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Spain in the 2017&#8211;2018 school year&#46; High-fidelity simulation scenarios on Severe traumatic disease were used with groups of 8 students each&#46; Each clinical case was developed by 2 students&#46; They received a briefing session prior to developing each scenario&#46; Each and every one of the cases was developed in a 15-min&#46; period&#46; The simulation was followed in real time by the rest of the workshop students&#46; At the end of each case&#44; a second 15-min&#46; debate session was conducted to analyze how the case was developed and how the decisions were made&#46; They were asked to make a voluntary assessment of the activity through questionnaires using the 5-point Likert scale &#40;1<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>complete disagreement&#44; 5<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>complete disagreement&#41; and open questions&#46; Some of the variables were evaluated before and after the teaching activity&#46; 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the students underlined teamwork and the acquisition of leadership skills in the first person&#46; They suggested increasing the frequency of these activities and expanding their use in the different academic courses&#46; As positive points&#44; they assessed the possibility of facing clinical cases &#40;11 students&#41;&#44; the practical character &#40;32 students&#41;&#44; and the possibility of participation in the first person &#40;7 cases&#41;&#46; Ninety-one-point-four per cent rated the course as excellent&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">High-fidelity simulation allowed students to perform in a clinical scenario using the same resources they will have available in their routine clinical practice&#46; On the other hand&#44; it allowed the detection of possible improvements for future editions and adapt it to the vision contributed by the students&#46; Finally&#44; it made student self-evaluation easy&#44; confirming its role as an effective tool for educational practices&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">The students&#8217; knowledge prior to post-simulation increased significantly and their confidence in being able to handle severe trauma improved as well&#46; These aspects are consistent with previous experiences above all regarding nursing students&#44;<a class="elsevierStyleCrossRefs" href="#bib0085"><span class="elsevierStyleSup">7&#44;8</span></a> where this teaching tool is more established&#46; A vertical&#44; more individualistic learning focused on the academic performance of medical studies could explain this difference&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">It has been reported that throughout their university training students do not have defined objectives to attain in terms of technical skills&#44; unlike knowledge goals that are clearly established&#46;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">9</span></a> Simulation may be useful as a teaching tool to complete that technical profile of the students&#46; However&#44; generalizing clinical simulations in the Medical Science syllabus has not been achieved&#46; It has been postulated that technical and economic requirements and the need for a large staff properly trained are obstacles for this consolidation&#46; Nevertheless&#44; data that question the &#8220;actual&#8221; cost of medical education are scarce and controversial&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">2</span></a> The experience gained in other disciplines like nursing&#44; along with its generalization in postgraduate training&#44; suggest that there may be a place for it in the undergraduate studies of Medical Schools&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">The development of experiences like ours has brought Intensive Medicine closer to Medical students&#46; Also&#44; these conclusions are consistent with simulation projects from other disciplines like neurosurgery&#46;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">10</span></a> This is another strong point of simulation&#44; that it allows filling the existing gap between academic training and actual medical practice&#46; This reflects the need to modify syllabi to engage students in their medical specialty and complement clinical knowledge with suitable practical skills&#46; We believe that student motivation can be enhanced through the use of simulations&#46; Producing highly competitive medical professionals in the coming years would result in a future generation of well-trained intensivists&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">The work has limitations&#46; There was one group of students only&#46; Subjective opinions have been assessed and the effectiveness of skill acquisition in the clinical practice was not measured&#46; It was conducted in one center only with a relatively small sample size&#44; which is why it cannot be generalized to other simulation scenarios&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">Clinical simulation can facilitate clinical reasoning and the acquisition of technical skills&#46; Severe traumatic disease is a good model because it requires a systematic approach&#44; the cross-sectional integration of knowledge&#44; developing leadership&#44; and a correct decision-making process&#46; Our pilot study suggests the possibility of including clinical simulation in the undergraduate training of Medical students&#46; On top of facilitating the acquisition of practical skills&#44; it brings students closer to the Intensive Medicine specialty&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of interest</span><p id="par0060" class="elsevierStylePara elsevierViewall">None reported&#46;</p></span></span>"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Ballesteros MA&#44; Feo Gonz&#225;lez M&#44; Suberviola B&#44; Mi&#241;ambres E&#46; Simulaci&#243;n cl&#237;nica en el paciente politraumatizado&#46; Aplicaci&#243;n en estudiantes de Medicina&#46; Med Intensiva&#46; 2020&#59;44&#58;389&#8211;391&#46;</p>"
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          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Evaluation of skills in clinical care to polytraumatized patients&#46; The bar represents the median and the error bar the interquartile range &#40;P25 and P75&#41;&#46;</p> <p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">The Wilcoxon signed-rank test was used to analyze change in the skills evaluated&#46; Significance level &#40;<span class="elsevierStyleItalic">p</span>&#41; was &#60;&#46;001 in all of them&#46;</p> <p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Hm&#46;&#44; hemodynamic&#46;</p>"
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          "leyenda" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Categorical variables were expressed as median and interquartile range &#40;IQR&#41;&#46;</p>"
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                  \t\t\t\t  " colspan="2" align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Objectives and content</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>The duration of the course was suitable&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">4 &#40;IQR 4&#8211;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>The in-depth level of the topics was suitable&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4 &#40;IQR 4&#8211;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>The content of the course fulfilled my training needs&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5 &#40;IQR 4&#8211;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>The objectives of the course were achieved&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5 &#40;IQR 4&#8211;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Methodology</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>The methodology used was the most suitable one for the objectives and contents&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#46;5 &#40;IQR 4&#8211;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>The methodology used enabled active participation&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5 &#40;IQR 4&#8211;5&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>The practices were useful and enough&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5 &#40;IQR 4&#8211;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Utility</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>The expectations I had regarding the utility of the workshop have been met&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4 &#40;IQR 4&#8211;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>The contents of the course have proven useful and met my expectations&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5 &#40;IQR 4&#8211;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>I am going to be able to apply the knowledge acquired to my professional clinical practice&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5 &#40;IQR 4&#8211;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Means</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>The technical means have worked correctly during the workshop&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4 &#40;IQR 3&#46;5&#8211;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>The facilities have made learning easier&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4 &#40;IQR 4&#8211;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Teaching staff</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>The teaching staff exhibited good competence level&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5 &#40;IQR 5&#8211;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>The teaching staff managed to maintain a good level of awareness&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5 &#40;IQR 5&#8211;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span> The teaching staff prompted debate and discussion and was close to the students&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5 &#40;IQR 5&#8211;5&#41;&nbsp;\t\t\t\t\t\t\n
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                    0 => array:2 [
                      "titulo" => "Training in the care of the critical and multiple-injured patient&#58; role of clinical simulation"
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                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "A&#46; Quesada Suescun"
                            1 => "F&#46;J&#46; Bur&#243;n Mediavilla"
                            2 => "A&#46; Castellanos Ortega"
                            3 => "I&#46; del Moral Vicente-Mazariegos"
                            4 => "C&#46; Gonz&#225;lez Fern&#225;ndez"
                            5 => "J&#46;J&#46; Olalla Antol&#237;n"
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                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Med Intens"
                        "fecha" => "2007"
                        "volumen" => "31"
                        "paginaInicial" => "187"
                        "paginaFinal" => "193"
                      ]
                    ]
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                    0 => array:2 [
                      "titulo" => "Simulation in undergraduate medical education"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "S&#46; O&#8217;Flynn"
                            1 => "G&#46; Shorten"
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                    0 => array:2 [
                      "doi" => "10.1097/EJA.0b013e32831a47df"
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur J Anaesthesiol"
                        "fecha" => "2009"
                        "volumen" => "26"
                        "paginaInicial" => "93"
                        "paginaFinal" => "95"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19142080"
                            "web" => "Medline"
                          ]
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                    ]
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                ]
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "A simulation curriculum for management of trauma and surgical critical care patients"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
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Scientific Letter
Clinical simulation in the polytraumatized patient. Application in medical students
Simulación clínica en el paciente politraumatizado. Aplicación en estudiantes de Medicina
M.A. Ballesterosa,
Corresponding author
gelesballesteros@yahoo.com

Corresponding author.
, M. Feo Gonzáleza, B. Suberviolaa, E. Miñambresa,b
a Medicina Intensiva, Hospital Universitario Marqués de Valdecilla-IDIVAL, Santander, Spain
b Facultad de Medicina, Universidad de Cantabria, Santander, Spain
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    "titulo" => "Clinical simulation in the polytraumatized patient&#46; Application in medical students"
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        "titulo" => "Simulaci&#243;n cl&#237;nica en el paciente politraumatizado&#46; Aplicaci&#243;n en estudiantes de Medicina"
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          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Evaluation of skills in clinical care to polytraumatized patients&#46; The bar represents the median and the error bar the interquartile range &#40;P25 and P75&#41;&#46;</p> <p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">The Wilcoxon signed-rank test was used to analyze change in the skills evaluated&#46; Significance level &#40;<span class="elsevierStyleItalic">p</span>&#41; was &#60;&#46;001 in all of them&#46;</p> <p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Hm&#46;&#44; hemodynamic&#46;</p>"
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Undergraduate and postgraduate medical education has traditionally been based on theoretical learning&#44; acquiring clinical skills through the direct treatment with patients&#46; Over the last few decades&#44; patient&#39;s safety and ethical imperatives have been focusing on the patient&#39;s protection and&#44; as a matter of fact&#44; learning via trial and error is ill-advised on current patients&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a> In this context&#44; clinical simulation has been developed as a teaching tool to provide comprehensive training that is risk-free for the patients&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">2</span></a> Its use has been growing in clinical areas such as anesthesiology&#44; intensive medicine&#44; and emergencies&#44; but above all it has focused on postgraduate training&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">3</span></a> Medical students receive for the most part vertical training where the use of clinical simulation is just a formality&#46; In this context&#44; clinical simulation with medical students has focused on cases of shock&#44; approach to sepsis or advanced life support&#44; but for severe traumatic injury it is more limited&#46;<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">4&#8211;6</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">A simulation activity was conducted at our service focused on severe traumas for 6th-year medical students during their intensive medicine practices&#46; The objectives were to assess the effectiveness of simulation in the management of severe trauma among the students and determine their perceptions on the suitability of simulation for technical skills&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">A cross-sectional prospective study was conducted with 6th-year medical students during their rotation at the intensive medicine unit of <span class="elsevierStyleItalic">Hospital Universitario Marqu&#233;s de Valdecilla</span>&#44; Spain in the 2017&#8211;2018 school year&#46; High-fidelity simulation scenarios on Severe traumatic disease were used with groups of 8 students each&#46; Each clinical case was developed by 2 students&#46; They received a briefing session prior to developing each scenario&#46; Each and every one of the cases was developed in a 15-min&#46; period&#46; The simulation was followed in real time by the rest of the workshop students&#46; At the end of each case&#44; a second 15-min&#46; debate session was conducted to analyze how the case was developed and how the decisions were made&#46; They were asked to make a voluntary assessment of the activity through questionnaires using the 5-point Likert scale &#40;1<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>complete disagreement&#44; 5<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>complete disagreement&#41; and open questions&#46; Some of the variables were evaluated before and after the teaching activity&#46; All answers were anonymous&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">There were 84 students&#44; 64&#46;5&#37; of them women&#46; Their mean age was 24 years &#40;SD 1&#46;2&#41;&#46; The resources available&#44; as well as the design of the activity were assessed positively&#46; Also&#44; the closeness and accessibility of the teaching staff were highlighted &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46; <a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a> shows the self-evaluation of the capacities analyzed before and after the training activity&#46; The degree of confidence acquired by the students after conducting the activity was significantly higher compared to the previous one&#44; which underlines the greater capacity for leadership and make decisions before a case of Severe traumatic disease &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">Similarly&#44; the students underlined teamwork and the acquisition of leadership skills in the first person&#46; They suggested increasing the frequency of these activities and expanding their use in the different academic courses&#46; As positive points&#44; they assessed the possibility of facing clinical cases &#40;11 students&#41;&#44; the practical character &#40;32 students&#41;&#44; and the possibility of participation in the first person &#40;7 cases&#41;&#46; Ninety-one-point-four per cent rated the course as excellent&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">High-fidelity simulation allowed students to perform in a clinical scenario using the same resources they will have available in their routine clinical practice&#46; On the other hand&#44; it allowed the detection of possible improvements for future editions and adapt it to the vision contributed by the students&#46; Finally&#44; it made student self-evaluation easy&#44; confirming its role as an effective tool for educational practices&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">The students&#8217; knowledge prior to post-simulation increased significantly and their confidence in being able to handle severe trauma improved as well&#46; These aspects are consistent with previous experiences above all regarding nursing students&#44;<a class="elsevierStyleCrossRefs" href="#bib0085"><span class="elsevierStyleSup">7&#44;8</span></a> where this teaching tool is more established&#46; A vertical&#44; more individualistic learning focused on the academic performance of medical studies could explain this difference&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">It has been reported that throughout their university training students do not have defined objectives to attain in terms of technical skills&#44; unlike knowledge goals that are clearly established&#46;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">9</span></a> Simulation may be useful as a teaching tool to complete that technical profile of the students&#46; However&#44; generalizing clinical simulations in the Medical Science syllabus has not been achieved&#46; It has been postulated that technical and economic requirements and the need for a large staff properly trained are obstacles for this consolidation&#46; Nevertheless&#44; data that question the &#8220;actual&#8221; cost of medical education are scarce and controversial&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">2</span></a> The experience gained in other disciplines like nursing&#44; along with its generalization in postgraduate training&#44; suggest that there may be a place for it in the undergraduate studies of Medical Schools&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">The development of experiences like ours has brought Intensive Medicine closer to Medical students&#46; Also&#44; these conclusions are consistent with simulation projects from other disciplines like neurosurgery&#46;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">10</span></a> This is another strong point of simulation&#44; that it allows filling the existing gap between academic training and actual medical practice&#46; This reflects the need to modify syllabi to engage students in their medical specialty and complement clinical knowledge with suitable practical skills&#46; We believe that student motivation can be enhanced through the use of simulations&#46; Producing highly competitive medical professionals in the coming years would result in a future generation of well-trained intensivists&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">The work has limitations&#46; There was one group of students only&#46; Subjective opinions have been assessed and the effectiveness of skill acquisition in the clinical practice was not measured&#46; It was conducted in one center only with a relatively small sample size&#44; which is why it cannot be generalized to other simulation scenarios&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">Clinical simulation can facilitate clinical reasoning and the acquisition of technical skills&#46; Severe traumatic disease is a good model because it requires a systematic approach&#44; the cross-sectional integration of knowledge&#44; developing leadership&#44; and a correct decision-making process&#46; Our pilot study suggests the possibility of including clinical simulation in the undergraduate training of Medical students&#46; On top of facilitating the acquisition of practical skills&#44; it brings students closer to the Intensive Medicine specialty&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of interest</span><p id="par0060" class="elsevierStylePara elsevierViewall">None reported&#46;</p></span></span>"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Ballesteros MA&#44; Feo Gonz&#225;lez M&#44; Suberviola B&#44; Mi&#241;ambres E&#46; Simulaci&#243;n cl&#237;nica en el paciente politraumatizado&#46; Aplicaci&#243;n en estudiantes de Medicina&#46; Med Intensiva&#46; 2020&#59;44&#58;389&#8211;391&#46;</p>"
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          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Evaluation of skills in clinical care to polytraumatized patients&#46; The bar represents the median and the error bar the interquartile range &#40;P25 and P75&#41;&#46;</p> <p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">The Wilcoxon signed-rank test was used to analyze change in the skills evaluated&#46; Significance level &#40;<span class="elsevierStyleItalic">p</span>&#41; was &#60;&#46;001 in all of them&#46;</p> <p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Hm&#46;&#44; hemodynamic&#46;</p>"
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                  \t\t\t\t"><span class="elsevierStyleItalic">Objectives and content</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>The duration of the course was suitable&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>The in-depth level of the topics was suitable&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">4 &#40;IQR 4&#8211;5&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>The content of the course fulfilled my training needs&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">5 &#40;IQR 4&#8211;5&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>The objectives of the course were achieved&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">5 &#40;IQR 4&#8211;5&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>The methodology used was the most suitable one for the objectives and contents&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">4&#46;5 &#40;IQR 4&#8211;5&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>The methodology used enabled active participation&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">5 &#40;IQR 4&#8211;5&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>The practices were useful and enough&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>The expectations I had regarding the utility of the workshop have been met&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">4 &#40;IQR 4&#8211;5&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>The contents of the course have proven useful and met my expectations&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>I am going to be able to apply the knowledge acquired to my professional clinical practice&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>The technical means have worked correctly during the workshop&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">4 &#40;IQR 3&#46;5&#8211;5&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>The facilities have made learning easier&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">4 &#40;IQR 4&#8211;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Teaching staff</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>The teaching staff exhibited good competence level&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5 &#40;IQR 5&#8211;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>The teaching staff managed to maintain a good level of awareness&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5 &#40;IQR 5&#8211;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span> The teaching staff prompted debate and discussion and was close to the students&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">5 &#40;IQR 5&#8211;5&#41;&nbsp;\t\t\t\t\t\t\n
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Idiomas
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