Simulação realística como método de ensino ativo em acidente vascular encefálico: estudo quase-experimental

Abstract

Introduction: Medical education has evolved from traditional, passive, teacher- centered methods to more dynamic and participatory approaches, such as active methodologies, aligned with constructivist pedagogy. In the active approach, realistic simulation (RS) stands out as an effective tool for developing theoretical and practical skills in a safe environment, especially in complex topics such as stroke. Objective: To test the effectiveness of the use of active teaching methodology employing RS with that of traditional methodology in the theoretical-practical performance of participating medical students on stroke. Methods: Quasi-experimental quantitative study with non- equivalent groups. Sample composed of third and fourth-period medical students from two higher education institutions (HEIs) in Palmas, TO, one that uses active teaching methodology (HEI AM), forming the realistic simulation group (RSG), and another that adopts traditional teaching methodology (HEI TM), composing the control group (CG). The research was divided into three phases, pre-intervention, intervention, and post- intervention. Two hypotheses were tested, both with dependent variables, gain in self- confidence and satisfaction in the practice of stroke and effectiveness in theoretical- practical teaching. In the pre-intervention, a pilot test was conducted with 14 medical students from the fifth period of the HEI AM. In the intervention, there were 107 participants in RSG and 54 in CG. After sample losses (34.5% in RSG and 18.5% in CG), the final sample was 70 and 44 participants. Both groups participated in a lecture on stroke. The Student Satisfaction and Self-Confidence in Learning (SSSL) was used to test the variable confidence and satisfaction, and the pre- and post-test questionnaire on stroke (QPRoT) was used to test the variable effectiveness of the methodologies. The intervention occurred only for the GSR, using the scenario for realistic simulation of stroke (SRSS), with validation of its construct using the Simulation Design Scale (SDS), Debriefing Experience Scale (DES), and Educational Practices Questionnaire (EPQ). Descriptive analysis based on the socioeconomic questionnaire (QSE) was used for the entire sample. Results: According to QSE, the sample of 114 participants was predominantly female (59.65%) and the median age was 22 years. The SRSS was validated by the content validity index ≥ 0.8 in more than half of the responses to SDS, DES, and EPQ. Applying Fisher's exact and chi-square tests to SSSL, a significant association was observed between most qualitative variables (Likert scale) and the groups, with greater satisfaction and self-confidence in learning for RSG. For the final QPRoT, the analysis by the Wilcoxon test (95% CI, p < 0.05) indicated a theoretical gain in both groups (CG from 28.4% to 34.2%; RSG from 28.2% to 50.6%), but statistically higher in RSG. The findings indicated greater effectiveness of the active methodology, with higher levels of satisfaction, self- confidence, and theoretical-practical performance. Conclusion: The active methodology showed greater effectiveness than the traditional one in theoretical- practical gains, self-confidence, and student satisfaction, which are fundamental aspects of medical training. It proved to be a viable, effective, and low-cost practice applicable to various educational contexts. Further studies are recommended to validate these findings in different institutional and regional realities.