Measurements
cyanosis, HSF
ACUTE ASTHMA
Both groups underwent a baseline testing (pre-test) including 20 Multiple Choice Questions (MCQ) for 20 min about their baseline knowledge of acute asthma management. The Questions focused on anamnestic and clinical diagnostic management, differential diagnoses recognition,severity assessment and detailed therapeutic management. The MCQ test score range from 0 (minimum) to 20 (maximum). Students completed a second MCQ immediately following the teaching session (MCQ post-test 1). The results of all MCQ examinations were fed back to each participating student upon completion of this teaching session and MCQ examination. After randomization, all students received an equivalent 30 min orientation to the human patient simulator (Laerdal SimMan® full scale patient simulator; Laerdal Medical Corporation, NY), in the ED simulation lab: realistic full-body adult patient simulator SimMan®3G (Laerdal company Prod No: 212–02050 serial NR 21244154781. Made in Norway). This simulator offers a multitude of respiratory signs such as all normal and pathological audible sounds with the stethoscope in 5 anterior and 6 posterior auscultatory sites as well as cyanosis, chest expansion. It is also possible to monitor pulse, oxygen saturation, heart rate and blood pressure non-invasively. These sessionincluded an introduction and a review of the simulator features as well as the physiologic monitoring devices. Students were instructed to verbalize their thoughts, orders, and actions during the simulated patient scenario. Simulation case scenario of acute asthma was developed by the authors and reviewed by an advisory committee. The execution of the simulation scenario required two instructors, one to engage within the scenario with the students, and a second to coordinate computer driven physiological responses dependent on intervention implemented by students. IVC group, attend real video projection filmed in ED after consent of both patient and healthcare team. The students of HFS group participated in a simulation session with an acute asthma scenario including the three known steps: briefing, scenario, and debriefing. The clinical scenario used is the same viewed in the video case as well as practiced on the simulator, however on the high fidelity simulator it was developed and programmed on the mannequin manually using the integrated software (LLEAP® version 5.1.0: 2015). Both teaching sessions lasted approximately 1 h. After the teaching sessions were complete, the students underwent gimmediately the post-test. Students also rated their satisfaction level with a 5 points Likert scale framed as attitude toward simulation compared with control group: dissatisfied (1 point), fairly satisfied (2 points), neither satisfied (3 points), satisfied (4 points) and very satisfied (5 points). The study population flowchart is depicted in Fig. The study population flowchart. IVC teaching group: interactive video case teaching group. HSF group: high fidelity simulation-based teaching group. MCQ: multiple choice questions