concepts; (2) students' test response time, and (3) students' learning experience and the perceived value of simulation integration.
Since Levene's test for homogeneity of variance is statistically significant (F=26.214, p<0.000), students' test scores are converted into binary variables. The degree of concept mastery is determined by the complete test score coded as "1" and the partial score coded as "0". Table 1 shows the distribution of partial and complete concept mastery for the three research cohorts. The logistic regression model with the scores of the student population and the Basic Principles of Human Biology (BP) is used as the predictor variable into the model. The results show that when comparing the 2018 and 2017 cohorts, the BP course score is not an important predictor of concept mastery. In contrast, the cohort itself is an important predictor. Keeping the BP level at a fixed value, compared with the 2017 students (cohort = 0) with MD1 students in 2018 (cohort = 0), the probability of fully grasping the concept of cardiovascular physiology was 4.068. In other words, students in 2018 are 306% more likely to fully grasp the concept than students in 2017. Table 2 shows the logical model statistics. When comparing the performance of students in the 2018 cohort and the 2016 cohort, similar results appeared. Although the BP score is not an important predictor of a student's grasp of the cardiovascular concept, the probability that the MD1 students in 2018 fully grasp the concept is 4.319 compared with the 2016 MD1 students. Overall, the results show that the 2018 MD1 students who have experienced this kind of simulated integrated cardiovascular physiology course are significantly more likely to achieve complete conceptual mastery. Table 3 shows the relevant logical model statistics. Table 1 Concept mastery distribution of the three research cohorts Table 2 Logistic model: Basic principle (BP) score and cohort (2018 and 2017) on the impact of concept mastery Table 3 Logistic model: BP score and cohort (2018 and 2016 ) Proficient in the impact of concepts
Table 1 Concept mastery distribution of the three research cohorts
Table 2 Logistic model: the impact of basic principles (BP) scores and cohorts (2018 and 2017) on concept mastery
Table 3 Logistic model: The influence of BP scores and cohorts (2018 and 2016) on concept mastery
Comparing the average test time for each individual test item shows that students in the 2018 cohort took the least time to answer each of the 10 test items. Figure 2 shows the average test time (in seconds) for each test item in the three groups of students. Figure 2 Response time of a single test item across groups.
Figure 2 Response time of a single test item across groups.
Again, the Levine test was significant for the test time in the three cohorts (F = 12.429, p<0.001). A non-parametric Kruskal-Wallis test was performed to determine differences between groups, then a Mann-Whitney test was performed for comparisons between groups, and Bonferroni correction was used for multiple comparisons. The test results show that there are significant differences in the test time of the three groups of students (chi-square=102.672, p<0.001). The average ranking score of each test item in the cohort in 2018 was 79.49 seconds and 193.40 seconds. The 2017 queue, the 2016 queue 171.78 seconds. The subsequent Mann-Whitney test with Bonferroni correction shows that it is different from 2016 students (z=−8.148, p<0.001) and 2017 students (z =−9.041, p =0.000).
Among the 101 students in the 2018 cohort, 45 students completed the survey, with a response rate of 44.5%. The results showed that MD students in the first year reported positive learning experiences gained from the simulated integrated cardiovascular physiology course (M=4.41). In addition, students reported the value of simulation integration courses in medical learning (M=4.20) and more future integrations (M=4.17). Table 4 shows the detailed results of learning experience evaluation and perceived value. Table 4 Students’ perceived value of the simulated comprehensive cardiovascular physiology course
Table 4 Students’ perceived value of the simulated comprehensive cardiovascular physiology course
This article reports the methods and results of integrating high-fidelity simulation into cardiovascular physiology courses. Our three-pronged simulation course integration method, including case introduction, case development and case study, outlines a preliminary repeatable model, the conceptual complexity of which continues to increase for future iterations and improvements. This method determines the direct and potential teaching value of incorporating simulation into the curriculum. The comparison of learning outcomes reflected by student test scores shows that after simulation integration, after controlling for individual differences measured by previous course scores, the 2018 MD1 student cohort has significant conceptual mastery compared with the first two corresponding cohorts improve. Compared with the MD1 students in the first two cohorts, the student's test time is also significantly reduced. In addition, the post-assessment data shows that the simulation integration course brings a meaningful and enjoyable learning experience, and students realize the expected value of simulation integration into their medical education. These findings are consistent with previous research reports that the integration of simulation in the preclinical curriculum is beneficial to medical students. 3,4,9-11
This kind of analog integration work has some limitations. First, we should pay attention to the interpretation of the students' learning outcomes that are significantly improved compared to the first two MD1 student cohorts, and control the previous course performance. Since the study is not random, there is no direct causality established. Because these factors are acquired at one point in time, we cannot be sure of their temporal correlation with the overall perceived positive value or result. Second, the study used cardiovascular test scores to measure 10 cardiovascular concepts as learning outcomes. Although all three groups of MD1 students have been tested on the same set of concepts or questions, the test itself is not a comprehensive test of mastery of all cardiovascular concepts. Third, considering that the experience survey was conducted through online invitation 2 months after the simulation integration, students focused on other course content, and the survey response rate was 44.5%. Although the sample size is sufficient to capture the overall scope of feedback, sampling bias may be risked risks of. Fourth, the intervention aims to increase early clinical exposure, enhance the grasp of basic scientific concepts and clinical reasoning. In this article, we introduced in detail the methods for enhancing basic scientific concept mastery and clinical reasoning, and introduced the course results of concept mastery, exam time and student feedback. The written answers of the 2018 students to the Element C-Activity One case study questions can be used as data sources. Currently, the authors are developing and validating scoring standards to measure clinical reasoning skills. Although clinical reasoning was intentionally integrated and implemented in element B and element C in the design of the intervention, this study lacked direct measurement of the data of students' clinical reasoning results.
Despite the above limitations, these preliminary observations emphasize the need to further evaluate the relative role of this MD1 comprehensive course enhancement method in cardiovascular physiology. As an attractive model, it can be extended not only to other learner groups, but also to other pathologies. Physiological condition or disease process. This is the first time that we have integrated simulation into the cardiovascular physiology curriculum to enhance clinical reasoning, clinical exposure, and grasp of cardiovascular concepts. There may be similar opportunities in other aspects of the course, and we can use more clinical cases and techniques to further strengthen learning. The three elements clarified in the integration of simulation courses (case introduction + case development + student-centered group case studies) may be used as test models to integrate simulation into a broader basic science curriculum and continuously increase complexity and students Independence. Extending to disciplines such as pharmacology, microbiology, and pathophysiology in a systematic manner can generate more empirical evidence to better provide information for future simulation enhancement education work.
The integration of simulation courses in a large classroom environment shows that it is capable of accommodating different groups of medical students with different academic status. At-risk learners can benefit from contextual learning, guided and iterative basic scientific concept reviews, and clinical reasoning. Advanced learners can benefit from early clinical environment exposure, standardized patient encounter modeling, reporting, and independent case studies. The high degree of enthusiasm and acceptance of the students proves their meaningful integration into the educational curriculum, laying a solid foundation for their future success as doctors. It can also be used as an illustrative case and method to bridge the existing gap between medical education, technology, teaching methods and results.
This simulation integration in the cardiovascular physiology curriculum provides an experience case and method for integrating basic science courses, simulation technology and various teaching methods to achieve ideal medical learning results and experiences.
Many people have contributed to this ongoing project. We are especially grateful to the staff of the Office of Digital Learning (ODL), especially Ms. Allison Legister, Michelle McIver and N'Dieye Danavall for coordinating and providing technical solutions. The author also thanks Dr. Fung Yu mei and the staff of the Clinical Skills Center for their work on the iSTAN setting.
The authors report no conflicts of interest in this work.
1. Bradley P. The history of simulation and possible future directions in medical education. Medical education. 2006;40(3):254–262. doi:10.1111/j.1365-2929.2006.02394.x
2. Elisseou S, Puranam S, Nandi M. A novel, trauma-informed physical examination course designed for first-year medical students. MedEdPORTAL. 2019; 15:10799. doi:10.15766/mep_2374-8265.10799
3. Tan G, Ti L, Suresh S, Ho B, Lee T. Teaching first-year medical students physiology: Does the human patient simulator allow more effective teaching? Singapore Medical Journal 2002;43(5):238-242.
4. Gordon J, Brown D, Armstrong E. Can simulated intensive care accelerate the basic science learning of preclinical medical students? A pilot study. Simulated Health C. 2006;1 (Inauguration): 13-17. doi:10.1097/01266021-200600010-00005
5. McGaghie W, Issenberg S, Cohen E, Barsuk J, Wayne D. Does simulation-based medical education and deliberate practice produce better results than traditional clinical education? A comparative review of a meta-analysis of the evidence. Akkad Medicine. 2011;86(6):706–711. doi:10.1097/acm.0b013e318217e119
6. McGaghie W, Issenberg S, Petrusa E, Scalese R. A critical review of simulation-based medical education research: 2003-2009. Medical education. 2010;44(1):50–63. doi:10.1111/j.1365-2923.2009.03547.x
7. Harris DM, Ryan K, Rabuck C. Use a high-fidelity patient simulator with first-year medical students to promote the learning of cardiovascular function curves. Adv Physiol Educ. 2012;36(3):213-219. doi:10.1152/advan.00058.2012
8. Issenberg B, McGaghie W, Petrusa E, Lee Gordon D, Scalese R. Features and uses of high-fidelity medical simulations that lead to effective learning: BEME systematic reviews. Medical education. 2005;27(1):10-28. doi:10.1080/01421590500046924
9. Okuda Y, Bryson E, DeMaria S, etc. Application of simulation in medical education: what is the evidence? Mount Sinai J Med. 2009;76(4):330–343. doi:10.1002/msj.20127
10. Prince K, Boshuizen H, van der Vleuten C, Scherpbier A. Students' views on preparation for clinical practice. Medical education. 2005;39(7):704-712. doi:10.1111/j.1365-2929.2005.02207.x
11. McKinney J, Cook D, Wood D, Hatala R. Simulation-based training of cardiac auscultation skills: systematic reviews and meta-analysis. J Gen intern doctor. 2012;28(2):283–291. doi:10.1007/s11606-012-2198-y
12. Congressman Mueller, Christ T, Dobrev D, etc. Teaching anti-arrhythmic treatment and electrocardiogram in simulator-based interdisciplinary undergraduate medical education. Br J Anaesth. 2005;95(3):300–304. doi:10.1093/bja/aei174
13. Nguyen K, Khallouq BB, Schuster A and others. Develop a tool for observing the critical thinking skills of a group of first-year medical students: a pilot study using physiology-based high-fidelity patient simulations. Adv Physiol Educ. 2017; 41(4): 604–611. doi:10.1152/advan.00126.2017
14. Gordon J, Hayden E, Ahmed R, Pawlowski J, Khoury K, Oriol N. Early bedside care during preclinical medical education: Can technology-enhanced patient simulation advance the flexnerian ideal? Akkad Medicine. 2010;85(2):370–377. doi:10.1097/acm.0b013e3181c88d74
This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and include the Creative Commons Attribution-Non-commercial (unported, v3.0) license. By accessing the work, you hereby accept the terms. The use of the work for non-commercial purposes is permitted without any further permission from Dove Medical Press Limited, provided that the work has an appropriate attribution. For permission to use this work for commercial purposes, please refer to paragraphs 4.2 and 5 of our terms.
Contact Us• Privacy Policy• Associations and Partners• Testimonials• Terms and Conditions• Recommend this site• Top
Contact Us• Privacy Policy
© Copyright 2021 • Dove Press Ltd • Software development of maffey.com • Web design of Adhesion
The views expressed in all articles published here are those of specific authors and do not necessarily reflect the views of Dove Medical Press Ltd or any of its employees.
Dove Medical Press is part of Taylor & Francis Group, the academic publishing department of Informa PLC. Copyright 2017 Informa PLC. all rights reserved. This website is owned and operated by Informa PLC ("Informa"), and its registered office address is 5 Howick Place, London SW1P 1WG. Registered in England and Wales. Number 3099067. UK VAT group: GB 365 4626 36
In order to provide our website visitors and registered users with services that suit their personal preferences, we use cookies to analyze visitor traffic and personalize content. You can understand our use of cookies by reading our privacy policy. We also retain data about visitors and registered users for internal purposes and to share information with our business partners. By reading our privacy policy, you can understand which of your data we retain, how to process it, with whom to share it, and your right to delete data.
If you agree to our use of cookies and the content of our privacy policy, please click "Accept".