CARDIOLOGY PATIENT SIMULATOR TO IMPROVE BEDSIDE CLINICAL SKILLS
Tsunekazu Takashina, MD,PhD,FAHA,FACC, Guest Editor
Chairman, JECCS, Asian Heart House, Osaka, Japan
International News and Highlights, Council Connections,
A Quarterly Communication of the AHA/ASA, Vol.3, No.3, Fall 2005
A most important step in the physical examination of patients with cardiovascular disease is to
obtain a good history with precise bedside physical findings. This is true in any country throughout
the world. The recent introduction of a cardiology patient simulator, by Dr. Gordon and his colleagues, has played an important role in clinical training in the past few decades(1,2).
Before the current advances of technology, heart sounds or murmurs were simulated mostly by an analogue method using vacuum tubes to produce sounds similar to such heart sound or murmurs(3,4).
In 1990, we reported a new cardiac auscultation simulator by applying digital and computer technology(5). In 1997, I as the project leader, reported a new cardiology patient simulator developed through the application of new digital and computer technology, capable of playing back selected physical findings (jugular-venous waves, arterial pulses of carotid, brachial, radial and femoral arteries and cardiac impulses), as well as cardiac sounds, murmurs and various respiratory sounds that had been prerecorded from actual patients(6). Its nickname is Simulator "K". The examiners are able to use their own ordinary type of stethoscope, just as in the examinations of real cardiac patients in routine clinical practice.
To evaluate the teaching effectiveness of the simulator, training courses for bedside diagnosis were provided for 872 primary-care physicians and 426 nurse and 249 medical students, for 3 hours on 2 occasions, from June 1997 to May 2005. Prior to the first training course, each group was given about one hour orientation to ensure that they knew how to use the simulator correctly.
All participants were pretested on a clinical cardiology multi-choice test and performed a bedside-skills examination of 5 randomly selected cases of 36 different cardiac conditions using the display programs of the computer. In the 2nd course, they were assigned another 5 cases, which they had not been taught previously, out of 36 different cardiac conditions. On the subsequent multiple-choice test and the bedside-skills examination done at the end of second training course, the results were:
- The physician group(Ｘ= 81.05, SD=3.50) showed a significantly better score(p<0.001) than on the pretest(Ｘ=62.34, SD=3.47);
- The nursing group scored much better(Ｘ=72.27,SD=5.63) than on the pretest(Ｘ=51.48, SD=5.47).
- The student group also showed a better score (Ｘ=74.56, SD=6.38) than on the pretest(Ｘ=64.72, SD=7.43).
Since 2000, we have conducted annual training courses for foreign physicians who were studying at the National Cardiovascular Center on the JICA (Japan International Cooperation Agency) program, Osaka, Japan. Although the following data is not included in the previous physician group, the foreign physician group( shown in figure 1) showed a superior score(Ｘ=87.65, SD=2.28) than on the pretest(Ｘ=70.65, SD=3.47).These particular 5 physicians were in teaching faculties and were selected from each country( 2 from South Africa, 1 from Thailand, 1 from Argentine and 1 from Eastern Europe).
We are quite certain that this simulator will soon become an essential tool for training physicians, medical students, nurses and paramedics, thereby improving bedside examination skills throughout the world.
References
1. Gordon MS, Ewy GA, DeLeon AC, Waugh Ram Felner JM, Forker AD, Gessner IH, Mayer JW, Patterson D: 'Harvey' the cardiology patient simulator: Pilot studies on teaching effectiveness. Am J Cardiol 1980;45:791-796.
2. Gordon MS, Ewy GA, DeLeon AC, Waugh Ram Felner JM, Forker AD, Gessner IH, Mayer JW, Patterson D: Teaching bedside cardiologic examination skills using 'Harvey', the cardiologic patient simulator. Med Clin North Am 1980;64:305-313.
3. Ravin A, Tucker CE, Craddock EE: An instrument for simulating heart sounds and murmurs. Am J Cardiol 1966;18: 622-626.
4. Doba N, Hinohara S: A training of heart sound auscultation by the simulator. Med Educ (Jpn) 1977;8:390-392.
5. Takashina T, Masuzawa T. Fukui Y. A new cardiac auscultation simulator. Clin Cardiol 1990;13:869-872.
6. Takashina T, Shimizu M, Katayama H: A new cardiology patient simulator. CARDIOL 1997;88: 408-413.
Figure 1. Training course for 5 foreign physicians at Asian Heart House in 2000. (Middle is author.)
