Simulação de alta e baixa fidelidade para o ensino de urgências e emergências respiratórias pediátricas: comparação da avaliação do aprendizado

Abstract

Introduction: simulation is an innovative educational technique, essential both for the training of students and medical professionals. Especially in emergency, it allows the presentation of different scenarios within a control environment. It improves diagnostic competence and enables, in real life, increased survival. Justification: recognizing conditions with potential evolution to respiratory failure is a fundamental part of medical education, due to its high prevalence. The assessment of diagnostic competence in pediatric respiratory settings with specific acquisition of skills and knowledge retention using this tool compared to other strategies is scarce in the literature. Review: in an integrative way, a critical analysis of studies and a synthesis of existing evidence in the literature on the contribution of simulation for the learning of pediatric respiratory emergencies and emergencies were carried out. Objectives: to compare and evaluate high-fidelity and low-fidelity simulation-based teaching methodologies, addressing issues related to respiratory failure or discomfort in the pediatric age group, in fourth-year medical students. Method: 70 students from a private college were selected and randomly divided into two groups, one was trained with high fidelity and the other with low fidelity, in scenarios of respiratory problems. The assessment instruments were a practical performance checklist, Likert questionnaire, and theoretical and practical pre- and post-test and memory retention after three months. Results: homogeneous groups were satisfied with the training. The high-fidelity group, despite feeling more challenged (χ 2=9,042;3) (p=0,029), showed more self-confidence to recognize changes (χ 2=11,198;4) (p=0.024), make decisions (χ 2= 11, 486;4) (p=0.022) and to differentiate between discomfort and respiratory failure (χ 2=11,167;4) (p=0.025). The theoretical test score increased in both methodologies pre-test median BF=17, AF=16 (p=0,336); median pos-test BF=20, AF=21 (p=0,043). In the evaluation of memory retention, the high-fidelity group reported feeling more self-confident to differentiate between discomfort and respiratory failure (χ2 =6,667;2) (p=0.036), in the real patient. Discussion: training was effective as an educational resource and was able to quantitatively assess the two levels of simulation in teaching proposed, addressing topics of severe respiratory diseases in Pediatrics. The role of loyalty and its impact on learning outcomes require further research and clarification of terminology adopted by researchers. Conclusions and final considerations: high and low fidelity simulations increase diagnostic competence and help to distinguish discomfort from respiratory failure in pediatrics. High fidelity makes the student feel more challenged and more self-confident to recognize the seriousness of the clinical case and to care for the real patient. Standardization rules for evaluating learning with simulation are of great importance and it is not just the level of fidelity that matters for learning.