Background Junior doctors receive limited exposure to bradyarrhythmias and pacing during training, yet are called upon to manage these once qualified.1,2 Pacing has shown itself to be ideally suited for simulation based teaching,3 but providing high fidelity simulation relies on costly simulation suits and the availability of instructors to lead sessions.4 Use of a dynamic simulator5 would allow students to access similar teaching online in their own time.6
Methodology A cross-platform web-based tutorial was designed in Adobe Flash. This utilised a dynamic pacing simulator embedded in a lumped compartment model of the vascular system to generate real-time ECG and cardiovascular parameters, which could be modified by pathology and responded to manipulation by a simulated Medtronic 5388 pacemaker. As a feasibility study a small group of senior medical students undergoing an attachment in cardiothoracic medicine were block randomised to receive either only traditional teaching, or access the tutorial in addition. The effect of this on their knowledge was assessed via paired multiple-choice questionnaires.
Results 33 students were enrolled, and 15 completed both MCQs. Exposure to the tutorial and simulator improved students’ ability to interpret ECGs by 1/5 marks (p = 0.380) and their knowledge regarding pacing by 1.6/6 marks (p = 0.020) compared to those who experienced purely traditional teaching.
Potential impact Students’ use of a dynamic simulator, accessed via the internet, is feasible for learning the techniques and pitfalls of epicardial pacing in their own time. This reduces the resource implications on educational establishments in providing instructor-lead, static simulation. In addition, dynamic simulation enables complex scenarios to be experienced, such as asynchronous pacing, T-wave over-sensing, and cross pacing, enabling students to directly experience the consequences of their mistakes in addition to their successes. A larger scale investigation to quantify the educational utility of this system is currently being undertaken.
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- Category: Course or curriculum evaluation/innovation/integration
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