EFFECTIVENESS OF HIGH-FIDELITY SIMULATION BASED ADVANCED CARDIAC LIFE SUPPORT TRAINING AMONG FINAL YEAR MEDICAL STUDENTS

Background:
With the rapid development of advanced technology, high fidelity simulation becomes popular and uses extensively in the field of medical education nowadays. However, study on outcome and effectiveness of simulation based medical education is still scattered and inconsistent. Traditional teaching of knowledge, skills and attitudes to handle acute cardiac emergencies using real patients is complicated and encompassed ethical problems. High-fidelity simulation can facilitate teaching and promote learning. Utilization of high fidelity simulations in real-time fashion using mannequins that provides appropriate feedback and ongoing assessment enhances learning potential and encourages critical thinking.

Objective:
To compare the effectiveness of simulation-based teaching using high and medium fidelity simulators among undergraduate medical students in the context of advanced cardiac life support (ACLS) knowledge and skills.

Methodology:
Research design: An experimental trial with parallel group design was used to compare the effectiveness of ACLS knowledge and skills of undergraduate medical students by using ACLS high and medium fidelity simulator. Ethic approval was taken from the University ethic committee.

Setting:
ACLS training was conducted in a simulation lab at the Faculty of medicine and health sciences, University Malaysia Sabah.

Subjects:
80 of final year medical students during medical senior posting were randomly allocated using a computer-generated list into medium-fidelity simulation (MFS) group or high-fidelity simulation(HFS) group to expose virtual resuscitation environment (40 students in each group). Both groups took part in simulation scenarios relating to ACLS, a 4-hour PowerPoint presentation, followed by demonstration on either high or medium fidelity mannequins.

Simulators:
Laerdal Sim-Man 3 G and Laerdal VitalSim Advanced Life Support mannequins, along with simulated hospital settings using modern cardiac monitors/ defibrillators and all associated equipment were used for the training. High-fidelity manikins (Resusci Anne simulator, model 150-00001, Laerdal Medical; and HAL 3000 and Noelle S575, Gaumard Scientific) were used to mimic physiological and rhythm changes of real patients

Study period:
Started from June 2016 to March 2017.

Results:
A total of 78 out of 80 students (97.5%) completed questionnaires. The mean objective structured clinical examination scores was significantly higher in the HFS group one compare with MFS group (71.8 vs 66.4)(t=2.08,p=0.040). However, the written examination scores between two groups were not found to be clinically significant. There was higher satisfaction towards the learning experience measured on a 5- point Likert scale in the high fidelity group than the medium fidelity.

Conclusion:
High-Fidelity Simulation is a powerful tool in cardiac resuscitation training among undergraduate medical students. Simulation and interactive methods make the learning process more innovative, interesting and joyful.