Evaluation of the efficiency of wireless voice transmission system with mobile application (smartsteo) in gaining respiratory and heart sound skills of interns

The aim of medical education is to train skilled and competent physicians for the patient and society. To be useful and effective, the processes related to clinical examination and diagnosis with patients should be carried out well. However, this is not possible due to reasons such as patient rights, short hospital stays, and patients' unwillingness to work with student groups. Trainings that cannot be done on the patient are carried out in the presence of phantom, that is, simulators, which have become standard in medical education. These reasons are the lack of patient consent, the absence of patients always, the high number of students, and the inapplicability due to specialist working times. Therefore, the use of simulators is of great importance. One of these simulator tools is phantom models containing stethoscope, in which normal or abnormal sounds of organs are played. In the medical field, simulations are made on phantoms with simulators. For example, it is not possible for a person who will learn to perform heart massage for the first time to regain the blood circulation of a person whose heart has stopped. For this reason, the use of phantoms is important for basic medical skills training. Thanks to the use of simulators and simulations, students have the chance to gain experience before their first encounter with the patient. With the inclusion of experts in the training, the importance of simulation training gains importance in terms of experience transfer. Since the education given to the students during the education phase addresses their visual and auditory senses and increases the level of practical education, more efficient learning is provided with the simulator besides the normal education. It is known that there is an increase in the qualifications of graduates thanks to the use of simulators. It is very important to transfer information to permanent memory by combining auditory learning and visual learning methods. The way of training with the simulator is very important in terms of creating permanent memory. The more sense organs are used during the training, the more medical skills that will be formed in permanent memory are important gains in the diagnosis to be made on the patient in the future, in terms of ensuring the accuracy of the diagnosis and the speed of diagnosis. One of these skills is the ability to interpret what the sounds our organs produce while they are working. The process of listening to the sounds made by the organs is called auscultation. Auscultation can be performed at the bedside or accompanied by a simulator. When examined in terms of education, the most ideal method is to gain the skills that will enable the student to distinguish the differences abnormalities in the sounds coming from the relevant organs of the patient, accompanied by an instructor. The more sounds he/she hears and the more familiar the ear becomes, the more likely it is to diagnose accurately and quickly when he/she encounters those sounds. Considering the number of students in medical faculties, it is not possible for the student to have continuous access to the simulators. It is easier for students to access stethoscope as educational material than simulators. Although there are many publications on simulation and medical education in the literature, there is a device with hardware similarity of foreign origin that uses the stethoscope in simulation, no device in the national framework supported by scenario education has been found. It is known that stethoscope training is important and ear familiarity increases with experience for good sound recognition. It is among the aims of the study that the correct use of the stethoscope and listening to the right areas will contribute to the correct diagnosis of diseases and improve the quality of physician education. It is aimed that the use of stethoscope and sound listening training will increase the auscultation experience of interns. In this thesis, an electronic stethoscope capable of transmitting wireless sound was developed to provide auscultation (sound listening) training, and the "SmartSteo" mobile application, supported by scenarios, was developed for the use of sounds in education. The effects of 61 interns trained with the developed system on their ability to recognize respiratory and heart sounds were evaluated. The sounds of different diseases added to the library in the mobile application were listened to with the help of headphones in the electronic stethoscope and education was given to the students. The training consists of 2 parts, namely the lecturer and the scenarios and training. The training, which was taken together with the lecturer, was made by listening to the sounds in the mobile application, accompanied by an expert. The specialist doctor explains the sounds of the sample cases to the student with different scenarios and ensures that the student's experience of recognizing sounds increases and he/she receives training on the use of the correct stethoscope. In scenarios training, the student receives training by listening to the scripted sounds of the cases found on the mobile application or at simulehasta.com with an electronic stethoscope. The training consists of audio questions and markable answers. By listening to the sound in the question and marking the correct answer for the question, it proceeds to the next question. The system consists of two main parts, software, and hardware. The software part consists of an Android and IOS supported mobile application "SmartSteo" coded on the flutter platform, and the website at simulehasta.com on the "moodle" infrastructure, which includes scenario training and an online exam system. The hardware consists of a normal stethoscope, a rechargeable battery and an electronic stethoscope obtained with an electronic card (vhm-314-v2) that can transmit wireless sound. The trainings consisted of 10 questions obtained from 8 cases, which were turned into scenarios prepared by the medical specialist with this system developed. Cases and scenarios have been uploaded to simulehasta.com as well as the mobile application (SmarSteo). Thus, it has become possible to receive training from both platforms. Auscultation training was given to 61 interns who continue their normal education in Akdeniz University Faculty of Medicine, Department of Emergency Medicine, with the system developed in this thesis. Before starting the training, all students were given a 10-question pre-test online exam, each question containing audio recordings related to auscultation training, on simulehasta.com. The questions and answers of the exam are provided in a different order for each student. Interns were randomly divided into two groups consisting of 30 and 31 people. The first group of lecturers was included in the training, and it was ensured that they received mobile application and electronic stethoscope and voice listening training together with the specialist doctor. The second group was provided with self-scenario training by using the mobile application and website. Both groups who completed the training were subjected to the post-test. The 3 analyzes made with the pre-test and post-test data showed that the simulation training given to the intern students made a positive contribution to the students with 20% (script training) and 33% (instructor training) score increases. P<0.05 was accepted as a significant difference. It was observed that there was a significant and positive difference between the first test and the last test according to the p=0.001 and p=0.002 values. The median value of the pre-test was 50, and the median value increased to 60 because of the training given to the scenario training. Similarly, the median value of the pre-test applied before the faculty member training increased to 80 at the end of the 60 training. In the analysis of the differences between the two groups compared to the pre-test, no significant results were found between the two groups. It is possible to express that this progresses positively in both groups, as it means that there is no difference between them. According to the last analysis, when the relationship between the pre-test and the post-test was examined separately and whether there was a difference between the groups, the difference between the training and the instructor was revealed. It has been shown by the data obtained in the study that the education made with the lecturer is better than the education that the student receives on his own and that all these educations contribute to the normal education. As a result, the education given with the mobile application developed within the scope of the study and an electronic stethoscope, positive results were created in the skill level of the students. It was understood that it contributed to the students' ability to understand and interpret what they heard, namely auscultation. It is foreseen that it can be a pioneering work with software and hardware support for national studies in the field of simulation. The developed software and hardware material shows an approach that also cares about patient rights for applications that are difficult to do with students in the clinical field. In addition, a tool has been developed that will allow students to practice many times before encountering the patient, and to practice distance education in any environment and at any time. The mobile application is planned to be offered free of charge to all students who have an e-mail address with an educational institution extension.