Impacto da simulação na habilidade de exame físico neurológico em estudantes de medicina

Abstract

This research, linked to the Research Line “Training and Practice of the Teaching Professional and Educational Practices” of the Graduate Program in Education (Master’s Degree) at Universidade do Oeste Paulista, originated from the need to deepen the understanding of the magnitude of the difference produced by simulation-based strategies compared to traditional teaching methodologies. Simulation has gained ground in medical courses, promoting earlier and controlled exposure of pre-internship students to medical practice through the use of simulated patients. However, it is important to determine whether simulation is more effective than conventional methods, such as dialogued lectures, in developing competency in clinical skills—thus justifying the investment of time, financial resources, and physical space for its implementation. Accordingly, the aim of this study was to evaluate whether simulation promotes greater skill acquisition than theoretical study in performing the neurological physical examination. To this end, a prospective, analytical, and longitudinal study was conducted. The neurological physical examination was chosen as the intervention due to its particular characteristics, which distinguish it from the general physical examination. Thirty-two first-year medical students (13 men) participated, divided into a Control Group (n = 16), which studied the neurological examination exclusively through dialogued lectures, and a Simulation Group (n = 16), which engaged in practical training using a simulated patient. Both groups invested the same amount of study time. Performance was assessed through an Objective Structured Clinical Examination (OSCE) consisting of four stations, applied at the end of the study/practice period on neurological examination. Statistical analysis was conducted using analysis of variance (ANOVA) between groups. The results revealed significantly higher performance among students who participated in practical training. Additionally, the Control Group showed significant differences in: (1) studying the neurological examination more prior to the OSCE, (2) seeking peers to better understand examination procedures, and (3) self-reporting their knowledge as only regular. Finally, a nine-month follow-up assessment showed that the Simulation Group felt more confident in being re-evaluated on the practical examination and self-rated their knowledge as superior. In conclusion, these findings suggest that simulation is an effective strategy for learning, supporting its recommendation for the development of specific practical competencies from the early phases of undergraduate medical education.