Optimizing Medical Education: Integrating Palpation and Radiologic Imaging in Simulation Labs



UNTHSC’s Regional Simulation Lab has created many opportunities for faculty to move beyond traditional, classroom-based approaches to an advanced, simulation-based learning environment. Unfortunately, there is minimal literature regarding the effective integration of distinct skills given that these sophisticated technologies can portray case scenarios that require the successful application of several skill sets.

The investigators will utilize approximately 10 – 15 minutes of the two hours of time scheduled in the year two GI course, to support students in integrating the two primary skill sets introduced 'separately' earlier. This instructional activity will provide students an opportunity to simultaneously see CT and Ultrasound scans representing an abnormal abdominal finding while simultaneously palpating (on a high-fidelity abdominal simulator) the associated abnormal physical examination findings.


UNTHSC utilizes a post-course evaluation tool collecting student feedback for continuous quality assurance of its curriculum. This year's post-course evaluation questions contain both a standardized set of questions and an additional set of questions designed to gather student opinions about how the course might be improved. Included in the survey were two sets of questions about the skills developed in this two-hour GI training activity.

The first set of questions is about the adequacy of the time spent in: 1) Ultrasound training in isolation, 2) abdominal palpation training in isolation, 3) the simultaneous training of both Ultrasound and CT images, and palpation training. The second set of questions represents student opinion regarding the percentage of the two hours of instructional activity that should be spent with 4) Ultrasound training in isolation, 5) abdominal palpation training in isolation, and 6) simultaneous training in both Ultrasound and CT images, and palpation.


Our findings, based upon a survey of 99 students, reveal the value of integrating palpation with radiologic imaging more than performing either skill in isolation. The survey suggests that students would prefer spending about three times longer in the lab integrating these two skill sets compared to the original 15 minutes allocated.


While traditionally topics in medical education are delivered to students in a piecemeal fashion, with the focus on mastering each skill in isolation before moving on to the next, this survey demonstrates that students value more opportunities to integrate various skills as they are first being introduced. This provides students with a more realistic understanding of how to use the resources they will have in the clinical setting to arrive at a diagnosis. This notion is further supported by the open-ended feedback solicited from the participants. In their comments, there is a strong desire for a more case-based approach to learning, in which students have the autonomy to work to solve a patient problem and dictate their diagnostic process in a more realistic, linear fashion rather than learning by simple demonstration and repetition. While more research is needed, these results demonstrate the value students place in integrating emerging simulation technology with pre-clinical medical education to help prepare students for their role in the clinical environment.