Effects of student standardized patients combined with situational simulation on teaching outcomes of acute and severe gastrointestinal tumors

Abstract

BACKGROUND

Student standardized patients (SSPs) can serve as valuable tools in teaching acute and severe gastrointestinal tumors.

AIM

To explore the effect of SSP on scenario simulation teaching and its impact on teaching outcomes.

METHODS

From July 2021 to June 2024, 200 nursing interns were taught about severe gastrointestinal tumor disease. In July 2022 the SSP scenario simulation teaching method was introduced to an observation group of 100 students. A control group of 100 students was taught using traditional methods from July 2021 to June 2022. The traditional teaching included classroom theoretical instruction, laboratory practical teaching, and course assessments. During the practical laboratory sessions, students performed operations using simulation mannequins, and course assessments were based on theoretical test scores combined with practical assessments using the mannequins. The teaching effects of both groups were compared in terms of comprehensive quality and student satisfaction.

RESULTS

The observation group exhibited significantly higher theoretical and operational scores (P < 0.05), a notably livelier classroom atmosphere (P < 0.05), and a higher learning satisfaction than the control group (98.00% vs 91.00%) (P < 0.05).

CONCLUSION

SSP combined with scenario simulation teaching enhanced the effectiveness of acute and severe gastrointestinal tumor disease education, improved students’ overall quality, and increased their learning satisfaction, making it a valuable approach for wider adoption.

Key Words: Student standardized patients; Situational simulation teaching; Acute and severe gastrointestinal tumor disease; Teaching effect; Gastrointestinal tumor

Core Tip: In teaching acute and severe gastrointestinal tumor diseases, it is essential to use scientific and effective methods. These methods not only improve teaching outcomes but also enhance students’ overall quality and satisfaction. By combining theoretical explanations with clinical case analyses, students gained a deeper understanding of complex pathological processes. Interactive discussions and simulated surgery training further developed students’ practical skills and clinical reasoning, which are vital for their future medical careers.

INTRODUCTION

Gastrointestinal tumors, which affect the stomach, intestines, and esophagogastric region, are neoplastic conditions classified as benign and malignant, with malignant tumors accounting for approximately 95% of cases[1]. These tumors cause pain, discomfort, and gastrointestinal disturbances. As the disease advances, patients with acute and severe gastrointestinal tumors may experience systemic pain, intestinal intussusception, obstruction, severe gastrointestinal bleeding, and other life-threatening symptoms[2]. The critical and rapidly progressing nature of these tumors, along with the complexity of treatments, places high demands on nursing staff in terms of technical skills and overall quality. Nursing interns, lacking relevant experience and professional theoretical knowledge, often feel overwhelmed when managing patients with acute and severe gastrointestinal tumors and complex instruments, highlighting the need to develop specialized knowledge and skills in this area[3]. Traditional teaching models no longer suffice in meeting clinical demands while also enhancing students’ professional knowledge.

The rapid advancement of medical education has highlighted the importance of innovation and practical teaching methods. Traditional approaches, such as classroom lectures and laboratory practice with simulation mannequins, have been widely used. However, these methods often fail to fully engage students or simulate real-life clinical scenarios essential for developing clinical thinking and problem-solving skills[4]. To overcome these limitations new teaching strategies have been introduced. Student standardized patients (SSPs) after professional training can realistically portray clinical symptoms, signs, and psychological changes accurately, addressing the limitations of traditional mannequins, and enhancing students’ observational skills and quality of learning, aligning with modern medical education[5]. This approach has gained significant attention for providing realistic, interactive learning experiences. Situational simulation teaching is an interactive, experiential teaching method that stimulates students’ engagement and cultivates problem-solving abilities by simulating specific scenarios[6]. This method has been shown to improve students’ clinical skills and confidence in managing complex medical situations.

Recent studies have highlighted the potential benefits of using SSPs and situational simulations in medical education. Zeng et al[3] conducted a 3-year prospective randomized study comparing SSPs with occupational standardized patients to improve clinical competency among traditional Chinese medicine medical students. Their results indicated that SSPs significantly enhanced clinical skills and communication abilities. Similarly, Tian et al[7] found that combining SimBaby with standardized patients improved medical students’ attitudes toward communication skills. These studies underscored the importance of interactive, experiential learning in medical education. However, most existing studies have focused on general medical education or diseases that are less complex than acute and severe gastrointestinal tumors. The critical nature and complexity of these diseases require a more innovative and comprehensive teaching approach. This study introduced a novel model that integrated SSPs with situational simulation teaching specifically designed for acute and severe gastrointestinal tumors, aiming to provide a more realistic and engaging learning experience for nursing interns. The approach ultimately enhanced their ability to manage complex clinical situations in the future.

The present study innovated by combining SSPs with situational simulation teaching specifically designed for acute and severe gastrointestinal tumors. This approach provided realistic clinical scenarios, allowing students to engage with SSPs, thus improving their communication and clinical thinking abilities. Additionally, the study offered a comprehensive evaluation of teaching effectiveness, students’ overall quality, and learning satisfaction. This holistic assessment enabled a thorough understanding of the impact of the teaching model on students’ learning and professional development. To further enhance the study’s innovation, we integrated modern educational theories with clinical practice. We designed standardized course cases based on real clinical situations, merging them with situational simulation teaching. This combination allowed students to apply theoretical knowledge in practical settings. Furthermore, we introduced a new research methodology by comparing traditional teaching methods with the SSP situational simulation approach. This comparison enabled both quantitative and qualitative evaluation of the effectiveness of the teaching models.

This study aimed to evaluate the effectiveness of combining SSPs with situational simulation teaching for acute and severe gastrointestinal tumor diseases. By comparing this approach with traditional teaching methods and reviewing recent studies, we aimed to highlight the academic contribution and innovations of our research. We believe that our findings will enhance the teaching of gastrointestinal tumors and offer valuable insights for developing innovative teaching methods in other medical fields.

MATERIALS AND METHODS

General information

We randomly selected 200 nursing interns studying acute and severe gastrointestinal tumors from July 2021 to June 2024. From July 2022 100 students received SSPs combined with situational simulation teaching and formed the observation group, while the remaining 100 students, who were taught using the traditional method from July 2021 to June 2022, formed the control group. The inclusion criteria were: (1) Students currently enrolled in school; and (2) Those who provided informed consent to participate. Exclusion criteria included: (1) Students who withdrew midway; and (2) Students not majoring in medicine. The observation group comprised 21 males and 79 females, aged 19-23 years, with an average age of 21.44 ± 1.66 years. The control group consisted of 52 males and 48 females, aged 19-24 years, with an average age of 21.63 ± 1.77 years. No significant differences were observed in clinical data between the two groups (P > 0.05; Table 1).

Table 1 Basic information.

Characteristic	Observation group (n = 100)	Control group (n = 100)	t/χ²	P value
Age (year), mean ± SD	21.44 ± 1.66	21.63 ± 1.77	0.87	0.384
Sex (male:female)	21:79	52:48	4.12	0.042
Educational level, n (%)
Bachelor’s degree	85 (85.0)	83 (83.0)
Associate degree	15 (15.0)	17 (17.0)

SD: Standard deviation.

Methods

The control group was taught using traditional methods, which included theoretical classroom instruction, practical laboratory teaching, and course assessments. In the practical laboratory sessions, students performed operations on simulation mannequins, with assessments based on both theoretical test scores and practical performance using simulation mannequins. The observation group, on the other hand, utilized SSPs combined with situational simulation teaching, implementing the following specific measures.

Designing standardized course cases: A project team of emergency and critical care instructors was formed to design situational cases for acute and severe gastrointestinal tumors. The team searched databases, including China National Knowledge Infrastructure and Wanfang, for relevant literature, consulted experts from tertiary general hospitals, and integrated clinical practice to create case scenarios. The cases focused on common gastrointestinal conditions, such as gastric cancer with massive bleeding, colorectal cancer with intestinal obstruction, and gastrointestinal perforation. Experts from tertiary general hospitals reviewed the cases, and revisions were made based on their feedback.

Forming an SSP team for critical gastrointestinal tumor diseases: A selection process for SSPs was based on voluntary registration and specific criteria, including being a nursing intern and possessing skills in acting, imitation, and communication. Six students who met these criteria were selected to participate in the study.

SSP training: The project team trained the SSPs over a 2-month period divided into three stages: (1) Basic training: The six selected SSPs were informed of their responsibilities and instructed to follow the performance process strictly. They observed videos of medical staff interacting with standardized patients and received training on clinical signs and manifestations related to acute and severe gastrointestinal tumors, such as colorectal cancer with intestinal obstruction and gastric cancer with massive gastrointestinal bleeding. They also observed real patients with these conditions in hospitals, noting their clinical manifestations, expressions, and characteristics; (2) Case training: The project team explained the case scenarios to the SSPs, detailing the diseases and clinical manifestations. SSPs were guided to demonstrate clinical presentations, such as abdominal pain, vomiting, and difficulty breathing, while incorporating patients’ expressions and micro-expressions into the scenario; and (3) Evaluation feedback training: After the scenario demonstration, the project team instructed the SSPs to evaluate the medical staff’s performance from the patient’s perspective.

SSP examination: The SSP was assessed before the formal start of the SSP and scenario simulation teaching. The assessment was conducted by research group members and relevant experts, focusing on the SSP’s performance during the scenario demonstration. This evaluation identified existing issues and proposed solutions.

Pre-implementation learning for SSP combined with scenario simulation teaching similar to the classroom theory teaching in the control group: Based on the theoretical knowledge, SSP combined with scenario simulation teaching was introduced. The research group divided the teaching content into sections (case discussion, scenario demonstration, summary, and feedback) and organized it into 12 class hours for nursing students. Stage 1: Case discussion. One hundred students, selected by the institute, were divided into 10 groups based on voluntary selection. Group leaders were chosen by the students, and each group discussed and analyzed teacher-designed scenarios, focusing on patient cases and intervention strategies. Stage 2: Situational demonstration. SSP performed according to scenarios designed by the research group members, including both known and unknown situations. In the known scenario, the group demonstrated intervention methods for patients with acute and severe gastric cancer, such as managing symptoms like fullness, anorexia, nausea, and vomiting. Students practiced nursing interventions, including condition observation, emergency symptomatic treatment, and communication with patients’ families. In an unknown scenario, students intervened in cases like dyspnea in patients with gastric cancer, practicing oxygen therapy. Stage 3: Summary and feedback. Following the demonstration of Group 10, the teacher organized an evaluation process, which included three parts: Group member self-evaluation; SSP feedback; and group member self-assessment. The SSP provided feedback on patient performance, and the teacher summarized the demonstration, addressing any issues. If necessary, the teacher with the SSP demonstrated the standard intervention methods for patients with gastrointestinal tumors.

Observational indicators

Teaching effect: After the teaching activities students were assessed using unified test papers, with theoretical and operational scores both reaching 100. The operational scores were based on personal assessment, communication, and procedural skills. Higher scores indicated better performance.

Comprehensive quality: At the conclusion of the teaching activities, a self-designed questionnaire with 15 items was used for evaluation. These items included aspects such as classroom engagement, student interest in learning, proactive behavior, case analysis, patient observation, communication with patients and family members, teamwork, problem-solving, emergency response, humanistic care awareness, clinical thinking, professional responsibility, and mastery of theoretical knowledge and skills. Each item was rated on a 5-point Likert scale (0-4), where a higher score indicated lower comprehensive quality. The Cronbach’s α coefficient for the scale was 0.933, indicating high internal consistency and reliability.

Student learning satisfaction: A hospital-developed scale was used to assess student satisfaction after teaching activities, covering aspects such as theoretical knowledge, operational skills, responsibilities, and teaching methods. Each item was scored from 0 to 25 points, with a total possible score of 100 points. Higher scores indicated a higher level of student learning satisfaction. The ratings were categorized as follows: Extremely satisfied (100 points); satisfied (90-99 points); neutral (80-89 points); and dissatisfied (< 80 points). The scale was tested, yielding a Cronbach’s α coefficient of 0.908, indicating high internal consistency and reliability.

Statistical analysis

Statistical processing was performed using SPSS 22.0 software. For count data, the χ² test was used, whereas measurement data (mean ± SD) that met normal distribution were analyzed using the t-test. Statistical significance was set at P < 0.05.

RESULTS

Comparison of the teaching effect between the two groups

Significant differences were observed in both theoretical and operational scores between the two groups (P < 0.05). The observation group scored higher than the control group (Table 2).

Table 2 Comparison of the teaching effects between the two groups.

Group	Case	Theoretical results	Operating results
Observation	100	87.41 ± 4.06	89.05 ± 6.44
Control	100	75.22 ± 4.17	79.14 ± 6.23
t	-	20.945	11.060
P value	-	< 0.001	< 0.001

Data are presented as mean ± SD.

Comparison of comprehensive quality between the two groups

The observation group fostered a livelier classroom atmosphere, which enhanced students’ comprehensive quality and increased learning interest, compared with the control group (P < 0.05) as shown in Table 3.

Table 3 Comparison of the comprehensive qualities of the two groups.

Index	Observation (n = 100)	Control (n = 100)	t	P value
Make the classroom atmosphere more lively	3.01 ± 0.44	2.41 ± 0.35	10.672	< 0.001
Enhance students’ interest in learning	2.98 ± 0.52	2.12 ± 0.29	14.444	< 0.001
Improve students’ subjective initiative	2.86 ± 0.41	2.08 ± 0.30	15.353	< 0.001
Improve students’ ability in case analysis and judgment	2.92 ± 0.36	2.45 ± 0.31	9.893	< 0.001
Improve the students’ condition observation ability	2.96 ± 0.44	2.23 ± 0.36	12.841	< 0.001
Improve communication ability between students and patients	3.11 ± 0.37	2.55 ± 0.40	10.277	< 0.001
Improve communication ability between students and their families	3.19 ± 0.30	2.62 ± 0.36	12.164	< 0.001
Improve students’ teamwork ability	3.07 ± 0.29	2.50 ± 0.44	10.817	< 0.001
Improve students’ ability to analyze and solve problems	3.12 ± 0.53	2.48 ± 0.50	8.784	< 0.001
Improve students’ ability to respond to various emergencies	2.98 ± 0.46	2.11 ± 0.35	15.052	< 0.001
Cultivate students’ awareness of humanistic care for patients	2.83 ± 0.45	2.09 ± 0.22	14.773	< 0.001
Cultivate students’ clinical thinking about patients	2.99 ± 0.47	2.32 ± 0.37	11.201	< 0.001
Cultivate students’ sense of professional responsibility	2.86 ± 0.55	2.27 ± 0.34	9.125	< 0.001
Improve students’ theory and skills	2.91 ± 0.33	2.39 ± 0.30	11.660	< 0.001
Improve students’ comprehensive quality and ability	3.21 ± 0.41	2.67 ± 0.44	8.979	< 0.001

Data are presented as mean ± SD.

Comparison of learning satisfaction between the two groups

The observation group had a learning satisfaction rate of 98.00%, higher than the control group’s rate of 91.00% (P < 0.05) as shown in Table 4.

Table 4 Comparison of learning satisfaction between the two student groups.

Group	Case	Very satisfied	Satisfied	Neutral	Unsatisfied	Total satisfaction
Observation	100	42 (42.00)	44 (44.00)	12 (12.00)	2 (2.00)	98 (98.00)
Control	100	39 (39.00)	40 (40.00)	12 (12.00)	9 (9.00)	91 (91.00)
χ2	-	-	-	-	-	4.714
P value	-	-	-	-	-	0.030

Data are presented as n (%).

DISCUSSION

Recent lifestyle changes and increased life pressures have led to a rise in gastrointestinal tumors, posing a significant threat to public health. Acute and severe gastrointestinal tumors in particular have a greater impact on patient safety[6,8]. Effective clinical interventions are essential to saving the lives of patients with these conditions[9,10]. Furthermore, due to the critical nature and rapid progression of acute and severe gastrointestinal tumors, there is a high demand for skilled clinical nurses. While traditional teaching models have somewhat improved nurses’ professional abilities, they are insufficient for developing problem-solving and communication skills necessary for interacting with patients and their families. This gap in training affects the overall effectiveness of education. Therefore, optimizing and reforming teaching methods for managing acute and severe gastrointestinal tumors is crucial.

This study found that the theoretical and practical scores of the observation group were significantly higher than the control group (P < 0.05), suggesting that combining SSPs and situational simulation teaching enhanced teaching effectiveness in acute and severe gastrointestinal tumor diseases education. Situational simulation teaching, a modern educational method, is an interactive, experiential approach that bridges the gap between theory and practice. It overcomes the limitations of traditional teaching models, engages students emotionally, stimulates their enthusiasm for learning, and improves teaching outcomes[11,12]. SSP, a form of standardized patients, provides students with opportunities to improve their professional knowledge, skills, communication, and confidence in a controlled environment, preparing them for real-life patient interactions[7]. By combining SSPs with situational simulation teaching and integrating standardized patients into clinical simulation scenarios designed by the project team in an environment similar to real cases, students were stimulated, transforming written cases into real patients related to acute and severe gastrointestinal tumors. This approach not only makes the classroom more engaging but also significantly increases students’ interest, enhances their mastery of skills related to acute and severe gastrointestinal tumor diseases, and improves teaching effectiveness[13].

The primary goal of modern medical education is to develop students’ knowledge and clinical skills to enhance their professional abilities, enabling them to provide better patient care in their future practice. Additionally, medical education should focus on cultivating comprehensive qualities in nursing students[14]. Since nursing students will directly interact with patients and their families, they must not only possess clinical skills but also the ability to communicate and care for patients. Therefore, improving the comprehensive qualities of nursing students is crucial in medical education.

The data in Table 2 show that evaluation indicators related to the enhancement of comprehensive qualities, such as creating a livelier classroom atmosphere and increasing students’ interest in learning, were higher in the observation group (P < 0.05). This suggests that combining SSPs with situational simulation teaching in acute and severe gastrointestinal tumors education helped improve students’ comprehensive qualities. In this approach, standard case scenarios were first designed and reviewed by relevant experts to ensure the authenticity of cases related to acute and severe gastrointestinal tumor diseases[15,16].

An SSP team for acute and severe gastrointestinal tumors was formed, and selection standards for team members were established. These members were trained and assessed to ensure they could create a realistic clinical environment for students[17]. The SSP combined with situational simulation teaching was implemented by introducing highly similar cases into classroom teaching. This approach vividly and objectively demonstrated the clinical manifestations of patients with acute and severe gastrointestinal tumor diseases, enabling nursing students to identify patient problems and apply the knowledge and skills they have learned to assess and solve these problems. The method followed helped develop students’ clinical thinking, condition observation, and communication ability and promoted the integration of theoretical knowledge with clinical practice, ultimately enhancing students’ comprehensive qualities[18,19].

This study found that the learning satisfaction of students in the observation group was 98.00% (P < 0.05), indicating that SSPs combined with situational simulation teaching improved students’ satisfaction. Through situation demonstrations, students observed realistic cases of acute and severe gastrointestinal tumor diseases. The SSP situation demonstration was divided into known and unknown scenarios, enhancing students’ ability to handle emergencies. This approach fostered problem-solving skills through communication with SSP, improved professional competencies, and prepared students to manage emergencies in future practice, ultimately boosting their learning satisfaction[20].

Although this study provided valuable insights into the effectiveness of combining SSPs with situational simulation teaching for acute and severe gastrointestinal tumor diseases, several limitations should be acknowledged. First, the study was conducted at a single institution, which may limit the generalizability of the findings to other educational settings or populations. Additionally, the focus on gastrointestinal tumor diseases necessitates further research to assess the broader applicability of this teaching method across other medical specialties and clinical scenarios. Future studies should expand the research scope to include fields such as emergency medicine, critical care, and complex surgical conditions. This approach could enhance the practical value and impact of the study, offering a more comprehensive understanding of how SSPs combined with situational simulation teaching can be optimized for diverse educational needs. Longitudinal studies and multicenter collaborations would also be valuable for evaluating the long-term effects of this teaching method on students’ professional development and clinical practice.

CONCLUSION

SSPs combined with situational simulation teaching enhanced the effectiveness of teaching, improved students’ comprehensive quality, and increased learning satisfaction, demonstrating high application value.