医学生におけるクリニカルシミュレーションの早期導入：SimZonesを用いた段階的経験

Early clinical training in undergraduate medical education often occurs in unstructured environments, limiting student participation and competency development. The SimZones framework offers a progressive approach to simulation-based education, yet evidence for its implementation in first-year medical students remains limited.

To describe the design, implementation, and outcomes of a structured clinical simulation program for first-year medical students using the SimZones framework.

A descriptive study with mixed-methods analysis was conducted in 2024 with 116 first-year medical students at a Chilean medical school. Students participated in structured Zone 1 simulation activities throughout the academic year in small groups (5-6 students), using 12 validated assessment instruments developed and validated by a multidisciplinary expert panel comprising 202 specific procedural steps including 30 critical safety steps. Activities focused on technical, communication, and attitudinal skills with study guides, pre-tests, and formative rubrics. The program culminated with a Zone 2 integrative activity simulating primary care consultations using standardized patients, clinical documentation, and faculty debriefing using the Plus/Delta model. Performance was assessed using standardized rubrics, and qualitative observations were analyzed thematically.

All 116 students completed the program. High performance was observed in attitudinal competencies (≥97%) and communication domains (≥89%), while technical skills showed variable achievement rates (range 63%-78%). Qualitative analysis identified strengths in empathy, professionalism, and teamwork, with areas for improvement in procedural technique, interview sequencing, and time management.

Early progressive simulation using the SimZones framework effectively develops foundational competencies in first-year medical students. The structured approach, combining deliberate practice with formative assessment and guided debriefing, supports competency-based medical education objectives while identifying specific areas requiring additional reinforcement in technical skill training.