Journal of Cancer Education

, Volume 34, Issue 1, pp 194–200 | Cite as

Hybrid Simulation in Teaching Clinical Breast Examination to Medical Students

  • Joseph Nassif
  • Abdul-Karim Sleiman
  • Anwar H. Nassar
  • Sima Naamani
  • Rana Sharara-ChamiEmail author


Clinical breast examination (CBE) is traditionally taught to third-year medical students using a lecture and a tabletop breast model. The opportunity to clinically practice CBE depends on patient availability and willingness to be examined by students, especially in culturally sensitive environments. We propose the use of a hybrid simulation model consisting of a standardized patient (SP) wearing a silicone breast simulator jacket and hypothesize that this, compared to traditional teaching methods, would result in improved learning. Consenting third-year medical students (N = 82) at a university-affiliated tertiary care center were cluster-randomized into two groups: hybrid simulation (breast jacket + SP) and control (tabletop breast model). Students received the standard lecture by instructors blinded to the randomization, followed by randomization group-based learning and practice sessions. Two weeks later, participants were assessed in an Objective Structured Clinical Examination (OSCE), which included three stations with SPs blinded to the intervention. The SPs graded the students on CBE completeness, and students completed a self-assessment of their performance and confidence during the examination. CBE completeness scores did not differ between the two groups (p = 0.889). Hybrid simulation improved lesion identification grades (p < 0.001) without increasing false positives. Hybrid simulation relieved the fear of missing a lesion on CBE (p = 0.043) and increased satisfaction with the teaching method among students (p = 0.002). As a novel educational tool, hybrid simulation improves the sensitivity of CBE performed by medical students without affecting its specificity. Hybrid simulation may play a role in increasing the confidence of medical students during CBE.


Clinical breast examination Simulation Medical education 



We would like to thank Ms. Randa Farha from the simulation laboratory at the American University of Beirut, the standardized patients who participated in this study, and Dr. Zavi Lakissian for assistance in submission of the manuscript. Institution where the research was conducted: American University of Beirut, Beirut, Lebanon.

Funding Information

Internal grant from the American University of Beirut.

Compliance with Ethical Standards

This is a randomized controlled blinded behavioral trial aiming at assessing the efficacy of hybrid simulation of CBE as an educational tool. It was approved by the Institutional Review Board (IRB) at the American University of Beirut.

Conflict of Interest

The authors declare that they have no conflict of interest.

Supplementary material

13187_2017_1287_MOESM1_ESM.pdf (89 kb)
ESM 1 (PDF 89 kb)


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Copyright information

© American Association for Cancer Education 2017

Authors and Affiliations

  • Joseph Nassif
    • 1
  • Abdul-Karim Sleiman
    • 2
    • 3
  • Anwar H. Nassar
    • 1
  • Sima Naamani
    • 4
  • Rana Sharara-Chami
    • 3
    • 4
    • 5
    Email author
  1. 1.Department of Obstetrics and GynecologyAmerican University of Beirut Medical CenterBeirutLebanon
  2. 2.Simulation Program, Faculty of MedicineAmerican University of BeirutBeirutLebanon
  3. 3.Duke Eye CenterDuke UniversityDurhamUSA
  4. 4.Department of Pediatrics and Adolescent MedicineAmerican University of BeirutBeirutLebanon
  5. 5.American University of BeirutBeirutLebanon

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