Abstract:

Introduction:
The use of clinical cases is a common strategy in the University studies and postgraduate training of Health Sciences disciplines. Students are trained with the goal of treating real patients. However, most of the time, clinical cases are presented in a simulated way because of the greater logistical difficulty of working with standardised real patients in the training sessions. Although some authors have described the simulated and the real patient as interchangeable, other authors have underlined the differences between them. Among the main advantages in favor of the use of real patients, some authors highlight that this type of patient can accurately describe their own sensations and feelings, simulating real clinical situations and allowing a better understanding to the students. The aim of this study was to compare the effect of the use of standardised clinical cases versus the use of simulated ones in the acquisition of skills and the assimilation of concepts in the Degree in Physiotherapy.

Methodology:
In order to achieve the aim of the study, the practical part of one of the main subjects of the Degree in Physiotherapy of the University of Valencia, “Kinesitherapy”, was chosen. This annual subject was selected because of its high load of practical content. Four specific concepts of Physiotherapy (immobilization, passive kinesitherapy, active kinesitherapy, and resistance kinesitherapy) were included. Each of them was presented in two different sessions, one through clinical cases with standardised patients and the other one with simulated patients. To evaluate the effectiveness of each modality, 91 students assessed through a scale of 11 points, being 0 "absolutely disagree" and 10 "absolutely agree", the relationship of the four concepts with their appraisal of the clinical cases, in both with simulated and standardized patients situations. The comparison between the results of the two modalities was made through a comparison of means.

Results:
According to the students' perception, the clinical cases that used standarised patients had a greater relationship with the four theoretical concepts. For the concept of immobilization, the real patient case obtained a mean score of 8.18 (1.08), compared to 7.29 (1.77) of the simulated case. For passive kinesitherapy a mean score of 8.09 (1.1) was reported for the real case and 7.56 (1.4) for the simulated case. For active kinesitherapy a mean score of 8.71 (0.83) was shown for the case with a real patient versus 7.98 (1.2) for the case with a simulated patient. Finally, the clinical case of resistance kinesitherapy obtained a mean score of 8.76 (1.24) when a real patient was used versus a score of 8.13 (1.09) using a simulated patient.

Conclusions:
These results suggest that the use of clinical cases with real standardised patients is more related to the theoretical concepts presented than the use of clinical cases with simulated patients in the “Kinesitherapy” subject of the Degree in Physiotherapy.

Keywords:

Clinical case, Education, Physiotherapy, Simulation.