Análise do modelo de aprendizagem em broncofibroscopia em simuladores com estudantes de medicina

Abstract

Bronchoscopy is the endoscopic examination of the airways essential for pneumological propaedeutic. It is a complex procedure that requires domains of cognitive and motor skills for its proper performance. Learning medical procedures is a complex process and attached to multiples factors, such as student skill, teacher effectiveness and student-teacher interaction. For adequate skill learning, students need to acquire essential aspects of procedural training, such as understanding indications and contraindications, risk-benefit, in addition to identifying their own limitations. Based on the Cognitive Load Theory (CLT), educational models emerge to facilitate the learning process of beginners. One of them is known as modelling example, in which learning occurs from the observation of models (in person or by video), allowing the student to understand the abstract concept of the task to be learned. One of the proposed form to assess the retention of acquired knowledge of a certain skill is through the application of the semantic verbal fluency test. It is a validated and widely used test for cognitive assessment. In this context, the present study evaluated the modelling example methodology in the teaching of virtual bronchoscopy in a simulator with medical students and the retention of knowledge in the short term (right after training), medium term (fifteen days after training) and in long term (twelve months after training), based on the metrics of the simulator. The Paas validity scale evaluated the cognitive load spent on learning. The long-term retention of knowledge (after twelve months) was evaluated by the semantic verbal fluency test. Simulation-based training was effective for both groups (p<0.05). Knowledge was retained in the medium term as the results were similar to the post-test results (p>0.05). However, the modelling example group outperformed the control group in these two phases in all measures (p<0.001). After 12 months, there was a decline in skill in both groups, but the intervention group performed better (p<0.001). Simulation-based training reduced cognitive load, but the modeling example group presented a statistically lower value (p<0.001), as postulated by CLT. The semantic verbal fluency showed a better cognitive learning in the modelling example group regarding long-term knowledge retention, with higher number of correct answers, a less dense net, more links and a larger diameter. Thus, it was observed that using the modelling example methodology allowed the retention of knowledge in bronchoscopy in a simulator in the short and medium term, associated with the reduction of the cognitive load for the learning. There was a decline in skills after twelve months without training, but with superior results compared to the control-group. Furthermore, the semantic verbal fluency test showed a better cognitive net for long-term learning in the modelling example group.