Simulation-based Learning: A Key Strategy in Patient Education Training for Medical Students

Simulation-based Learning: A Key Strategy in Patient Education Training for Medical Students | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Article Simulation-based Learning: A Key Strategy in Patient Education Training for Medical Students María Aparicio, Jesus López-Herce, Natividad Montalvo, Maria Jose Solana, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-9193457/v1 This work is licensed under a CC BY 4.0 License Status: Under Revision Version 1 posted 12 You are reading this latest preprint version Abstract The aim of this study was to compare different methods of patient education for medical students. A prospective study involving 5th and 6th year medical students that were assigned to three groups paediatric primary care (group 1), paediatric intensive care (group 2), and paediatric emergency (group 3). All groups received the same theoretical training in patient education. Additionally, group 1 received practical training in patient education with patients, group 2 received practical training in patient education with simulation, and group 3 did not receive any practical training in patient education. A theoretical pre- and post-training assessment and a practical simulation assessment were performed. Furthermore, the students evaluated their practical performance. Results between the three groups and the assessment by the students and their teachers were compared. After theoretical training, all groups improved their theoretical knowledge (mean [SD]) (pretest 8.0[0.1]; posttest 9.3[0.0]; p < 0.001). In the practical evaluation, group 2 students obtained a higher evaluation (8.1[0.1]) than group 1 (7.4[0.1]) and group 3 (7.1[0.1]). p < 0.05). The students' self-assessment was higher (8.2[0.1]) than that of the researchers (7.6[0.1]; p < 0.001). Our results show that combining theoretical lessons with simulation-based learning is the best method to reach practical competencies in patient education for medical students. Health sciences/Health care Health sciences/Medical research Patient education medical student simulation clinical practice practical training Figures Figure 1 Figure 2 Figure 3 Figure 4 INTRODUCTION Patient education training refers to the training provided to medical professionals on how to effectively educate patients about their health conditions, treatment plans, and overall wellness. This training focuses on developing the skills necessary for medical professionals to communicate clearly, empathetically, and accurately with patients, ensuring that patients understand their medical conditions and the necessary steps for their care and recovery [ 1 ]. It ranges from assessing the patient's needs with an adequate medical history to providing adequate information, confirming that the patient has understood this information and doing all of this in an empathetic environment. Physicians who are not trained in patient education often provide information on the basis of their experience without applying a specific methodology [ 2 , 3 ]. In recent years, patient education has evolved toward patient-centered education, taking into account patients’ motivation, beliefs and concerns to identify barriers and provide individualized education tailored to patients’ needs [ 4 , 5 ]. Patient education is a core competency for medical students [ 6 , 7 ], with benefits for both patients and students [ 6 , 7 ]. Despite this, medical students receive little training in an unstructured way, as training is generally not included in the mandatory activities of practical rotations. Forbes et al. conducted several studies on patient education training in physiotherapy students and reported that short and intensive training has a positive effect on theoretical knowledge and practical skills in patient education [ 6 , 8 , 9 ]. Several studies have proven the usefulness of simulation methods with simulated patients who allow trainees to interact while learning [ 10 , 11 , 12 ]. However, there is no evidence that these methods are superior to theoretical training or direct learning during practical rotation. The primary objective of this study was to compare the effectiveness of two methods of patient education training for medical students (simulation training versus clinical practice education) with a control group of students who received only theoretical training. The secondary objectives were to compare the students' self-assessment with that of the researchers and the agreement between the researchers in the assessment of the recorded images of the students' performance. METHODS A prospective nonrandomized comparative study was conducted. 5th- and 6th-year medical students who performed their clinical rotations in the pediatric primary care PCP (group 1), pediatric intensive care unit (PICU) (group 2) and pediatric emergency rooms (PER) (group 3) of the Complutense University of Madrid (UCM), during the academic years 2021–2022 and 2022–2023 and voluntarily participated in the study. Any student had not received any previous training in patient education. There were no exclusion criteria. The study was approved as a teaching innovation project by the UCM committee (Innova Docencia 2022 number 337), ratifying the lack of need for assessment by a research ethics committee. All methods were performed in accordance with the ethics and national legals guidelines and regulations in accordance with the Declaration of Helsinki. The study was carried out as part of the pediatrics teaching practice and did not involve any risk. The students were provided with detailed information about the study, were given an explanatory sheet, were offered voluntary participation and were asked for informed consent. The data were anonymized and securely stored on the UCM website, as were the recorded videos. Phases and activities (Fig. 1 ) Phase 1. Theoretical training . The three groups received the same theoretical training on patient education in the first days of their rotation in pediatrics. First, a theoretical assessment was carried out, consisting of 10 test questions with 4 possibilities. This was followed by theoretical training in patient education, which consisted of a 25-minute presentation and the viewing and discussion of two videos with the students. Immediately after the theoretical training, the same theoretical assessment was repeated. Phase 2. Practical training (three weeks). Group 1 received practical training during the PCP rotation by the clinical tutors/researchers: During the first two weeks, patient education provided by the tutor was observed and subsequently commented on. In the third week, the student progressively performed patient education, and then, together with the tutor, their performance was analyzed. Group 2 received a practical patient education workshop in the second or third week of rotation. Firs of all, students received an explanation of the objectives and functioning of the simulation. Subsequently the students played the role of doctors (one roll played each and observed 2–3 roll played by others) and provided health education to the clinical tutors/researchers, who were instructors in advanced simulation and played the role of a child's parents. The methodology of the practice was as follows: 1st. Performance by a pupil; 2nd evaluation: a) self-evaluation/ group evaluation and b) evaluation by instructor: 3rd. Summary and conclusions. For patient education training, three clinical cases were used in both groups: asthma, gastroenteritis and upper respiratory tract infection (which were different from those used in the practical assessment). The students had to perform the following tasks: 1st, to know the patient's characteristics (personal, family, social), assess their educational needs, knowledge of the disease, concerns and expectations about their treatment; 2nd, to transmit educational content, adapting to the patient's characteristics; and 3rd, to evaluate the patient's learning, assessing what they have learned. The trainees in group 3 observed and practiced the clinical and patient education activities performed with patients attending the Emergency Department without receiving any specific practical training in patient education. Phase 3: Practical assessment The practical assessment took place in the last week of the rotation. The students in group 1 participated in the PCP consultation, and those in groups 2 and 3 participated in the PICU. A simulation was carried out in which the student played the role of the doctor and the clinical tutors/researchers played the role of the parents. The student had to take the clinical history and provide health education on acute bronchiolitis to the mother or father. The student had 10 minutes to read the written case and prepare his/her performance. The performance lasted 10 minutes and was video recorded for later evaluation and analysis by the PCP and PICU researchers via the template in Table 1 . The test for practical assessment was designed by researchers on the basis of theoretical training, taking as a reference the template developed by Forbes et al 9 for their study of patient education in physiotherapy students and adapting it for medical students. Table 1 PRACTICAL ASSESSMENT FOR TUTORS AND STUDENTS COMPETENCIES Score 0–10 I. ASSESSES THE PATIENT'S NEEDS 1 Provides a cordial welcome and introduces himself appropriately. 2 Active listening, letting the patient speak and paying attention to how they understand their problem. 3 Seeks the patient's perceptions and/or concerns 4 Conduct an orderly and focused interview 5 Summarises the clinical data to the patient in a concrete way II. PROVIDES PATIENT-CENTRED INFORMATION 6 Clearly states a diagnosis or defines the health problem 7 Effectively explains the patient's condition or problem 8 It explains the treatment in detail 9 Uses shared decision making (explaining options to the patient and arriving at a treatment decision together) 10 Explain in detail the foreseeable evolution/alarm symptoms 11 Acknowledges and resolves patient concerns appropriately 12 Uses patient-tailored learning content 13 Uses communication styles/languages appropriate for the patient III. ASSESSES PATIENT LEARNING 14 Evaluates what parents have learned IV. CONNECTS EMOTIONALLY WITH THE PATIENT 15 Empathises with the patient and parents OVERALL SCORE (total) Assessment criteria: 0. Skill/competence not observed; 1–4. Poor and insufficient skill/competence; 5–6. Skill/competence at a sufficient level; 7–8. Skill/competence at a good level; 9–10. Skill/competence at an excellent level; Not evaluable (NE) = No opportunity to demonstrate the skill/competence. The 15 questions were classified under four headings: assessment of patient needs, patient-centered education, evaluation of patient learning and connecting emotionally with the patient. At the end of the performance, the trainee completed a self-assessment of their performance via the same template as the tutors did, adding two questions: 1) I understand the role of patient education and 2) I understand the impact of social, cultural and behavioral variables on patient learning. At the end of the study, the students completed a satisfaction survey regarding their participation in the study. Outcome variables The main variables were the results of the pre- and posttraining tests, the results of the practical assessment carried out by four clinical tutors/researchers (two from the PCP and two from the PICU) and the self-assessment of the trainees. The secondary variables were the results of the student satisfaction survey and the results of each section of the practical assessment. Statistical study The sample size was calculated on the basis of the study by Forbes et al 9 . with an alpha risk of 0.05 and a beta risk of 0.2 in a bilateral contrast, the sample size had to be at least 22 students in each group. Statistical analysis was carried out with SPSS v25 (IBM). Descriptive statistics were performed with the estimation of frequencies of qualitative variables and measures of trend and dispersion of quantitative variables. Continuous variables did not follow a normal distribution, so comparisons were made between them via the Mann‒Whitney U test with significance level adjustment and, in the case of paired variables, the Wilcoxon signed-rank test. Spearman's C coefficient was used to calculate the correlation between the different tutors' ratings. RESULTS Sixty-seven students participated in the study (22 in group 1, 23 in group 2 and 22 in group 3). Of these, 34 belonged to the 5th year of the degree of medicine, and 33 belonged to the 6th year. In all the groups, female sex predominated (n = 43; 64.2%), which coincided with the percentage of women in medicine at our university. There were no sex differences among the three groups or between the 5th and 6th years of medicine. Theoretical evaluation Figure 2 summarizes the results of the theoretical pre- and posttraining assessments in the three groups. No differences were found between the groups in terms of the pretest results (p = 0.38). The posttraining theoretical assessment score was significantly higher than the pretraining score (mean [standard deviation (SD)]) (pretest: 8.07 [0.16]; posttest: 9.31 [0.09]; p < 0.001). The results improved after theoretical training in all three groups (group 1: p = 0.001; group 2: p = 0.003; group 3: p = 0.005). The students in group 1 (PCP) scored significantly higher on the posttraining test (9.81 [0.08]) than did those in group 2 (PICU) (9.18 [0.16]) (p = 0.002) and group 3 (PER) (8.95 [0.19]; p < 0.001). There were no significant differences between groups 2 and 3 (p = 0.39). Practical evaluation For the tutor rating, the PICU students (group 2) scored significantly higher (8.17 [0.14]) than did the PCP (group 1) (7.44 [0.18]; p = 0.004) and PER (group 3) (7.18 [0.14]); p < 0.001) students. There were also significant differences between groups 1 and 3 (p = 0.034). Differences were maintained when the evaluations of the PCP and PICU tutors were analyzed separately, but in the latter, the differences did not reach statistical significance (p = 0.155). Student self-assessment was higher thantutor assessment overall (8.26 [0.11] vs. 7.63 [0.11]; p < 0.001) and in all groups (Fig. 3 ) The practical assessment was divided into four parts: part I, assessment of patient needs (APN); part II, patient-centered information (PCI); part III, assessment of patient learning (APL); part IV, emotional connection with the patient (ECP). The results of the four parts are shown in Fig. 4 . The students in Group 2 (7.80 [0.19]) scored higher than those in Groups 1 (6.87 [0.24]; p = 0.009) and 3 (6.37 [0.19]; p < 0.001). There were no differences between groups 1 and 3. There were no significant differences in self-assessment among the three groups. The PICU trainees' rating was better than that of PER for PCP tutors (7.4 [0.23] vs 5.83 [0.19]; p < 0.001) and PICU tutors (8.23 [0.18] vs 6.9 [0.22]) p < 0.001). For the PCP tutors, the rating of the PCP students (6.65 [0.22]) was better than that of the PER students (5.83 [0.19]): p = 0.010), with no differences found between the PCP and PICU. In the second part, the students in Group 1 scored significantly higher (8.56 [0.16]) than did those in Group 3 (8.21 [0.13]; p = 0.018). There were no significant differences between the other groups. The score of the PCP tutors was higher for the PCP trainees (group 1) (8.54 [0.18]) than for the PER trainees (group 3) (8.30 [0.12]; p = 0.037) and the PICU trainees (group 2) (8.20 [0.11]); p = 0.02). The PICU tutor score was also higher for students in Group 1 (8.58 [0.17]; p = 0.029) and Group 2 (8.61 [0.12]; p = 0.022) than for those in Group 3 (8.12 [0.16]), with no differences between Groups 1 and 2. There were no differences in student self-assessment between any of the groups. The third part was the one in which the students obtained the worst scores. The Group 2 (PICU) students scored better (8.46 [0.57]) than did the Group 1 (PCP) (2.53 [0.82] p < 0.001) and Group 3 (PER) (4.00 [0.95]; p = 0.002) students. These differences were maintained when the evaluations of the PCP and PICU tutors were analyzed separately. There were no differences between the PCP and PER groups. The self-assessment of the students in Group 2 was significantly greater (9.05 [0.23]) than that of the students in Groups 1 (7.00 [0.26]; p < 0.001) and 3 (6.26 [0.78]; p = 0.002), and as with the tutor ratings, there were no significant differences in the assessment of the students in Groups 1 and 3 (Fig. 4 ). In the fourth part, the students in group 1 (PCP) obtained a better score (8.54 [0.23]) than did those in group 2 (PICU) (8.37 [0.08]; p = 0.041) and group 3 (PER) (8.19 [0.11]; p = 0.013). This difference was maintained only between the PCP and PER ratings of the PCP tutors (8.15 [0.29] vs. 7.76 [0.13]; p = 0.038). There were no differences in the students' self-assessments in this block across the different groups (Fig. 4 ). Correlation between tutors' assessments A strong positive correlation and agreement (p < 0.001) were found between the PCP and PICU tutor scores for each of the four performance blocks, with Spearman correlation coefficients of + 0.68 for the I APN and + 0.531 for the II. PCI, + 0.869 for III. APL and + 0.415 for IV.ECP. Satisfaction survey The results of the student satisfaction survey are summarized in Table 2 . The overall evaluation was very positive. Table 2 STUDENT RESPONSES TO THE SATISFACTION SURVEY QUESTIONS (n responders) RESPONSE OPTIONS and RESULTS n (%) THEORETICAL PART Theoretical content (66) Very good 39 (58%) Good 25(38%) Fair 1 (2%) Poor 0(0%) Very poor 0 (0% ) Contents (66) Sufficient 64(97%) Scarce 2 (3%) Excessive 0 (0%) Theoretical part duration (66) Sufficient 61(92%) Scarce 2 (3%) Excessive 3 (5%) Theoretical part format (66) Adequate 50 (76%) I would prefer in person 15 (23%) I would prefer remote, but live 1 (2%) Videos (65) Adequate 59 (91%) Scarce. 5 (8%) Excessive. 1(2%) PRACTICAL PART Practical training (52) Very good 41(79%) Good 11(21%) Fair 0(0%) Poor 0 (0%) Very poor 0(0%) Duration (52) Adequate 47(90%) Scarce 4(8%) Excessive 1(2%) Form of practical training (52) Adequate 45 (87%) Better training with a patient 7 (13%) EVALUATION Theoretical assessment (55) Adequate 51(93%) Excessive 2(4%) Short 1(2%) Does not assess well 0 (0%) There should be no theoretical assessment 0 ( 0%) Practical evaluation (55) Adequate 54(98%) Excessive 1(2%) Short 0(0%) Does not assess well 0 (0%) There should be no practical assessment 0 (0%) TEACHING STAFF Teacher education (45) Very good 41(91%) Good 4 (9%) Fair 0 (0%) Poor 0(0%) Very poor 0(0%) Coordination between theoretical and practical content (45) Very good 35(78%) Good 10(22%) Fair 0(0%) Poor 0(0%) Very poor 0 (0%) Teachers' attitude (45) Very good 45(100%) Good 0(0%) Fair 0(0%) Poor 0(0%) Very poor 0(0%) TRAINING IN PATIENT EDUCATION Is training in patient education necessary in the medical degree? (45) Yes 45(100%) No 0(0%) Is practical training in patient education necessary? (45) Yes 45(100%) No 0 ( 0%) The desirability of recycling (45) Yes 44 (98%) No 1(2%) PC: primary care; PICU: paediatric intensive care unit; PICU: paediatric intensive care unit; PED: paediatric emergency department (*) p < 0.001; (+) p < 0.005 PCP: primary care paediatrics; PICU: paediatric intensive care unit; PICU; PER: paediatric emergency room; Global mean: average of the four tutors PCP: Primary Care Pediatrics; PICU: Paediatric intensive care unit; PER: Paediatric Emergency Room DISCUSSION Our results show that mixed training with a theoretical class and specific training with simulation achieves better practical training in patient education than do exclusive theoretical training and training with practice in PCP practice. Patient education is the process that enhances patients' knowledge and skills to make decisions and engage in activities that improve their health. The fundamental objectives of patient education are to empower patients to make informed decisions that promote health and to encourage their active participation in the educational process through a critical attitude and involvement in decision-making. Patient education encompasses a wide range of activities, from providing information to practical teaching of technical skills and the use of devices. This study focuses primarily on the educational activities conducted by physicians informing the parents of pediatric patients with acute illnesses Patient education is one of the most important factors influencing therapeutic success [ 13 ]. Despite this, little importance has been given to patient education in the training of healthcare professionals [ 2 , 14 ] and this is done in a poorly structured manner, which is one of the causes of therapeutic failure [ 2 , 3 ]. Few studies have analyzed the efficacy of various methods of patient education [ 15 ]. Our study is the first to compare two methods of practical patient education training in medical students, one using simulation and the other directly with the patient, using a control group that only received theoretical training and a clinical rotation [ 15 ]. Our results show that the theoretical training achieved an adequate acquisition of knowledge with a significant improvement between the previous score (8.07 [0.16]) and the subsequent score (9.31 [0.09]), although in the previous evaluation, the level of knowledge was already acceptable, probably because they were 5th- and 6th-year medical students and, although not in a regulated manner, had received some kind of previous training. In the assessment of practical training, the students achieved adequate practical competence in patient education (PCP 7.44 [0.18]; PICU 8.17 [0.14] and PER 7.18 [0.14]), although we cannot compare their improvement because no prior practical assessment was carried out. When analyzing the competencies acquired in each of the four aspects of patient education, the students scored significantly higher in patient-centered information (8.39 [0.08]) and emotional connection (8.37 [0.09]) than in assessing the patient's needs (7.03 [0.14]) and especially in assessing the patient's learning (5.05 [0.54]). This is probably because, without specific training, health professionals focus primarily on the transmission of information about disease and treatment and do not assess what the patient has learned. Another remarkable aspect is that students score high in emotional connection with patients, which is a key factor in strengthening the doctor–patient relationship and improving the effectiveness of education outcomes. Evaluating this aspect is challenging because the expression of empathy can vary among individuals. For this item, we assessed whether the student directly asked the parents about their concerns regarding their child's illness. We also considered complementary aspects such as maintaining eye contact while speaking, tone of voice, and body language. Assessment of the patient's needs is essential for education, which is focused not only on information about the disease but also on the patient [ 16 ]. Finally, evaluating what the patient has learned is the best method for determining whether the transmission of information has been effective [ 15 ]. This item assessed whether the student asked the parents to explain what they had understood in order to evaluate whether the parents had correctly comprehended the disease, risk factors, and necessary actions. This is a fundamental aspect of patient education, as it allows for verification that the explained concepts have been well understood. In our study, this competency was the worst acquired by the students (46% of the students did not carry out the evaluation of learning). This is the item in which there was the greatest difference between the three groups, and only the students in group 2 (UCIP) achieved an adequate score because they received specific training to do so. This fact indicates that training and coaching in this respect should be reinforced. The simulation-trained students scored higher in global competencies, as assessed by the tutors and in the students' self-assessment, which reinforces the consistency of the results. Structured simulation training is a good method for learning patient education in medical students, which coincides with the findings of other authors [ 17 ]. Simulation allows for quality, planned and structured teaching without requiring a large number of teaching staff or disrupting clinical care. This method can be used for students in other professions (nursing, pharmacy) and in postgraduate training (pediatric and nursing residents). A specific scenario can be designed to practice and assess patient education competencies in different situations. The recordings can also be used for the self-assessment of students to improve their competences. When comparing each type of competency across the three types of training, simulation-trained trainees achieved significantly higher scores than those trained with the other two types of training in assessing patient needs and evaluating patient learning. These are two of the competencies that are least common in clinical practice and therefore benefit most from structured training. This explains the low scores for the other two types of training. On the other hand, the PCP students scored slightly higher in emotional connection with the patient. This fact reinforces the formative role of clinical practice in learning empathy with the patient. Students who only received theoretical training on patient education achieved the lowest scores, confirming that although theoretical training is necessary, it is not sufficient to achieve adequate competence in patient education. Our results show that the evaluation system used in our study can be a useful tool for the evaluation of patient education. The assessment method with a simulation scenario allows the systematic evaluation of all aspects of patient education in a simpler and more structured way than actual observation with patients. The video recording of the performance allows for a detailed a posteriori analysis of the trainees' performance. The scenario was specifically designed on a frequent and important case in pediatric clinical practice to assess all educational competencies. As the assessment of some of the items is complex, several consensus meetings were needed to achieve homogeneity of criteria. On the other hand, this method of assessment requires training of the instructors who perform the role of parents. In our study, this role was performed by three instructors (two in PCP settings [group 1] and the same in all hospital settings [groups 2 and 3]), which facilitated the homogeneity of performance. The teaching team possesses extensive experience in simulation methodology, holding accreditation as a training group in advanced pediatric simulation from the International Group for Advanced Pediatric Simulation (GIPS). The team develops numerous undergraduate and postgraduate training courses employing simulation methodology, including courses for instructors in advanced pediatric simulation. Students had previously undertaken simulation activities. In our university, fifth-year students receive 11 practical pediatric seminars using simulation methodology. Independently of this, students participating in the study received specific training on the methodology to be used in the study prior to the specific training. When comparing the evaluations made between the different clinical tutors/researchers (two from the PCP and two from the hospital), there was a good correlation, both in the overall score and in each of the specific areas, although the scores of the hospital teachers were higher. To rule out bias in the teachers' assessment of their own students, the scores given by both groups of researchers (PCP and PICU) to each of the two groups of students were compared. Although each group of clinical tutors/researchers scored their own students slightly higher, the differences in scores were very small (0.26 points in the overall score), so we can rule out that this possible bias may have influenced the results. Finally, the self-assessment of the students was higher than that of the clinical tutors/researchers, both in the overall score (tutors 7.63 [0.11]; self-assessment 8.26 [0.11]; p < 0.001) and in each of the specific competencies (except for patient-centered information). This is in line with findings in other studies [ 18 ] and underlines the importance of receiving feedback from the tutor in order to ensure proper learning. While the primary objective of the study was not to compare the evaluations of tutors and students in the educational process, it is important for students to assess their own performance as self-assessment is also a part of learning. The differences were insignificant, except in the assessment of patient learning. This may be because the trainees felt that they had met the objective because the patients said they had understood the information and had their doubts resolved, but in reality, it was not checked whether they had understood it. On the other hand, in our study, the students did not review the recording of their performance, which makes their evaluation less objective. The review of the recording of their performance by each student can also be a method of reinforcing learning, as it allows the student to better identify the competences to be improved. Our study has several limitations. First, the number of students included in each group was not very high, although it was enough to show the differences in teaching results. The sample selection was not random but rather was based on consecutive sampling. The students chose their pediatric rotations in alphabetical order, with the first position chosen randomly, without knowing about the study's existence. This could affect the generalizability of the results. On the other hand, as 5th- and 6th-year medical students, they had already had previous clinical experience, at least observing patient education. This may be the reason for the relatively high score in the theoretical preexamination. As there was no prior assessment of practical skills, it is not possible to know the previous level of the students before the intervention and therefore the degree of improvement in practical skills. One of the most important limitations of our study is that we did not include a control group in which no theoretical training was carried out, which would have allowed a better comparison of the effectiveness of the three teaching methods. We also did not include a group in which simulation training was combined with clinical practice in PCP education. With respect to the assessment method, the most important limitation is that the performance of the students was not carried out in the same place. The students who rotated on the PCP were assessed in the consulting room with a computer, and the hospital students were assessed in a simulated consulting room without a computer. These environmental factors could have introduced some bias in the contact with the patient, as they were more attentive to the computer. However, the PCP students scored higher on patient empathy, so this factor does not seem to have significantly influenced the results. One of the main limitations may have been that the teachers who taught were those who acted as parents and who carried out the assessment. This might have introduced some risk of subjectivity bias, but as discussed above, our analysis shows that this risk, if present, was insignificant. The competency evaluation template was created by the researchers on the basis of the theoretical training provided. It is not a validated scale, as we did not find any validated scale The template was the result of a thorough process carried out by the research team to produce a document that would accurately reflect the student's learning and allow for a homogeneous assessment by the tutors. The fact that the evacuation of the four tutors was very similar suggests that the objective was achieved Finally, our study analyzed only short-term learning, and it would be necessary to test whether this learning is sustained in the long term and whether there are differences between the various methods. The strength of our study is that the design and development were carried out by a small, well-coordinated group of physicians with extensive clinical, patient education and simulation experience. Conclusions This study highlights the superiority of mixed training approaches, combining theoretical lessons with simulation-based learning, in fostering practical competencies in patient education among medical students. Simulation effectively enhances critical skills, including assessing patient needs and evaluating patient learning, which are often underdeveloped in traditional clinical practice. Embedding simulation-based learning in medical education provides a structured, repeatable, and resource-efficient method for teaching complex competencies. Institutions should design scenario-based assessments to reflect common clinical situations, include video recordings for self-assessment, and integrate this approach across disciplines. Simulation can significantly improve educational outcomes, fostering short to medium term clinical efficacy, but we believe should be used simultaneously and complementary to clinical practice, which is where the student learns to interact with the patient. Further research would be needed to know whether these skills are maintained in the medium- long term. Abbreviations UHGM General University Hospital Gregorio Marañón UCM Complutense University of Madrid PCP Pediatric primary care PICU Pediatric intensive care unit PER Pediatric emergency rooms SD Standard deviation APN Assessment of patient needs PCI Patient-centered information APL Assessment of patient learning ECP Emotional connection with the patient Declarations ACKNOWLEDGMENTS : The authors wish to thank the students who have participated in the project. AUTHORS’ CONTRIBUTION MA, JLH, SM participate in conceptualization, methodology, investigation, validation, formal analysis, project administration, supervision, data curation writing – original draft, Writing - review & editing. NM, MJS, PV participated in conceptualization, methodology, investigation, writing-review and editing AVAILABILITY OF DATA AND MATERIALS All data generated and analysed during this study are included in this published article ADDITIONAL INFORMATION Competing interests : The authors declare that they have no competing interests. Funding/Support : None. Declaration of AI and AI-assisted technologies in the writing process The authors hereby declare they did not use generative AI and AI-assisted technologies during the manuscript writing process. References Bartlett, E. E. At last, a definition. Patient Educ. Couns. 7 (4), 323–324 (1985). Svavarsdóttir, M. H., Sigurardóttir, Á. K. & Steinsbekk, A. How to become an expert educator: A qualitative study on the view of health professionals with experience in patient education Approaches to teaching and learning. BMC Med. Educ. 15 , 87 (2015). Kääriäinen, M. & Kyngäs, H. The quality of patient education evaluated by the health personnel. 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Training physiotherapy students to educate patients: A randomized controlled trial. Patient Educ. Couns. 101 (2), 295–303 (2018). Dwamena, F. et al. Interventions for providers to promote a patient-centered approach in clinical consultations. Cochrane Database Syst. Rev. 12 (12), CD003267 (2012). Gartmeier, M. et al. Fostering professional communication skills of future physicians and teachers: effects of e-learning with video cases and role-play. Instr Sci. 43 (4), 443–462 (2015). Bosse, H. M. et al. The effect of using standardized patients or peer role play on ratings of undergraduate communication training: A randomized controlled trial. Patient Educ. Couns. 87 (3), 300–306 (2012). Lagger, G., Pataky, Z. & Golay, A. Efficacy of therapeutic patient education in chronic diseases and obesity. Patient Educ. Couns . 79 (3), 283–286 (2010). Wolld Heallth Organization. Transforming and Scaling up health professionals’ education and training. WHO Publ 124 (2013). Forbes, R. et al. Effectiveness of patient education training on health professional student performance: A systematic review. Patient Educ. Couns. 104 (10), 2453–2466 (2021). Kjær, L. B., Nielsen, K. J. S., Christensen, M. K. & Strand, P. Patient-centered learning in practice. A mixed methods study of supervision and learning in student clinics. Patient Educ. Couns. 112 , 107717 (2023). Hough, J., Levan, D., Steele, M., Kelly, K. & Dalton, M. Simulation-based education improves student self-efficacy in physiotherapy assessment and management of pediatric patients. BMC Med. Educ. 19 (1), 1–11 (2019). Davis, D. A. et al. Accuracy of physician self-assessment compared with observed measures of competence: a systematic review. JAMA 296 , 1094–1102 (2006). Additional Declarations No competing interests reported. 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19:53:44","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-9193457/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-9193457/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":108819568,"identity":"9b60921f-91da-4bdd-84d4-baf40d58e7e0","added_by":"auto","created_at":"2026-05-08 16:37:56","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":529755,"visible":true,"origin":"","legend":"\u003cp\u003eSee image above for figure legend.\u003c/p\u003e","description":"","filename":"Figure11.jpg","url":"https://assets-eu.researchsquare.com/files/rs-9193457/v1/edcb483582145000b6bd8fd6.jpg"},{"id":109252474,"identity":"a82393ca-9f90-42bc-b241-0021261ff416","added_by":"auto","created_at":"2026-05-14 09:26:58","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":313685,"visible":true,"origin":"","legend":"\u003cp\u003eSee image above for figure legend.\u003c/p\u003e","description":"","filename":"Figure12.jpg","url":"https://assets-eu.researchsquare.com/files/rs-9193457/v1/b8b9e11edd090cbff9bff250.jpg"},{"id":108819565,"identity":"6bbd8ce7-2675-4a0f-8ddb-962a0e0dae4d","added_by":"auto","created_at":"2026-05-08 16:37:55","extension":"jpg","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":327351,"visible":true,"origin":"","legend":"\u003cp\u003eSee image above for figure legend.\u003c/p\u003e","description":"","filename":"Figure13.jpg","url":"https://assets-eu.researchsquare.com/files/rs-9193457/v1/a794cfd94c8dafacc599c585.jpg"},{"id":108820876,"identity":"c6d6c1eb-15a0-4599-9ebf-f3312bad2e99","added_by":"auto","created_at":"2026-05-08 16:43:19","extension":"jpg","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":486739,"visible":true,"origin":"","legend":"\u003cp\u003eSee image above for figure legend.\u003c/p\u003e","description":"","filename":"Figure14.jpg","url":"https://assets-eu.researchsquare.com/files/rs-9193457/v1/fe85a3f6c49a813195dadd27.jpg"},{"id":109252731,"identity":"805d4174-21d3-4cf9-b887-47f0476a17f3","added_by":"auto","created_at":"2026-05-14 09:31:45","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1925407,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-9193457/v1/2f618439-fbff-4940-9254-a7fab4d16281.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"\u003cp\u003eSimulation-based Learning: A Key Strategy in Patient Education Training for Medical Students\u003c/p\u003e","fulltext":[{"header":"INTRODUCTION","content":"\u003cp\u003ePatient education training refers to the training provided to medical professionals on how to effectively educate patients about their health conditions, treatment plans, and overall wellness. This training focuses on developing the skills necessary for medical professionals to communicate clearly, empathetically, and accurately with patients, ensuring that patients understand their medical conditions and the necessary steps for their care and recovery [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. It ranges from assessing the patient's needs with an adequate medical history to providing adequate information, confirming that the patient has understood this information and doing all of this in an empathetic environment.\u003c/p\u003e \u003cp\u003ePhysicians who are not trained in patient education often provide information on the basis of their experience without applying a specific methodology [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. In recent years, patient education has evolved toward patient-centered education, taking into account patients\u0026rsquo; motivation, beliefs and concerns to identify barriers and provide individualized education tailored to patients\u0026rsquo; needs [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e].\u003c/p\u003e \u003cp\u003ePatient education is a core competency for medical students [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e], with benefits for both patients and students [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Despite this, medical students receive little training in an unstructured way, as training is generally not included in the mandatory activities of practical rotations. Forbes et al. conducted several studies on patient education training in physiotherapy students and reported that short and intensive training has a positive effect on theoretical knowledge and practical skills in patient education [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eSeveral studies have proven the usefulness of simulation methods with simulated patients who allow trainees to interact while learning [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. However, there is no evidence that these methods are superior to theoretical training or direct learning during practical rotation.\u003c/p\u003e \u003cp\u003eThe primary objective of this study was to compare the effectiveness of two methods of patient education training for medical students (simulation training versus clinical practice education) with a control group of students who received only theoretical training. The secondary objectives were to compare the students' self-assessment with that of the researchers and the agreement between the researchers in the assessment of the recorded images of the students' performance.\u003c/p\u003e"},{"header":"METHODS","content":"\u003cp\u003eA prospective nonrandomized comparative study was conducted. 5th- and 6th-year medical students who performed their clinical rotations in the pediatric primary care PCP (group 1), pediatric intensive care unit (PICU) (group 2) and pediatric emergency rooms (PER) (group 3) of the Complutense University of Madrid (UCM), during the academic years 2021\u0026ndash;2022 and 2022\u0026ndash;2023 and voluntarily participated in the study. Any student had not received any previous training in patient education. There were no exclusion criteria.\u003c/p\u003e \u003cp\u003e The study was approved as a teaching innovation project by the UCM committee (Innova Docencia 2022 number 337), ratifying the lack of need for assessment by a research ethics committee. All methods were performed in accordance with the ethics and national legals guidelines and regulations in accordance with the Declaration of Helsinki. The study was carried out as part of the pediatrics teaching practice and did not involve any risk. The students were provided with detailed information about the study, were given an explanatory sheet, were offered voluntary participation and were asked for informed consent. The data were anonymized and securely stored on the UCM website, as were the recorded videos.\u003c/p\u003e \u003cp\u003e \u003cb\u003ePhases and activities\u003c/b\u003e (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e)\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003ePhase 1. Theoretical training\u003c/em\u003e.\u003c/p\u003e \u003cp\u003eThe three groups received the same theoretical training on patient education in the first days of their rotation in pediatrics. First, a theoretical assessment was carried out, consisting of 10 test questions with 4 possibilities. This was followed by theoretical training in patient education, which consisted of a 25-minute presentation and the viewing and discussion of two videos with the students. Immediately after the theoretical training, the same theoretical assessment was repeated.\u003c/p\u003e \u003cp\u003e \u003cem\u003ePhase 2. Practical training (three weeks).\u003c/em\u003e \u003c/p\u003e \u003cp\u003eGroup 1 received practical training during the PCP rotation by the clinical tutors/researchers: During the first two weeks, patient education provided by the tutor was observed and subsequently commented on. In the third week, the student progressively performed patient education, and then, together with the tutor, their performance was analyzed.\u003c/p\u003e \u003cp\u003eGroup 2 received a practical patient education workshop in the second or third week of rotation. Firs of all, students received an explanation of the objectives and functioning of the simulation. Subsequently the students played the role of doctors (one roll played each and observed 2\u0026ndash;3 roll played by others) and provided health education to the clinical tutors/researchers, who were instructors in advanced simulation and played the role of a child's parents. The methodology of the practice was as follows: 1st. Performance by a pupil; 2nd evaluation: a) self-evaluation/ group evaluation and b) evaluation by instructor: 3rd. Summary and conclusions.\u003c/p\u003e \u003cp\u003eFor patient education training, three clinical cases were used in both groups: asthma, gastroenteritis and upper respiratory tract infection (which were different from those used in the practical assessment).\u003c/p\u003e \u003cp\u003eThe students had to perform the following tasks: 1st, to know the patient's characteristics (personal, family, social), assess their educational needs, knowledge of the disease, concerns and expectations about their treatment; 2nd, to transmit educational content, adapting to the patient's characteristics; and 3rd, to evaluate the patient's learning, assessing what they have learned.\u003c/p\u003e \u003cp\u003eThe trainees in group 3 observed and practiced the clinical and patient education activities performed with patients attending the Emergency Department without receiving any specific practical training in patient education.\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003ePhase 3: Practical assessment\u003c/h2\u003e \u003cp\u003eThe practical assessment took place in the last week of the rotation. The students in group 1 participated in the PCP consultation, and those in groups 2 and 3 participated in the PICU. A simulation was carried out in which the student played the role of the doctor and the clinical tutors/researchers played the role of the parents. The student had to take the clinical history and provide health education on acute bronchiolitis to the mother or father. The student had 10 minutes to read the written case and prepare his/her performance. The performance lasted 10 minutes and was video recorded for later evaluation and analysis by the PCP and PICU researchers via the template in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. The test for practical assessment was designed by researchers on the basis of theoretical training, taking as a reference the template developed by Forbes et al\u003csup\u003e9\u003c/sup\u003e for their study of patient education in physiotherapy students and adapting it for medical students.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003ePRACTICAL ASSESSMENT FOR TUTORS AND STUDENTS\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCOMPETENCIES\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eScore\u003c/p\u003e \u003cp\u003e0\u0026ndash;10\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003eI. ASSESSES THE PATIENT'S NEEDS\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eProvides a cordial welcome and introduces himself appropriately.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eActive listening, letting the patient speak and paying attention to how they understand their problem.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSeeks the patient's perceptions and/or concerns\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eConduct an orderly and focused interview\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSummarises the clinical data to the patient in a concrete way\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eII. PROVIDES PATIENT-CENTRED INFORMATION\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eClearly states a diagnosis or defines the health problem\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eEffectively explains the patient's condition or problem\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIt explains the treatment in detail\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUses shared decision making (explaining options to the patient and arriving at a treatment decision together)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eExplain in detail the foreseeable evolution/alarm symptoms\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAcknowledges and resolves patient concerns appropriately\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUses patient-tailored learning content\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUses communication styles/languages appropriate for the patient\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eIII. ASSESSES PATIENT LEARNING\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eEvaluates what parents have learned\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eIV.\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eCONNECTS EMOTIONALLY WITH THE PATIENT\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eEmpathises with the patient and parents\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eOVERALL SCORE (total)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"3\"\u003eAssessment criteria: 0. Skill/competence not observed; 1\u0026ndash;4. Poor and insufficient skill/competence; 5\u0026ndash;6. Skill/competence at a sufficient level; 7\u0026ndash;8. Skill/competence at a good level; 9\u0026ndash;10. Skill/competence at an excellent level; Not evaluable (NE)\u0026thinsp;=\u0026thinsp;No opportunity to demonstrate the skill/competence.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThe 15 questions were classified under four headings: assessment of patient needs, patient-centered education, evaluation of patient learning and connecting emotionally with the patient. At the end of the performance, the trainee completed a self-assessment of their performance via the same template as the tutors did, adding two questions: 1) I understand the role of patient education and 2) I understand the impact of social, cultural and behavioral variables on patient learning.\u003c/p\u003e \u003cp\u003eAt the end of the study, the students completed a satisfaction survey regarding their participation in the study.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eOutcome variables\u003c/h3\u003e\n\u003cp\u003eThe main variables were the results of the pre- and posttraining tests, the results of the practical assessment carried out by four clinical tutors/researchers (two from the PCP and two from the PICU) and the self-assessment of the trainees.\u003c/p\u003e \u003cp\u003eThe secondary variables were the results of the student satisfaction survey and the results of each section of the practical assessment.\u003c/p\u003e\n\u003ch3\u003eStatistical study\u003c/h3\u003e\n\u003cp\u003eThe sample size was calculated on the basis of the study by Forbes et al\u003csup\u003e9\u003c/sup\u003e. with an alpha risk of 0.05 and a beta risk of 0.2 in a bilateral contrast, the sample size had to be at least 22 students in each group.\u003c/p\u003e \u003cp\u003eStatistical analysis was carried out with SPSS v25 (IBM). Descriptive statistics were performed with the estimation of frequencies of qualitative variables and measures of trend and dispersion of quantitative variables.\u003c/p\u003e \u003cp\u003eContinuous variables did not follow a normal distribution, so comparisons were made between them via the Mann‒Whitney U test with significance level adjustment and, in the case of paired variables, the Wilcoxon signed-rank test. Spearman's C coefficient was used to calculate the correlation between the different tutors' ratings.\u003c/p\u003e"},{"header":"RESULTS","content":"\u003cp\u003eSixty-seven students participated in the study (22 in group 1, 23 in group 2 and 22 in group 3). Of these, 34 belonged to the 5th year of the degree of medicine, and 33 belonged to the 6th year. In all the groups, female sex predominated (n\u0026thinsp;=\u0026thinsp;43; 64.2%), which coincided with the percentage of women in medicine at our university. There were no sex differences among the three groups or between the 5th and 6th years of medicine.\u003c/p\u003e\n\u003ch3\u003eTheoretical evaluation\u003c/h3\u003e\n\u003cp\u003eFigure \u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e summarizes the results of the theoretical pre- and posttraining assessments in the three groups. No differences were found between the groups in terms of the pretest results (p\u0026thinsp;=\u0026thinsp;0.38). The posttraining theoretical assessment score was significantly higher than the pretraining score (mean [standard deviation (SD)]) (pretest: 8.07 [0.16]; posttest: 9.31 [0.09]; p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). The results improved after theoretical training in all three groups (group 1: p\u0026thinsp;=\u0026thinsp;0.001; group 2: p\u0026thinsp;=\u0026thinsp;0.003; group 3: p\u0026thinsp;=\u0026thinsp;0.005). The students in group 1 (PCP) scored significantly higher on the posttraining test (9.81 [0.08]) than did those in group 2 (PICU) (9.18 [0.16]) (p\u0026thinsp;=\u0026thinsp;0.002) and group 3 (PER) (8.95 [0.19]; p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). There were no significant differences between groups 2 and 3 (p\u0026thinsp;=\u0026thinsp;0.39).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003ePractical evaluation\u003c/h2\u003e \u003cp\u003eFor the tutor rating, the PICU students (group 2) scored significantly higher (8.17 [0.14]) than did the PCP (group 1) (7.44 [0.18]; p\u0026thinsp;=\u0026thinsp;0.004) and PER (group 3) (7.18 [0.14]); p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) students. There were also significant differences between groups 1 and 3 (p\u0026thinsp;=\u0026thinsp;0.034). Differences were maintained when the evaluations of the PCP and PICU tutors were analyzed separately, but in the latter, the differences did not reach statistical significance (p\u0026thinsp;=\u0026thinsp;0.155).\u003c/p\u003e \u003cp\u003eStudent self-assessment was higher thantutor assessment overall (8.26 [0.11] vs. 7.63 [0.11]; p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) and in all groups (Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e)\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eThe practical assessment was divided into four parts: part I, assessment of patient needs (APN); part II, patient-centered information (PCI); part III, assessment of patient learning (APL); part IV, emotional connection with the patient (ECP).\u003c/p\u003e \u003cp\u003eThe results of the four parts are shown in Fig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e4\u003c/span\u003e. The students in Group 2 (7.80 [0.19]) scored higher than those in Groups 1 (6.87 [0.24]; p\u0026thinsp;=\u0026thinsp;0.009) and 3 (6.37 [0.19]; p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). There were no differences between groups 1 and 3. There were no significant differences in self-assessment among the three groups. The PICU trainees' rating was better than that of PER for PCP tutors (7.4 [0.23] vs 5.83 [0.19]; p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) and PICU tutors (8.23 [0.18] vs 6.9 [0.22]) p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). For the PCP tutors, the rating of the PCP students (6.65 [0.22]) was better than that of the PER students (5.83 [0.19]): p\u0026thinsp;=\u0026thinsp;0.010), with no differences found between the PCP and PICU.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eIn the second part, the students in Group 1 scored significantly higher (8.56 [0.16]) than did those in Group 3 (8.21 [0.13]; p\u0026thinsp;=\u0026thinsp;0.018). There were no significant differences between the other groups. The score of the PCP tutors was higher for the PCP trainees (group 1) (8.54 [0.18]) than for the PER trainees (group 3) (8.30 [0.12]; p\u0026thinsp;=\u0026thinsp;0.037) and the PICU trainees (group 2) (8.20 [0.11]); p\u0026thinsp;=\u0026thinsp;0.02). The PICU tutor score was also higher for students in Group 1 (8.58 [0.17]; p\u0026thinsp;=\u0026thinsp;0.029) and Group 2 (8.61 [0.12]; p\u0026thinsp;=\u0026thinsp;0.022) than for those in Group 3 (8.12 [0.16]), with no differences between Groups 1 and 2. There were no differences in student self-assessment between any of the groups.\u003c/p\u003e \u003cp\u003eThe third part was the one in which the students obtained the worst scores. The Group 2 (PICU) students scored better (8.46 [0.57]) than did the Group 1 (PCP) (2.53 [0.82] p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) and Group 3 (PER) (4.00 [0.95]; p\u0026thinsp;=\u0026thinsp;0.002) students. These differences were maintained when the evaluations of the PCP and PICU tutors were analyzed separately. There were no differences between the PCP and PER groups. The self-assessment of the students in Group 2 was significantly greater (9.05 [0.23]) than that of the students in Groups 1 (7.00 [0.26]; p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) and 3 (6.26 [0.78]; p\u0026thinsp;=\u0026thinsp;0.002), and as with the tutor ratings, there were no significant differences in the assessment of the students in Groups 1 and 3 (Fig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIn the fourth part, the students in group 1 (PCP) obtained a better score (8.54 [0.23]) than did those in group 2 (PICU) (8.37 [0.08]; p\u0026thinsp;=\u0026thinsp;0.041) and group 3 (PER) (8.19 [0.11]; p\u0026thinsp;=\u0026thinsp;0.013). This difference was maintained only between the PCP and PER ratings of the PCP tutors (8.15 [0.29] vs. 7.76 [0.13]; p\u0026thinsp;=\u0026thinsp;0.038). There were no differences in the students' self-assessments in this block across the different groups (Fig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eCorrelation between tutors' assessments\u003c/h3\u003e\n\u003cp\u003eA strong positive correlation and agreement (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) were found between the PCP and PICU tutor scores for each of the four performance blocks, with Spearman correlation coefficients of +\u0026thinsp;0.68 for the I APN and +\u0026thinsp;0.531 for the II. PCI, +\u0026thinsp;0.869 for III. APL and +\u0026thinsp;0.415 for IV.ECP.\u003c/p\u003e\n\u003ch3\u003eSatisfaction survey\u003c/h3\u003e\n\u003cp\u003eThe results of the student satisfaction survey are summarized in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e. The overall evaluation was very positive.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eSTUDENT RESPONSES TO THE SATISFACTION SURVEY\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"10\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eQUESTIONS (n responders)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"9\" nameend=\"c10\" namest=\"c2\"\u003e \u003cp\u003eRESPONSE OPTIONS and RESULTS n (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTHEORETICAL PART\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"9\" nameend=\"c10\" namest=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTheoretical content (66)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eVery good\u003c/p\u003e \u003cp\u003e39 (58%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c5\" namest=\"c3\"\u003e \u003cp\u003eGood 25(38%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003eFair\u003c/p\u003e \u003cp\u003e1 (2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e \u003cp\u003ePoor\u003c/p\u003e \u003cp\u003e0(0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eVery poor\u003c/p\u003e \u003cp\u003e0 (0% )\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eContents (66)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eSufficient 64(97%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c8\" namest=\"c4\"\u003e \u003cp\u003eScarce 2 (3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c10\" namest=\"c9\"\u003e \u003cp\u003eExcessive 0 (0%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTheoretical part duration (66)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eSufficient 61(92%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c8\" namest=\"c4\"\u003e \u003cp\u003eScarce 2 (3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c10\" namest=\"c9\"\u003e \u003cp\u003eExcessive 3 (5%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTheoretical part format (66)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eAdequate 50 (76%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c8\" namest=\"c4\"\u003e \u003cp\u003eI would prefer in person 15 (23%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c10\" namest=\"c9\"\u003e \u003cp\u003eI would prefer remote, but live 1 (2%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVideos (65)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eAdequate 59 (91%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c8\" namest=\"c4\"\u003e \u003cp\u003eScarce. 5 (8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c10\" namest=\"c9\"\u003e \u003cp\u003eExcessive. 1(2%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePRACTICAL PART\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"9\" nameend=\"c10\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePractical training (52)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eVery good\u003c/p\u003e \u003cp\u003e41(79%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003eGood\u003c/p\u003e \u003cp\u003e11(21%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003eFair 0(0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c9\" namest=\"c7\"\u003e \u003cp\u003ePoor\u003c/p\u003e \u003cp\u003e0 (0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eVery poor\u003c/p\u003e \u003cp\u003e0(0%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDuration (52)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eAdequate 47(90%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c8\" namest=\"c4\"\u003e \u003cp\u003eScarce 4(8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c10\" namest=\"c9\"\u003e \u003cp\u003eExcessive 1(2%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eForm of practical training (52)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eAdequate 45 (87%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c8\" namest=\"c4\"\u003e \u003cp\u003eBetter training with a patient 7 (13%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c10\" namest=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eEVALUATION\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"9\" nameend=\"c10\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTheoretical assessment (55)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAdequate\u003c/p\u003e \u003cp\u003e51(93%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003eExcessive\u003c/p\u003e \u003cp\u003e2(4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003eShort\u003c/p\u003e \u003cp\u003e1(2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c9\" namest=\"c7\"\u003e \u003cp\u003eDoes not assess well\u003c/p\u003e \u003cp\u003e0 (0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eThere should be no theoretical assessment\u003c/p\u003e \u003cp\u003e0 ( 0%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePractical evaluation (55)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAdequate\u003c/p\u003e \u003cp\u003e54(98%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003eExcessive\u003c/p\u003e \u003cp\u003e1(2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003eShort\u003c/p\u003e \u003cp\u003e0(0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c9\" namest=\"c7\"\u003e \u003cp\u003eDoes not assess well 0 (0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eThere should be no practical assessment 0 (0%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTEACHING STAFF\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"9\" nameend=\"c10\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTeacher education (45)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eVery good\u003c/p\u003e \u003cp\u003e41(91%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003eGood\u003c/p\u003e \u003cp\u003e4 (9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003eFair\u003c/p\u003e \u003cp\u003e0 (0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c9\" namest=\"c7\"\u003e \u003cp\u003ePoor\u003c/p\u003e \u003cp\u003e0(0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eVery poor\u003c/p\u003e \u003cp\u003e0(0%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCoordination between theoretical and practical content (45)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eVery good\u003c/p\u003e \u003cp\u003e35(78%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003eGood\u003c/p\u003e \u003cp\u003e10(22%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003eFair\u003c/p\u003e \u003cp\u003e0(0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c9\" namest=\"c7\"\u003e \u003cp\u003ePoor\u003c/p\u003e \u003cp\u003e0(0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eVery poor\u003c/p\u003e \u003cp\u003e0 (0%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTeachers' attitude (45)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eVery good\u003c/p\u003e \u003cp\u003e45(100%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003eGood\u003c/p\u003e \u003cp\u003e0(0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003eFair\u003c/p\u003e \u003cp\u003e0(0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c9\" namest=\"c7\"\u003e \u003cp\u003ePoor\u003c/p\u003e \u003cp\u003e0(0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eVery poor\u003c/p\u003e \u003cp\u003e0(0%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTRAINING IN PATIENT EDUCATION\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"9\" nameend=\"c10\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIs training in patient education necessary in the medical degree? (45)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c6\" namest=\"c2\"\u003e \u003cp\u003eYes 45(100%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c10\" namest=\"c7\"\u003e \u003cp\u003eNo 0(0%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIs practical training in patient education necessary? (45)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c6\" namest=\"c2\"\u003e \u003cp\u003eYes 45(100%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c10\" namest=\"c7\"\u003e \u003cp\u003eNo 0 ( 0%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eThe desirability of recycling (45)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c6\" namest=\"c2\"\u003e \u003cp\u003eYes 44 (98%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c10\" namest=\"c7\"\u003e \u003cp\u003eNo 1(2%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"10\"\u003ePC: primary care; PICU: paediatric intensive care unit; PICU: paediatric intensive care unit;\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"10\"\u003ePED: paediatric emergency department (*) p\u0026thinsp;\u0026lt;\u0026thinsp;0.001; (+) p\u0026thinsp;\u0026lt;\u0026thinsp;0.005\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"10\"\u003ePCP: primary care paediatrics; PICU: paediatric intensive care unit; PICU;\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"10\"\u003ePER: paediatric emergency room; Global mean: average of the four tutors\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"10\"\u003e\u003cb\u003ePCP: Primary Care Pediatrics; PICU: Paediatric intensive care unit; PER: Paediatric Emergency Room\u003c/b\u003e\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eOur results show that mixed training with a theoretical class and specific training with simulation achieves better practical training in patient education than do exclusive theoretical training and training with practice in PCP practice.\u003c/p\u003e \u003cp\u003ePatient education is the process that enhances patients' knowledge and skills to make decisions and engage in activities that improve their health. The fundamental objectives of patient education are to empower patients to make informed decisions that promote health and to encourage their active participation in the educational process through a critical attitude and involvement in decision-making.\u003c/p\u003e \u003cp\u003ePatient education encompasses a wide range of activities, from providing information to practical teaching of technical skills and the use of devices. This study focuses primarily on the educational activities conducted by physicians informing the parents of pediatric patients with acute illnesses\u003c/p\u003e \u003cp\u003ePatient education is one of the most important factors influencing therapeutic success [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. Despite this, little importance has been given to patient education in the training of healthcare professionals [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e] and this is done in a poorly structured manner, which is one of the causes of therapeutic failure [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eFew studies have analyzed the efficacy of various methods of patient education [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. Our study is the first to compare two methods of practical patient education training in medical students, one using simulation and the other directly with the patient, using a control group that only received theoretical training and a clinical rotation [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eOur results show that the theoretical training achieved an adequate acquisition of knowledge with a significant improvement between the previous score (8.07 [0.16]) and the subsequent score (9.31 [0.09]), although in the previous evaluation, the level of knowledge was already acceptable, probably because they were 5th- and 6th-year medical students and, although not in a regulated manner, had received some kind of previous training.\u003c/p\u003e \u003cp\u003eIn the assessment of practical training, the students achieved adequate practical competence in patient education (PCP 7.44 [0.18]; PICU 8.17 [0.14] and PER 7.18 [0.14]), although we cannot compare their improvement because no prior practical assessment was carried out.\u003c/p\u003e \u003cp\u003eWhen analyzing the competencies acquired in each of the four aspects of patient education, the students scored significantly higher in patient-centered information (8.39 [0.08]) and emotional connection (8.37 [0.09]) than in assessing the patient's needs (7.03 [0.14]) and especially in assessing the patient's learning (5.05 [0.54]). This is probably because, without specific training, health professionals focus primarily on the transmission of information about disease and treatment and do not assess what the patient has learned.\u003c/p\u003e \u003cp\u003eAnother remarkable aspect is that students score high in emotional connection with patients, which is a key factor in strengthening the doctor\u0026ndash;patient relationship and improving the effectiveness of education outcomes. Evaluating this aspect is challenging because the expression of empathy can vary among individuals. For this item, we assessed whether the student directly asked the parents about their concerns regarding their child's illness. We also considered complementary aspects such as maintaining eye contact while speaking, tone of voice, and body language.\u003c/p\u003e \u003cp\u003eAssessment of the patient's needs is essential for education, which is focused not only on information about the disease but also on the patient [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. Finally, evaluating what the patient has learned is the best method for determining whether the transmission of information has been effective [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. This item assessed whether the student asked the parents to explain what they had understood in order to evaluate whether the parents had correctly comprehended the disease, risk factors, and necessary actions. This is a fundamental aspect of patient education, as it allows for verification that the explained concepts have been well understood. In our study, this competency was the worst acquired by the students (46% of the students did not carry out the evaluation of learning). This is the item in which there was the greatest difference between the three groups, and only the students in group 2 (UCIP) achieved an adequate score because they received specific training to do so. This fact indicates that training and coaching in this respect should be reinforced.\u003c/p\u003e \u003cp\u003eThe simulation-trained students scored higher in global competencies, as assessed by the tutors and in the students' self-assessment, which reinforces the consistency of the results. Structured simulation training is a good method for learning patient education in medical students, which coincides with the findings of other authors [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. Simulation allows for quality, planned and structured teaching without requiring a large number of teaching staff or disrupting clinical care. This method can be used for students in other professions (nursing, pharmacy) and in postgraduate training (pediatric and nursing residents).\u003c/p\u003e \u003cp\u003eA specific scenario can be designed to practice and assess patient education competencies in different situations. The recordings can also be used for the self-assessment of students to improve their competences.\u003c/p\u003e \u003cp\u003eWhen comparing each type of competency across the three types of training, simulation-trained trainees achieved significantly higher scores than those trained with the other two types of training in assessing patient needs and evaluating patient learning. These are two of the competencies that are least common in clinical practice and therefore benefit most from structured training. This explains the low scores for the other two types of training.\u003c/p\u003e \u003cp\u003eOn the other hand, the PCP students scored slightly higher in emotional connection with the patient. This fact reinforces the formative role of clinical practice in learning empathy with the patient.\u003c/p\u003e \u003cp\u003eStudents who only received theoretical training on patient education achieved the lowest scores, confirming that although theoretical training is necessary, it is not sufficient to achieve adequate competence in patient education.\u003c/p\u003e \u003cp\u003eOur results show that the evaluation system used in our study can be a useful tool for the evaluation of patient education.\u003c/p\u003e \u003cp\u003eThe assessment method with a simulation scenario allows the systematic evaluation of all aspects of patient education in a simpler and more structured way than actual observation with patients. The video recording of the performance allows for a detailed a posteriori analysis of the trainees' performance.\u003c/p\u003e \u003cp\u003eThe scenario was specifically designed on a frequent and important case in pediatric clinical practice to assess all educational competencies. As the assessment of some of the items is complex, several consensus meetings were needed to achieve homogeneity of criteria.\u003c/p\u003e \u003cp\u003eOn the other hand, this method of assessment requires training of the instructors who perform the role of parents. In our study, this role was performed by three instructors (two in PCP settings [group 1] and the same in all hospital settings [groups 2 and 3]), which facilitated the homogeneity of performance. The teaching team possesses extensive experience in simulation methodology, holding accreditation as a training group in advanced pediatric simulation from the International Group for Advanced Pediatric Simulation (GIPS). The team develops numerous undergraduate and postgraduate training courses employing simulation methodology, including courses for instructors in advanced pediatric simulation. Students had previously undertaken simulation activities. In our university, fifth-year students receive 11 practical pediatric seminars using simulation methodology. Independently of this, students participating in the study received specific training on the methodology to be used in the study prior to the specific training.\u003c/p\u003e \u003cp\u003eWhen comparing the evaluations made between the different clinical tutors/researchers (two from the PCP and two from the hospital), there was a good correlation, both in the overall score and in each of the specific areas, although the scores of the hospital teachers were higher.\u003c/p\u003e \u003cp\u003eTo rule out bias in the teachers' assessment of their own students, the scores given by both groups of researchers (PCP and PICU) to each of the two groups of students were compared. Although each group of clinical tutors/researchers scored their own students slightly higher, the differences in scores were very small (0.26 points in the overall score), so we can rule out that this possible bias may have influenced the results.\u003c/p\u003e \u003cp\u003eFinally, the self-assessment of the students was higher than that of the clinical tutors/researchers, both in the overall score (tutors 7.63 [0.11]; self-assessment 8.26 [0.11]; p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) and in each of the specific competencies (except for patient-centered information). This is in line with findings in other studies [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e] and underlines the importance of receiving feedback from the tutor in order to ensure proper learning. While the primary objective of the study was not to compare the evaluations of tutors and students in the educational process, it is important for students to assess their own performance as self-assessment is also a part of learning. The differences were insignificant, except in the assessment of patient learning. This may be because the trainees felt that they had met the objective because the patients said they had understood the information and had their doubts resolved, but in reality, it was not checked whether they had understood it. On the other hand, in our study, the students did not review the recording of their performance, which makes their evaluation less objective. The review of the recording of their performance by each student can also be a method of reinforcing learning, as it allows the student to better identify the competences to be improved.\u003c/p\u003e \u003cp\u003eOur study has several limitations. First, the number of students included in each group was not very high, although it was enough to show the differences in teaching results. The sample selection was not random but rather was based on consecutive sampling. The students chose their pediatric rotations in alphabetical order, with the first position chosen randomly, without knowing about the study's existence. This could affect the generalizability of the results. On the other hand, as 5th- and 6th-year medical students, they had already had previous clinical experience, at least observing patient education. This may be the reason for the relatively high score in the theoretical preexamination. As there was no prior assessment of practical skills, it is not possible to know the previous level of the students before the intervention and therefore the degree of improvement in practical skills.\u003c/p\u003e \u003cp\u003eOne of the most important limitations of our study is that we did not include a control group in which no theoretical training was carried out, which would have allowed a better comparison of the effectiveness of the three teaching methods. We also did not include a group in which simulation training was combined with clinical practice in PCP education.\u003c/p\u003e \u003cp\u003eWith respect to the assessment method, the most important limitation is that the performance of the students was not carried out in the same place. The students who rotated on the PCP were assessed in the consulting room with a computer, and the hospital students were assessed in a simulated consulting room without a computer. These environmental factors could have introduced some bias in the contact with the patient, as they were more attentive to the computer. However, the PCP students scored higher on patient empathy, so this factor does not seem to have significantly influenced the results.\u003c/p\u003e \u003cp\u003eOne of the main limitations may have been that the teachers who taught were those who acted as parents and who carried out the assessment. This might have introduced some risk of subjectivity bias, but as discussed above, our analysis shows that this risk, if present, was insignificant.\u003c/p\u003e \u003cp\u003eThe competency evaluation template was created by the researchers on the basis of the theoretical training provided. It is not a validated scale, as we did not find any validated scale\u003c/p\u003e \u003cp\u003eThe template was the result of a thorough process carried out by the research team to produce a document that would accurately reflect the student's learning and allow for a homogeneous assessment by the tutors. The fact that the evacuation of the four tutors was very similar suggests that the objective was achieved\u003c/p\u003e \u003cp\u003eFinally, our study analyzed only short-term learning, and it would be necessary to test whether this learning is sustained in the long term and whether there are differences between the various methods.\u003c/p\u003e \u003cp\u003eThe strength of our study is that the design and development were carried out by a small, well-coordinated group of physicians with extensive clinical, patient education and simulation experience.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eThis study highlights the superiority of mixed training approaches, combining theoretical lessons with simulation-based learning, in fostering practical competencies in patient education among medical students. Simulation effectively enhances critical skills, including assessing patient needs and evaluating patient learning, which are often underdeveloped in traditional clinical practice. Embedding simulation-based learning in medical education provides a structured, repeatable, and resource-efficient method for teaching complex competencies. Institutions should design scenario-based assessments to reflect common clinical situations, include video recordings for self-assessment, and integrate this approach across disciplines. Simulation can significantly improve educational outcomes, fostering short to medium term clinical efficacy, but we believe should be used simultaneously and complementary to clinical practice, which is where the student learns to interact with the patient. Further research would be needed to know whether these skills are maintained in the medium- long term.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eUHGM\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eGeneral University Hospital Gregorio Mara\u0026ntilde;\u0026oacute;n\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eUCM\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eComplutense University of Madrid\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003ePCP\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003ePediatric primary care\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003ePICU\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003ePediatric intensive care unit\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003ePER\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003ePediatric emergency rooms\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eSD\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eStandard deviation\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eAPN\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eAssessment of patient needs\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003ePCI\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003ePatient-centered information\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eAPL\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eAssessment of patient learning\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eECP\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eEmotional connection with the patient\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eACKNOWLEDGMENTS\u003c/strong\u003e:\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe authors wish to thank the students who have participated in the project.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAUTHORS’ CONTRIBUTION\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eMA, JLH, SM participate in conceptualization, methodology, \u0026nbsp;investigation, validation, formal analysis, project administration, supervision, data curation \u0026nbsp;writing – original draft, Writing - review \u0026amp; editing. NM, MJS, PV participated in conceptualization, \u0026nbsp;methodology, investigation, writing-review and editing\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAVAILABILITY OF DATA AND MATERIALS\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll data generated and analysed during this study are included in this published article\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eADDITIONAL INFORMATION\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e: The authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding/Support\u003c/strong\u003e: None.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDeclaration of AI and AI-assisted technologies in the writing process\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors hereby declare they did not use generative AI and AI-assisted technologies during the manuscript writing process.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eBartlett, E. 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Couns.\u003c/em\u003e \u003cb\u003e112\u003c/b\u003e, 107717 (2023).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHough, J., Levan, D., Steele, M., Kelly, K. \u0026amp; Dalton, M. Simulation-based education improves student self-efficacy in physiotherapy assessment and management of pediatric patients. \u003cem\u003eBMC Med. Educ.\u003c/em\u003e \u003cb\u003e19\u003c/b\u003e (1), 1\u0026ndash;11 (2019).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDavis, D. A. et al. Accuracy of physician self-assessment compared with observed measures of competence: a systematic review. \u003cem\u003eJAMA\u003c/em\u003e \u003cb\u003e296\u003c/b\u003e, 1094\u0026ndash;1102 (2006).\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"scientific-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"scirep","sideBox":"Learn more about [Scientific Reports](http://www.nature.com/srep/)","snPcode":"","submissionUrl":"","title":"Scientific Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Patient education, medical student, simulation, clinical practice, practical training","lastPublishedDoi":"10.21203/rs.3.rs-9193457/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-9193457/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eThe aim of this study was to compare different methods of patient education for medical students. A prospective study involving 5th and 6th year medical students that were assigned to three groups paediatric primary care (group 1), paediatric intensive care (group 2), and paediatric emergency (group 3). All groups received the same theoretical training in patient education. Additionally, group 1 received practical training in patient education with patients, group 2 received practical training in patient education with simulation, and group 3 did not receive any practical training in patient education. A theoretical pre- and post-training assessment and a practical simulation assessment were performed. Furthermore, the students evaluated their practical performance. Results between the three groups and the assessment by the students and their teachers were compared. After theoretical training, all groups improved their theoretical knowledge (mean [SD]) (pretest 8.0[0.1]; posttest 9.3[0.0]; p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). In the practical evaluation, group 2 students obtained a higher evaluation (8.1[0.1]) than group 1 (7.4[0.1]) and group 3 (7.1[0.1]). p\u0026thinsp;\u0026lt;\u0026thinsp;0.05). The students' self-assessment was higher (8.2[0.1]) than that of the researchers (7.6[0.1]; p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Our results show that combining theoretical lessons with simulation-based learning is the best method to reach practical competencies in patient education for medical students.\u003c/p\u003e","manuscriptTitle":"Simulation-based Learning: A Key Strategy in Patient Education Training for Medical Students","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-05-08 16:14:42","doi":"10.21203/rs.3.rs-9193457/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-05-15T09:00:11+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-05-13T07:57:24+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"222077204611898777194657901351082602883","date":"2026-05-10T05:31:10+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"36998497467788585428725791005121855109","date":"2026-05-07T14:43:15+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-04-30T09:01:09+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"151379243872487629033646843609465063608","date":"2026-04-26T20:43:49+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"286291870090579131694657419535406932214","date":"2026-04-24T02:10:11+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-04-24T01:49:29+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-04-24T01:48:14+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2026-03-26T18:52:50+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-03-25T19:40:06+00:00","index":"","fulltext":""},{"type":"submitted","content":"Scientific Reports","date":"2026-03-25T19:35:43+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"scientific-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"scirep","sideBox":"Learn more about [Scientific Reports](http://www.nature.com/srep/)","snPcode":"","submissionUrl":"","title":"Scientific Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"aa9e2b01-fc62-4f58-822f-45a09bb256a4","owner":[],"postedDate":"May 8th, 2026","published":true,"recentEditorialEvents":[{"type":"decision","content":"Revision requested","date":"2026-05-15T09:00:11+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-05-13T07:57:24+00:00","index":117,"fulltext":""},{"type":"reviewerAgreed","content":"222077204611898777194657901351082602883","date":"2026-05-10T05:31:10+00:00","index":116,"fulltext":""},{"type":"reviewerAgreed","content":"36998497467788585428725791005121855109","date":"2026-05-07T14:43:15+00:00","index":114,"fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-04-30T09:01:09+00:00","index":93,"fulltext":""}],"rejectedJournal":[],"revision":"","amendment":"","status":"in-revision","subjectAreas":[{"id":67585074,"name":"Health sciences/Health care"},{"id":67585075,"name":"Health sciences/Medical research"}],"tags":[],"updatedAt":"2026-05-15T09:27:21+00:00","versionOfRecord":[],"versionCreatedAt":"2026-05-08 16:14:42","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-9193457","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-9193457","identity":"rs-9193457","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}