Abstract:

The problem of doctors having sub-optimal cardiovascular clinical skills has been attributed to deficiency in training. As changes in medical care reduce the faculty time and patients available for teaching, simulation and multimedia systems are becoming a required component of medical curricula. Recent advances in simulation technology have enhanced the opportunity for clinical skills training. ‘Harvey’ a life-sized manikin capable of simulating the bedside findings of 27 cardiac diseases, including blood pressure, venous, arterial and precordial impulses and auscultation, has been integrated into phase I and phase II medical curriculum of School of Medicine in National University of Singapore, reinforcing the constructivist approach adopted in the spiral curriculum in cardiology. Since 2008, department of physiology used ‘Harvey’ in small group work sessions and independent learning. The adoption of ‘Harvey’ as a tool in the curriculum has been facilitated by study guides and a staff development programme.
To evaluate the ‘Harvey’ curriculum, medical students were asked to give a feedback on the simulator sessions. A structured questionnaire was designed to reflect study goals. Furthermore, individual and group interviews were also conducted with faculty instructors and students.
The participants were first and second year medical students who had passed their theoretical course in cardiovascular physiology. In the simulation session, the first year students practiced general cardiovascular examination, identifying the main cardiovascular signs (e.g., central venous pressure, carotid artery pulsation and apex beat) followed by auscultation of normal and pathological cardiac sounds and murmurs. In second year medical student simulator sessions, the students were practiced clinical examination of aortic regurgitation clinical case study. After the simulation sessions, feedback was collected using a structured questionnaire.
The majority of students trained on ‘Harvey’ were able to identify normal and abnormal cardiovascular clinical sings as well as recognize common cardiac auscultation finding (e.g., 95% recognized normal heart sounds, 85% recognize 4th heart sound, 92% recognized aortic stenosis and 89% aortic regurgitation). Furthermore, Positive outcomes were derived from the student and faculty instructors survey and interviews. The majority find ‘Harvey’ simulator interesting and facilitating learning (98%) and most of the participants wish for more simulation sessions (87%).
This study identified the possibility for expanding undergraduate cohorts to support the acquisition of clinical and medical skills. Flexibility, facilitated learning and creativity characterize the new era curricula. High-fidelity patient simulation seems to fulfill these requirements.

Keywords:

High-fidelity patient simulation, undergraduate medical curriculum, Harvey simulator.