Council on Medical Student Education in Pediatrics


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You can learn a lot by watching – especially if you know what to watch for! Stegmann K et al. Vicarious learning during simulations: is it more effective than hands--on training? Medical Education 2012 46:1001--1008.

Reviewed by Makia Powers

What was the study question?
Is "learning by doing" is as effective as learning by watching (vicarious learning) in teaching doctor--patient communication strategies? Also, do observation scripts and feedback formulation scripts affect knowledge of doctor--patient communication? How are all these things related?

How was the study done?
Two hundred medical students at the Ludwig Maximilians University in Munich completed two simulation sessions of taking a history, performing a digital rectal examination (DRE), and counseling a patient. They were randomly assigned to a specific learning order – either performance then observation or vice versa. Observation scripts – detailed checklists of things to be done during the session -- were used by half of the students as they observed their peer. At the conclusion of the session, the standardized patient and student observer provided feedback. Half of the students were given a feedback form to guide them in providing this feedback. Knowledge of doctor--patient communication was measured before both the first and second learning sessions and then one day after the second learning session by asking students to describe in detail the essential components of an effective clinical encounter for a patient requiring a DRE.

What were the results?
In a simulation setting, vicarious learning (observation) was more effective than "learning by doing" in obtaining knowledge about doctor--patient relationships. The use of observation scripts greatly enhanced the vicarious learning experience. Use of feedback forms did not affect knowledge about doctor--patient relationships.

What are the implications of these findings?
Medical educators should understand the potential value in adding directed observations (vicarious learning) to their curricula.

Editor's note: This study may explain part of the benefit of bed--side rounds. It also suggests that if we give students a form that cues them to observe certain things during these rounds, their learning would be greatly enhanced. Many questions come to mind: What is the long--term effect of this intervention? Did the students retain this knowledge weeks or months later? Did they really learn or did they just remember the checklist of items on the observation form? Should we consider routinely pairing students for clinical encounters? Does anyone have experience with this? Should COMSEP develop an observation form to be used? (SLB).

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