CORRESPONDENCE |
Antiarrhythmic therapy and ECG
* E-mail: w.s.brown{at}dundee.ac.ukEditor—We read with interest Mueller and colleagues'1 paper on simulators in teaching antiarrhythmic therapy to undergraduates. The authors conclude that their ‘study provides justification for the use of simulators in education programmes designed for undergraduate medical students’ but we have some reservations.
There did not seem to be any pre-intervention testing. This means that the tendency in the simulator group to use DC cardioversion for the patient with ventricular tachycardia (VT) could have been present at baseline. These are third year students and it is not inconceivable that they could have some knowledge about the treatment of VT from their previous years of medical school. Additionally, this teaching was incorporated as part of a 6-week course, and the authors do not state when during this time the seminars were given. If the students taught with the simulator received their teaching nearer the end of their course than the control group, it would not be surprising if they performed better when tested. Moreover, a repeat test at 3–6 months may help to determine whether the perceived gain in the simulator group is sustained, particularly as skills learnt using simulators are often not retained long term.2
There were two statistically significant findings relating to the students' views of the seminars. Firstly, those receiving teaching with the simulator felt that the seminar was better at linking theory to practice as has been demonstrated previously.3 Although the difference reached statistical significance, even the control group agreed that the course was good at linking theory to practice. Secondly, the simulator group was less likely to think that the course contained too much theory. It is not surprising that students were more positive about a seminar including just 45 min of PowerPoint presentations followed by a session with a simulator compared with a seminar containing 2 h of PowerPoint presentations! A similar positive effect may have been seen if a third group had been studied that was exposed to a more entertaining teaching method than PowerPoint lectures; for example, videos of ‘real life’ patient treatment or computer-aided learning (CAL). There is evidence to suggest that simulators do not confer any greater educational value than videos4 5 and CAL has been demonstrated to be an effective teaching aid for undergraduates.6
The authors also talk enthusiastically about their interdisciplinary approach and how they believe that this led to the overall good results. Although it is an attractive suggestion that incorporating anaesthetists in interdisciplinary teaching improves students' learning experience, it could simply be the ability and enthusiasm of the teachers that was the reason for success and that their individual specializations made no difference. Mueller's paper does not provide evidence to support the idea that interdisciplinary teaching is more effective as there was no group which had single disciplinary teaching.
Simulators are fun to use but have limitations and are expensive. Costs that need to be considered include the initial cost of purchasing simulators, maintenance costs and the cost of training instructors. Studies have tried to show their effectiveness in teaching but most have concluded only that they are ‘at least as effective’ as other entertaining teaching methods. If expense is no problem, then simulators can be a useful teaching alternative, but more research is needed before their expense can be fully justified for teaching in this area.
1 Dundee, UK
2 Middlesborough, UK
* E-mail: michael.mueller{at}uniklinikum-dresden.de
Editor—We thank Drs Brown and Kessell for their comments on our article.1
During the 6 week course ‘Basics of Drug Therapy’ one lecture is held on antiarrhythmic drugs. All students took part in our course ‘Anthiarrhythmic Therapy and ECG’ after that lecture, there are no additional lectures or seminars on antiarrhythmic drugs. To avoid a bias in pre-intervention knowledge between both groups, we randomized students into control and simulator group. A repeat test would have been helpful to evaluate long-term retention of knowledge on antiarrhythmic therapy but was not done. However, the treatment of arrhythmia is complex and cannot be compared with the retention of basic life support skills2 as mentioned by Brown and Kessell. A previous study showed good retention of pharmacology knowledge in third year medical students.7
The study cited by Brown and Kessell which had previously shown good linking of theory and practice using simulators3 cannot be compared with our study in this context. We would surely not expect the same results when investigating the use of a part task trainer in pharmacological teaching compared with other colleagues using a highly sophisticated SimMan simulator in a course on the treatment of medical emergencies.
We do not agree that PowerPoint lectures are in general ‘not entertaining’. However, for teaching of drug effects we did set up the new course concept using a simulator because we wanted to implement interactive training. Morgan showed that students significantly rated simulator training as a ‘Valuable Learning Experience’ compared with students who had been taught using a videotape on the same learning content.4
The authors are indeed enthusiastic teachers. As the teachers in both groups were the same two people there should be no bias in the intervention. When reforming medical education at our university all new courses had been set up by interdisciplinary faculty. We thought it would be inappropriate to go back one step. As Brown mentioned and we had already stated in our article, unfortunately there was no third non-interdisciplinary group.
The statement of Brown and Kessell that simulators are expensive is too general. We agree that one has to calculate the initial cost, maintenance and personnel costs. Simulators in the field of medicine are available from <
2008 up to full-scale patient simulators for >200 000. The low-fidelity simulator we used in our course cost <7000 and is now 7 years old. Maintenance of the simulator cost <1000 during this period. The simulator can be run by one of the two teachers in the described course. As an advanced life support simulator is probably available at any medical school, the use of the simulator would not produce significant additional costs compared with the training without simulator.
Dresden, Germany
References
1 Mueller MP, Christ T, Dobrev D, et al. Teaching antiarrhythmic therapy and ECG in simulator-based interdisciplinary undergraduate medical education. Br J Anaesth 2005; 95: 300–4
2 Wik L, Myklebust H, Auestad BH, Steen PA. Retention of basic life support skills 6 months after training with an automated voice advisory manikin system without instructor involvement. Resuscitation 2002; 52: 273–9[CrossRef][Web of Science][Medline]
3 Weller JM. Simulation in undergraduate medical education: bridging the gap between theory and practice. Med Educ 2004; 38: 32–8[CrossRef][Web of Science][Medline]
4 Morgan PJ, Cleave-Hogg D, McIlroy J, Devitt JH. Simulation technology: a comparison of experiential and visual learning for undergraduate medical students. Anesthesiology 2002; 96: 10–16[CrossRef][Web of Science][Medline]
5 Curran VR, Aziz K. Evaluation of the effect of a computerised training simulator (ANAKIN) on the retention of neonatal resuscitation skills. Teach Learn Med 2004; 16: 157–64[CrossRef][Web of Science][Medline]
6 Hudson JN. Computer-aided learning in the real world of medical education: does the quality of interaction with the computer affect student learning? Med Educ 2004; 38: 887–95[CrossRef][Web of Science][Medline]
7 Rodriguez R, Campos-Sepulveda E, Vidrio H, Contreras E, Valenzuela F. Evaluating knowledge retention of third-year medical students taught with an innovative pharmacology program. Acad Med 2002; 77: 574–7[Web of Science][Medline]
8 Doyle DJ. Simulation on the cheap. Can J Anaesth 2005; 47: 375–6
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