CAEP GeMES | Simulation Versus Case-Based Teaching

In Featured, Great Evidence in Medical education Summary (GEMeS) by Daniel Ting3 Comments

Dr. Jonah is a self-identified “old school” Emergency Physician. He has been teaching learners for decades and has a great knack for collecting cases. Dr. Jonah’s favorite way of teaching is taking these cases and discussing them with students in a small group setting. In recent years, he has seen many of his younger colleagues taking learners to the simulation lab and running various cases. It almost seems like simulation is the only way they teach! Dr. Jonah is skeptical that this is the most effective teaching method–after all, the mannequins aren’t completely realistic and you often have to “half-pretend” with them. Moreover, it seems that so much of the time is wasted with orienting the learners to the simulation technologies. What’s wrong with a good old fashioned case discussion? 

Simulation has become a key teaching method in Emergency Medicine, and in some instances, has replaced case-based discussion. This “Great Evidence in Medical education Summary” (GEMeS – pronounced “gems”), titled “Is simulation-based teaching better than case-based teaching in terms of knowledge gain, knowledge retention and satisfaction?” was originally posted by the CAEP EWG GEMeS Team on January 14, 2016. A PDF version of the GEMeS summary is available here.

Education Question or Problem

Is simulation-based teaching better than case-based teaching in terms of knowledge acquisition, knowledge retention and satisfaction?

Bottom Line

There was no difference in knowledge acquisition and retention, but simulation resulted in increased participant satisfaction.
Couto, T. B., Farhat, S. C. L., Geis, G. L., Olsen, O., & Schvartsman, C. (2015). High-fidelity simulation versus case-based discussion for teaching medical students in Brazil about pediatric emergencies. Clinics (São Paulo, Brazil), 70(6), 393–9.
Link to Journal
Level of Evidence
Non-randomized controlled trial, with cross-over design
Study Design
Non-randomized controlled trial, with cross-over design, of simulation-based teaching compared with case-based discussion among medical students using a pre-test, a post-test and a retention test (4–6 months later) via multiple-choice questionnaires (MCQs)
Funding Sources
The work was supported by the Departamento de Pediatria da Faculdade de Medicina da Universidade de São Paulo. Simulations and case-based discussions were performed at the Faculdade de Medicina da Universidade de São Paulo (FMUSP) during students’ emergency pediatric rotation, with no additional external funding. Laerdal Medical lent SimBabys for this project.
The voluntary intervention was offered to all 174 sixth-year (the final year in Brazilian medical education) medical students of the FMUSP during their first-semester rotation clerkship in pediatrics (emergency department or pediatric ward) in 2012.
Level of Learning
Undergraduate medical education

Synopsis of Study

To answer their question, the study investigators invited all sixth-year medical students to participate in this trial. One cohort (n = 76) was taught anaphylaxis with a simulation scenario and supra-ventricular tachycardia with case-based discussion. Another cohort (n = 87) was taught the same concepts but with the opposite teaching methods.

163 students participated. 124 filled the satisfaction questionnaire and 108 filled the retention test (4-6 months later); 33.7% of students were lost to follow-up.

No difference was found between the two teaching methods in terms of knowledge acquisition and retention. However, participant satisfaction was better with simulation.

The authors state that a one-time simulation intervention may not be enough for the students to gain knowledge as they are learning the method as much as the content.

The next step is to test their hypothesis with multiple scenarios, speculating that retention would be better with simulation than case-based discussion once the simulation method is adequately mastered by the students.

Why is it relevant to Emergency Medicine Education?

Emergency physicians are often the ones that teach resuscitation skills, and simulation is often a technique used to do so. As simulation is taking place more and more in our programs, we will be asked to buy expensive equipment, and could end up investing a lot of time developing scenarios. Considering the cost and time, is simulation worth the investment?

This study helps us to understand the limitations of simulation as an educational modality, by becoming more realistic about what simulation can or cannot do. There is a place for simulation in medical education, but we have to use it for what it really is good for.

What are the best uses of simulation in medical education? Have we arrived at a point where it is now being overused? 


More About the CAEP GEMeS

This post was originally authored for the Canadian Association of Emergency Physicians (CAEP) Great Evidence in Medical Education Summaries (GEMeS) project sponsored by the CAEP Academic Section’s Education Working Group and edited by Drs. Teresa Chan and Julien Poitras. CAEP members receive GEMeS each month in the CAEP Communiqué. CanadiEM will be reposting some of these summaries, along with a case/contextualizing concept to highlight some recent medical education literature that is relevant to our nation’s teachers.


Daniel Ting

Daniel Ting is an Emergency Physician and Clinical Assistant Professor at the University of British Columbia, based in Vancouver. He is the Editor-in-Chief of CanadiEM and a Decision Editor at the Canadian Journal of Emergency Medicine. He completed the CanadiEM Digital Scholarship Fellowship in 2017-18. No conflicts of interest (COI).
Jean-Francois Deshaies

Jean-Francois Deshaies

Jean-Francois is an Assistant Professor in the Department of Family Medicine and Emergency Medicine at the University of Sherbrooke. He is the local co-director of ACLS and resuscitation. Jean-Francois is also invested in hospital management, especially in collective prescription and protocols.
Jean-Francois Deshaies

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