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There has been little information about how the COVID-19 pandemic has impacted medical students’ knowledge acquisition. The aim of the study was to identify the impact of the COVID-19 pandemic on medical students’ knowledge acquisition by comparing the students’ performance on two Progress Test exams administered in 2019 (pre-pandemic) and 2020 (during the pandemic). We included data from 1,491 students at two medical schools in Brazil. Both schools had experienced interrupted preclinical classes and clinical clerkship rotations in March 2020 but had resumed remote preclinical classes with online activities within 1 month after the interruption and clerkship rotations within five to 6 months after the interruption. We analyzed the data with the Rasch model from Item Response Theory to calibrate the difficulty of the two exams and calculated the performance of the students, with comparison of the differences of mean knowledge for each year and between the two cohorts. We found that the students’ knowledge in the cohort of 2019 was higher than those in the cohort of 2020, except in the second year. Also, the students did not show any increase in knowledge between 2019 and 2020 in the clerkship years. It appears that the pandemic significantly impaired the knowledge acquisition of medical students, mainly in the clerkship years, where practical activities are the central part of training. This is of special concern in low- and middle-income countries where graduated medical doctors are allowed to practice without further training or are required to have continuing professional development.

SUMMARY INTRODUCTION: The challenge of facing COVID-19 falls under all health care structures, and without specific training to health care professionals they are probably the professionals with the highest level of exposure. Regardless of the level of health care, the training of professionals aims to optimize resources and attend patients while assuring quality and security. POINT OF VIEW: This report proposes simulation training for health care professionals to update professionals for attending patients during the pandemic. This training was built with five simulated stations, considering different stages of a patient with COVID-19. This report takes advantage of different simulation techniques, such as skills training, standardized patient, medium- and high-fidelity simulator, rapid cycle of deliberate practice, and in situ simulation. DISCUSSION: Medical procedures for COVID-19 patients offer additional risk for health care professionals, especially considering exposure to procedures that generate aerosols, such as compression, mask ventilation, and orotracheal intubation. Thus, finding educational strategies that allow training is essential to simulate the evolution of COVID-19 patients in a safe manner. CONCLUSION: Simulation has proven to be a useful and effective form of training around the world for training health teams on the front lines for patient care in COVID-19.

BACKGROUND: Coronavirus disease-19 (COVID-19) has imposed a new reality that presents several challenges for healthcare professionals. The main challenge has been the lack of proper training in relation to an unknown disease. OBJECTIVE: To investigate healthcare professionals’ acquisition of knowledge of a new airway management protocol for COVID-19 through their participation in simulation training. DESIGN AND SETTING: Pre and post-test study with purpose sampling, carried out in a tertiary-level hospital in the city of Campinas, state of São Paulo, Brazil. METHODS: This was a cross-sectional pre and post-test intervention among healthcare professionals working in the intensive care unit and emergency department of a large hospital. The training was carried out using an in situ simulation scenario and the participants answered pre and post-tests consisting of a 20-item questionnaire about the new protocol. RESULTS: The paired-sample t test demonstrated that there was a significant increase in test score (t = −19.06; P < 0.001), from before the training (M = 8.62; standard deviation, SD = 3.53) to after the simulation training (M = 17.02; SD = 1.76). CONCLUSIONS: The simulated training had a positive impact on the healthcare professionals’ acquisition of the COVID-19 protocol. We also demonstrated that in situ simulation training was an efficient tool for implementing new protocols, thus bringing benefits to healthcare systems, professionals and patients.

BACKGROUND: Because of the social isolation and distancing measures that were imposed to stop the spread of coronavirus disease 19 (COVID-19), new ways of teaching were implemented. OBJECTIVES: To describe the implementation of telesimulation and seek to assess students’ perceptions regarding telesimulation. DESIGN AND SETTING: Retrospective quantitative study conducted within the hospital simulation at a private medical school in São Paulo, Brazil. METHODS: After telesimulation training, students answered a questionnaire that provided an overall assessment of this activity, self-assessment and assessments of the facilitators and infrastructure provided by the University. RESULTS: Among the students, 50% reported that the activity was below expectations and 45% reported that it was in line with their expectations. The strong points of the activity were the clinical cases, workload and teachers. The main challenge was students’ difficulty in reflecting on their learning and the infrastructure. CONCLUSIONS: Since students have less experience and fewer clinical encounters than residents or professionals, they also face more difficulty. Although telesimulation may have provided a valid alternative to replace simulation training during the COVID-19 pandemic, more face-to-face activities should be offered to students, when possible.

Aims The COVID-19 pandemic has seen a major disruption to undergraduate and postgraduate clinical medical education. The aim of this rapid review was to identify and synthesize published literature relating to the solutions, enablers and barriers to online learning implemented in clinical medical education during the first year of the COVID-19 pandemic. Methods All articles published before March 2021 in peer-reviewed journals, including MedEdPublish, that described authors' experience of online learning in response to the COVID-19 pandemic. A descriptive analysis of the solutions and a qualitative template analysis of enablers and barriers. Results 87 articles were identified for inclusion. Face to face teaching was maintained with interactive approaches between learners and/or learners and teachers. Several innovative solutions were identified. The enablers were a readiness and rapid response by institutions, with innovation by teachers. The barriers were the lack of planning and resources, usability problems and limited interactivity between teachers and students. Conclusions Important and timely evidence was obtained that can inform future policy, practice and research. The findings highlighted the urgent need to use rapid design and implementation methods with greater explicit descriptions in published articles to ensure applicability to other contexts.

Made available in DSpace on 2022-04-29T08:33:02Z (GMT). No. of bitstreams: 0 Previous issue date: 2021-09-01 Several methods have been proposed for analyzing differences between test scores, such as using mean scores, cumulative deviation, and mixed-effect models. Here, we explore the pooled analysis of retested Progress Test items to monitor the performance of first-year medical students who were exposed to a new curriculum design. This was a cross-sectional study of students in their first year of a medical program who participated in the annual interinstitutional Progress Tests from 2013 to 2019. We analyzed the performance of first-year students in the 2019 test and compared it with that of first-year students taking the test from 2013 to 2018 and encountering the same items. For each item, we calculated odds ratios with 95% confidence intervals; we also performed meta-analyses with fixed effects for each content area in the pooled analysis and presented the odds ratio (OR) with a 95% confidence interval (CI). In all, we used 63 items, which were divided into basic sciences, internal medicine, pediatrics, surgery, obstetrics and gynecology, and public health. Significant differences were found between groups in basic sciences (OR = 1.172 [CI95% 1.005 CI 1.366], p = 0.043) and public health (OR = 1.54 [CI95% CI 1.25–1.897], p < 0.001), which may reflect the characteristics of the new curriculum. Thus, pooled analysis of pretested items may provide indicators of different performance. This method may complement analysis of score differences on benchmark assessments. Department of Neurology Psychology and Psychiatry Botucatu Medical School UNESP–Universidade Estadual Paulista, São Paulo Department of Surgery and Orthopedics Botucatu Medical School UNESP–Universidade Estadual Paulista, São Paulo Department of Gynecology and Obstetrics Botucatu Medical School UNESP–Universidade Estadual Paulista, São Paulo Department of Medical Psychology and Psychiatry School of Medical Sciences UNICAMP–Universidade Estadual de Campinas, São Paulo Department of Internal Medicine Botucatu Medical School UNESP–Universidade Estadual Paulista, São Paulo Department of Pediatrics School of Medical Sciences UNICAMP–Universidade Estadual de Campinas, São Paulo Department of Neurology Psychology and Psychiatry Botucatu Medical School UNESP–Universidade Estadual Paulista, São Paulo Department of Surgery and Orthopedics Botucatu Medical School UNESP–Universidade Estadual Paulista, São Paulo Department of Gynecology and Obstetrics Botucatu Medical School UNESP–Universidade Estadual Paulista, São Paulo Department of Internal Medicine Botucatu Medical School UNESP–Universidade Estadual Paulista, São Paulo

Background Students require feedback on their self-regulated learning (SRL) processes to improve the performance of clinical examinations. The key SRL processes used by students can be identified by SRL-micro-analysis but, this method has not been previously applied to physiotherapy students. The aim of this pilot study was to test a research design that might allow the evaluation of the potential usefulness of SRL microanalysis for the identification of key SRL processes used by physiotherapy students during the performance of a clinical examination skill. The objectives of the pilot study were: 1) to evaluate whether SRL-microanalysis could identify differences in the use of SRL processes between successful and unsuccessful students; 2) to evaluate the reliability of SRL microanalysis ratings produced by different assessors. Methods SRL-microanalysis was used with second year physiotherapy students of a Spanish university (n = 26) as they performed a goniometric task. The task required students to obtain a goniometric measurement of the shoulder joint of a peer. Two assessors evaluated student performance and conducted the SRL- microanalysis with all students. An analysis of inter-rater reliability was performed to evaluate the degree of agreement between assessors. Results The SRL-microanalysis revealed differences in the use of key SRL processes between successful (n = 15: 57.0%) and unsuccessful performers (n = 11: 43.0%): The differences were particularly evident in strategic planning and self-monitoring skills. There was good inter-rater reliability for scoring of strategic planning (k = 0.792), self-monitoring (k = 0.946) and self-evaluation (k = 0.846). Conclusion The use of SRL microanalysis characterized the key SRL processes of physiotherapy students performing a clinical skill with reliability between the assessors. This pilot study supports the potential usefulness of SRL-microanalysis for the identification of key SRL processes in physiotherapy education. Therefore, this study paves the way to the development of a full study, with a larger number of students and more diverse clinical tasks, to evaluate the SRL processes in successful and unsuccessful students.

Over the past 5years, cancer has replaced coronary heart disease as the leading cause of death in the Netherlands. It is thus paramount that medical doctors acquire a knowledge of cancer, since most of them will face many patients with cancer. Studies, however, have indicated that there is a deficit in knowledge of oncology among medical students, which may be due not only to the content but also to the structure of the curriculum. In this study, we compared students' knowledge acquisition in four different undergraduate medical programs. Further, we investigated possible factors that might influence students' knowledge growth as related to oncology. The participants comprised 1440 medical students distributed over four universities in the Netherlands. To measure students' knowledge of oncology, we used their progress test results from 2007 to 2013. The progress test consists of 200 multiple-choice questions; this test is taken simultaneously four times a year by all students. All questions regarding oncology were selected. We first compared the growth of knowledge of oncology using mixed models. Then, we interviewed the oncology coordinator of each university to arrive at a better insight of each curriculum. Two schools showed similar patterns of knowledge growth, with a slight decrease in the growth rate for one of them in year 6. The third school had a faster initial growth with a faster decrease over time compared to other medical schools. The fourth school showed a steep decrease in knowledge growth during years 5 and 6. The interviews showed that the two higher-scoring schools had a more focused semester on oncology, whereas in the others, oncology was scattered throughout the curriculum. Furthermore, the absence of a pre-internship training program seemed to hinder knowledge growth in one school. Our findings suggest that curricula have an influence on students' knowledge acquisition. A focused semester on oncology and a pre-internship preparatory training program are likely to have a positive impact on students' progress in terms of knowledge of oncology.

Objective Spreading training sessions over time instead of training in just 1 session leads to an improvement of long-term retention for factual knowledge. However, it is not clear whether this would also apply to surgical skills. Thus, we performed a systematic review to find out whether spacing training sessions would also improve long-term retention of surgical skills. Design We searched the Medline, PsycINFO, Embase, Eric, and Web of Science online databases. We only included articles that were randomized trials with a sample of medical trainees acquiring surgical motor skills in which the spacing effect was reported. The quality and bias of the articles were assessed using the Cochrane Collaboration's risk of bias assessment tool. Results With respect to the spacing effect, 1955 articles were retrieved. After removing duplicates and articles that did not meet the inclusion criteria, 11 articles remained. The overall quality of the experiments was “moderate.” Trainees in the spaced condition scored higher in a retention test than students in the massed condition. Conclusions Our systematic review showed evidence that spacing training sessions improves long-term surgical skills retention when compared to massed practice. However, the optimal gap between the re-study sessions is unclear.

Background: Assessment is an essential part of the educational system. Usually, assessment is used to measure students’ knowledge, but it can also be used to drive students’ learning and behaviors....

There has been increasing interest in medical education regarding the importance of regulation of learning since it extends understanding about the process of learning beyond the essential cognitiv...

Starting in 2009, cancer has been the leading cause of death in the Netherlands. Oncology is therefore an important part of the medical curriculum in undergraduate education. It is crucial that medical students know about cancer, since doctors will encounter many cases of oncology. We have compared the influence that teaching oncology has when spread over a 3-year curriculum versus concentrated in one semester. The participants comprised 525 medical students from one medical school with comprehensive integrated curricula. Of those, 436 followed the massed curriculum, with oncology concentrated in one semester. The remaining 89 students followed a spaced-out curriculum, in which oncology was spread out over 3 years. To measure students' knowledge, we used their progress test results from 2009 to 2012. All questions about oncology were categorized and selected. Because of our unbalanced sample and missing data and to reduce the chances for a type II error, we compared the growth of oncology questions using mixed effect models. A cubic growth model with an unstructured covariance matrix fitted our data best. At the start, students in the spaced-out curriculum scored higher on oncology questions. The initial growth was faster for the spaced-out curriculum students, whereas the acceleration over time was slower compared to the massed curriculum students. At the end of the growth curve, the knowledge of the massed curriculum students increased faster. In the last test, the massed curriculum students outperformed those in the spaced-out curriculum. The way students acquired and applied their knowledge was similar in both curricula. It seems, however, that students benefitted more from massed than spaced-out education, which may be due to the comprehensive integrated teaching involved.

Design and development research has the aim of understanding the feasibility and acceptability of implementing early-stage pilot research before interventions are fully implemented and evaluated for their impact. Increasing the use of design and development research in medical education research requires greater awareness of its importance by all stakeholders, the use of iterative research methodologies, such as educational design research, and the application of modified existing frameworks for healthcare feasibility studies.

Evidence-based medical education has been widely promoted but our discussions with medical educators across different countries has highlighted that adopting this approach can be frustrating. There is often a lack of useful evidence that can inform the practical decisions that medical educators have to make about curriculum development or the way that they should teach, especially in relation to low and middle income countries. To overcome these challenges, we recommend that studies increase their reporting of the context and process of any interventions. We also recommend international collaborations with a common goal to answer a research question that is of importance across different contexts. Future research should also focus on understanding the challenges of implementing evidence-based medical education in different countries.

Made available in DSpace on 2021-06-25T12:27:53Z (GMT). No. of bitstreams: 0 Previous issue date: 2020-01-01 Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) Introduction Including palliative care (PC) in overloaded medical curricula is a challenge, especially where there is a lack of PC specialists. We hypothesised that non-specialised rotations could provide meaningful PC learning when there are enough clinical experiences, with adequate feedback. Objective Observe the effects of including PC topics in non-specialised placements for undergraduate medical students in two different medical schools. Design Observational prospective study. Setting Medical schools in Brazil. Participants 134 sixth-year medical students of two medical schools. Methods This was a longitudinal study that observed the development of Self-efficacy in Palliative Care (SEPC) and Thanatophobia (TS) in sixth-year medical students in different non-specialised clinical rotations in two Brazilian medical schools (MS1 and MS2). We enrolled 78 students in MS1 during the Emergency and Critical Care rotation and 56 students in MS2 during the rotation in Anaesthesiology. Both schools provide PC discussions with different learning environment and approaches. Primary outcomes SEPC and TS Scales were used to assess students at the beginning and the end of the rotations. Results In both schools' students had an increase in SEPC and a decrease in TS scores. Conclusion Non-specialised rotations that consider PC competencies as core aspects of being a doctor can be effective to develop SEPC and decrease TS levels. Univ Estadual Campinas, Internal Med, Sch Med Sci, Campinas, SP, Brazil Univ Estadual Campinas, Dept Med Psychol & Psychiat, Sch Med Sci, Campinas, SP, Brazil Univ Estadual Paulista, Dept Anesthesiol, Fac Med, Campus Botucatu, Botucatu, SP, Brazil Univ Liverpool, Palliat Care Inst Liverpool, Liverpool, Merseyside, England Univ Med Ctr Groningen, Cedar Ctr Educ Dev & Res Hlth Sci, Groningen, Netherlands Univ Minho, Life & Hlth Sci Res Inst, Braga, Portugal Univ Estadual Paulista, Dept Anesthesiol, Fac Med, Campus Botucatu, Botucatu, SP, Brazil CAPES: 88881.188776/2018-01

IntroductionTeaching medical skills during clinical rotation is a complex challenge, which often does not allow students to practise their skills. Nowadays, the use of simulation training has increased to teach skills to medical students. However, transferring the learnt skills from one setting to the other is challenging. In this study, we investigated whether adding a simulation training before the clinical rotation would improve students’ acquisition and retention of knowledge.MethodsTwo subsequent cohorts were compared. Group A followed the traditional curriculum without additional simulation training. Group B attended an additional simulation training, in which history taking, physical examination and procedures for the primary survey in emergency situations were taught. Both groups answered the same knowledge test before entering their clinical rotation and after 6 months. To analyse students’ scores over time, we conducted a repeated measure analysis of variance. To investigate the difference between knowledge, we conducted a t-test.ResultsGroup B scored significantly higher in both tests and all subscores, except in the Trauma topic in the first measurement point. Students in group A showed decay in knowledge whereas group B showed an increase in knowledge.ConclusionsAdding a simulation training, before students entered their clinical rotation, improves students’ knowledge acquisition and retention compared with those who did not receive the additional simulation training.

This study investigated the associations between self-assessed empathy levels by physicians in training and empathy levels as perceived by their patients after clinical encounters. The authors also examined whether patient assessments were valid and reliable tools to measure empathy in physicians in training. Objectives This study investigated the associations between self-assessed empathy levels by physicians in training and empathy levels as perceived by their patients after clinical encounters. The authors also examined whether patient assessments were valid and reliable tools to measure empathy in physicians in training. Design A multicentric, observational, cross-sectional study. Setting This study was conducted in three public teaching hospitals in Brazil. Participants From the 668 patients invited to participate in this research, 566 (84.7%) agreed. Of these, 238 (42%) were male and 328 (58%) were female. From the invited 112 physicians in training, 86 (76.8%) agreed. Of the 86 physicians in training, 35 (41%) were final-year medical students and 51 (59%) were residents from clinical and surgical specialties. The gender distribution was 39 (45%) males and 47 (51%) females. Primary and secondary outcome measures Physicians in training filled the Jefferson Scale of Physician Empathy (JSE) and the Interpersonal Reactivity Index. Patients answered the Jefferson Scale of Patient’s Perceptions of Physician Empathy (JSPPPE) and the Consultation and Relational Empathy Scale (CARE). Results This study found non-significant correlations between patient and physicians-in-training self-assessments, except for a weak correlation (0.241, p, Fundação de Amparo à Pesquisa do Estado de São Paulo - FAPESP' (grant number: 2016/11908-1) and by the ’Conselho Nacional de Desenvolvimento Científico e Tecnológico - CNPq' (grant number: 202319/2017-2)

Contains fulltext : 215817.pdf (Publisher’s version ) (Open Access) PURPOSE: Assessment in different languages should measure the same construct. However, item characteristics, such as item flaws and content, may favor one test-taker group over another. This is known as item bias. Although some studies have focused on item bias, little is known about item bias and its association with items characteristics. Therefore, this study investigated the association between item characteristics and bias. METHODS: The University of Groningen offers both an international and a national bachelor's program in medicine. Students in both programs take the same progress test, but the international progress test is literally translated into English from the Dutch version. Differential item functioning was calculated to analyze item bias in four subsequent progress tests. Items were also classified by their categories, number of alternatives, item flaw, item length, and whether it was a case-based question. RESULTS: The proportion of items with bias ranged from 34% to 36% for the various tests. The number of items and the size of their bias was very similar in both programmes. We have identified that the more complex items with more alternatives favored the national students, whereas shorter items and fewer alternatives favored the international students. CONCLUSION: Although nearly 35% of all items contain bias, the distribution and the size of the bias were similar for both groups. The findings of this paper may be used to improve the writing process of the items, by avoiding some characteristics that may benefit one group whilst being a disadvantage for others.

In this “when i say…” article, the authors define ‘computerized adaptive testing’ by explaining how its application aligns with modern learning theories and could be utilized to better support trainees’ learning.

Contains fulltext : 200007.pdf (Publisher’s version ) (Open Access) PURPOSE: It is assumed that case-based questions require higher order cognitive processing, whereas questions that are not case-based require lower order cognitive processing. In this study, we investigated to what extent case-based questions and questions that are not case-based, relate to Bloom's taxonomy. METHODS: In this article, 4800 questions of the Progress Test were classified whether it was a case-based question and the level of Bloom's taxonomy. Lower-order questions require students to remember or/and basically understand the knowledge. Higher-order questions require students to apply, analyze, or/and evaluate. A phi-coefficient was calculated to investigate the relations between the presence of case-based questions and the required level of cognitive processing. RESULTS: Our results demonstrated that case-based questions were measuring higher levels of cognitive processing in 98.1% of the questions. Of the non-case-based questions, 33.7% required a higher level of cognitive processing. The phi-coefficient demonstrated a significant moderate correlation between the presence of a patient case in a question and its required level of cognitive processing (phi-coefficient = 0.55, p

Background: Progress testing is an assessment tool used to periodically assess all students at the end-of-curriculum level. Because students cannot know everything, it is important that they recognize their lack of knowledge. For that reason, the formula-scoring method has usually been used. However, where partial knowledge needs to be taken into account, the number-right scoring method is used. Research comparing both methods has yielded conflicting results. As far as we know, in all these studies, Classical Test Theory or Generalizability Theory was used to analyze the data. In contrast to these studies, we will explore the use of the Rasch model to compare both methods.Methods: A 2 x 2 crossover design was used in a study where 298 students from four medical schools participated. A sample of 200 previously used questions from the progress tests was selected. The data were analyzed using the Rasch model, which provides fit parameters, reliability coefficients, and response option analysis.Results: The fit parameters were in the optimal interval ranging from 0.50 to 1.50, and the means were around 1.00. The person and item reliability coefficients were higher in the number-right condition than in the formula-scoring condition. The response option analysis showed that the majority of dysfunctional items emerged in the formula-scoring condition.Conclusions: The findings of this study support the use of number-right scoring over formula scoring. Rasch model analyses showed that tests with number-right scoring have better psychometric properties than formula scoring. However, choosing the appropriate scoring method should depend not only on psychometric properties but also on self-directed test-taking strategies and metacognitive skills.

Introduction Assessment for learning means changing students’ behaviour regarding their learning. Cumulative assessment has been shown to increase students’ self-study time and spread their study time throughout a course. However, there was no difference regarding students’ knowledge at the end of the course. In theory, studying over time instead of cramming before the exam increases students’ knowledge retention. In this study, we investigated whether the students that participated in a cumulative assessment program would score higher than those who did not, after 3, 6, 9 and 12 months. Methods The participants of the current study were 62 second-year medical students who voluntarily participated in an experiment on cumulative assessment at the University of Groningen. Of 62 students, 25 were in the cumulative assessment condition, and 37 were in the control condition. The groups did not differ in GPA before the experiment. We retrieved their data regarding the Progress test. The content of the test is based on the Dutch National Blueprint for the Medical Curriculum about the knowledge objectives of the undergraduate medical school. Each progress test contains 200 multiple choice questions and is constructed to reflect the entire domain of medical knowledge. We selected the questions of the four subsequent Progress Test that reflected the content of the course. To compare students’ scores on questions over time, we used a general linear model (GLM). Results Our results demonstrated that there was no difference between groups over time. However, there was a main effect of time (F(3, 3) = 1020.286, p 0.05). Furthermore, we did not find an interaction effect between time and groups (F(3, 225) = 0.041, p > 0.05). Discussion Students in both groups acquired knowledge over time. There was no difference between both groups regarding the amount of knowledge students acquired and retained. Probably, this might be due to the comprehensively integrated teaching in our university in which the content of subjects is repeated over time. Alternatively, the gap between tests may not be optimal. Future research should investigate whether the gap between tests has an influence on students’ knowledge acquisition.

BACKGROUND: Beside acquiring knowledge, medical students should also develop the ability to apply and reflect on it, requiring higher-order cognitive processing. Ideally, students should have reached higher-order cognitive processing when they enter the clinical program. Whether this is the case, is unknown. We investigated students' cognitive processing, and awareness of their knowledge during medical school.METHODS: Data were gathered from 347 first-year preclinical and 196 first-year clinical students concerning the 2008 and 2011 Dutch progress tests. Questions were classified based upon Bloom's taxonomy: "simple questions" requiring lower and "vignette questions" requiring higher-order cognitive processing. Subsequently, we compared students' performance and awareness of their knowledge in 2008 to that in 2011 for each question type.RESULTS: Students' performance on each type of question increased as students progressed. Preclinical and first-year clinical students performed better on simple questions than on vignette questions. Third-year clinical students performed better on vignette questions than on simple questions. The accuracy of students' judgment of knowledge decreased over time.CONCLUSIONS: The progress test is a useful tool to assess students' cognitive processing and awareness of their knowledge. At the end of medical school, students achieved higher-order cognitive processing but their awareness of their knowledge had decreased.

The use of simulation in health education expands learning opportunities, contributing in a relevant way to the prevention of errors during professional activity. However, there are several challenges to achieving efficient simulated training, including the need to adapt the knowledge produced in different contexts. How should a simulation center be organized? How to take into account the peculiarities of the students in applying the concept of debriefing? Have the evaluation tools been validated for the population in which they are being applied? What elements should be included in simulation-based teaching to improve acquisition and/or retention of skills, knowledge, and attitudes? At what point, in the curriculum, should every possibility of simulated training be introduced in order to make the investment valid? In this editorial, the authors point out the importance of simulation training in healthcare and the need for research aimed at understanding the different situations and providing answers to these questions.