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0063 Feasibility Study: A Web-base Deductive Simulator Allows Medical Students’ To Learn The Techniques Of Pacing And Improve Their Rhythm Recognition Skills At Home
  1. Nicholas Plummer1,2,
  2. Kenneth Gilpin3,
  3. Alain Vuylsteke4,2
  1. 1Lancashire Teaching Hospitals NHS Foundation Trust, Preston, UK
  2. 2University of Cambridge, Cambridge, UK
  3. 3Armidale Rural Referral Hospital, New South Wales, Australia
  4. 4Papworth Hospital NHS Foundation Trust, Papworth, UK


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.


  1. Eslava D, Dhillon S, Berger J, Homel P, Bergmann S. Interpretation of electrocardiograms by first-year residents: the need for change. J Electrocardiol 2009;42:693–7

  2. Murphy JJ. Problems with temporary cardiac pacing. Expecting trainees in medicine to perform transvenous pacing is no longer acceptable. BMJ 2001;323:527

  3. Crowe ME, Hayes CT, Hassan Z-U. Using software-based simulation for resident physician training in the management of temporary pacemakers. Simul Heal 2013;8:109–13

  4. Bradley P. The history of simulation in medical education and possible future directions. Med Educ 2006;40:254–62

  5. Gilpin K, Pybus DA, Vuylsteke A. Medical simulation in "my world". Anaesthesia2012;67:702–5

  6. Ruiz JG, Mintzer MJ, Leipzig RM. The impact of E-learning in medical education. Acad Med 2006;81:207–12.

  • Category: Course or curriculum evaluation/innovation/integration

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