Role of SimMan in teaching clinical skills to preclinical medical students

Background: Simulation training has potential in developing clinical skills in pre-clinical medical students, but there is little evidence on its effectiveness. Methods: Twenty four first year graduate entry preclinical medical students participated in this crossover study. They were divided into two groups, one performed chest examination on each other and the other used SimMan. The groups then crossed over. A pretest, midtest and post-test was conducted in which the students answered the same questionnaire with ten questions on knowledge, and confidence levels rated using a 5 point Likert scale. They were assessed formatively using the OSCE marking scheme. At the end of the session, 23 students completed a feedback questionnaire. Data was analyzed using one-way ANOVA and independent t-test. Results: When the two groups were compared, there was no significant difference in the pretest and the post-test scores on knowledge questions whereas the midtest scores increased significantly (P < 0.001) with the group using SimMan initially scoring higher. A significant increase in the test scores was seen between the pre-test and the mid-test for this group (P=0.009). There was a similar albeit non significant trend between the midtest and the post-test for the group using peer examination initially. Mean confidence ratings increased from the pretest to midtest and then further in the post-test for both groups. Their confidence ratings increased significantly in differentiating between normal and abnormal signs [Group starting with SimMan, between pretest and midtest (P= 0.01) and group starting with peer examination, between midtest and post-test (P=0.02)]. When the students' ability to perform examination on each other for both groups was compared, there was a significant increase in the scores of the group starting with SimMan (P=0.007). Conclusions: This pilot study demonstrated a significant improvement in the students' knowledge and competence to perform chest examination after simulation with an increase in the student's perceived levels of confidence. Feedback from the students was extremely positive. SimMan acts as a useful adjunct to teach clinical skills to preclinical medical students by providing a simulated safe environment and thus aids in bridging the gap between the preclinical and clinical years in medical undergraduate education.