The use of "war games" to enhance high-risk clinical decision-making in students and residents

Teaching Before, During, and After a Surgical Resuscitation

Teaching during a surgical resuscitation can be difficult due to the infrequency of these events. Furthermore, when these events do occur, the trainee can experience cognitive overload and an overwhelming amount of stress, thereby impairing the learning process. The emergent nature of these scenarios can make it difficult for the surgical educator to adequately teach. Repeated exposure through simulation, role play, and "war games" are great adjuncts to teaching and preparation before crisis. However, surgical educators can further enhance the knowledge of their trainees during these scenarios by using tactics such as talking out loud, targeted teaching, and debriefing.

Teaching geriatric medicine through gamification: a tool for enhancing postgraduate education in geriatric medicine

BACKGROUND

Polypharmacy is becoming increasingly common and all doctors must be prepared to manage it competently.

AIMS

The aim of this project is to evaluate the feasibility and use of a novel gamification-based teaching intervention on polypharmacy among doctors undergoing advanced geriatric training. Among others, one of the learning goals for the students was to be able to describe the adherence to medication.

METHODS

Electronic questionnaire sent to students of the third session "evidence-based medicine in geriatrics" of advanced postgraduate course in geriatrics of the European Academy for Medicine of Ageing.

RESULTS

Most students reported issues with forgetting doses and remembering sufficiently to establish a medication routine due to busy schedules as well as social influences around medication taking. Reflecting on the challenges of the game, most students reported that their own prescribing practice was likely to change.

DISCUSSION AND CONCLUSION

The current model of learning appears to be a feasible approach for postgraduate medical education or in other areas of healthcare such as nursing or physiotherapy. Learning through action and reflection promotes deeper thinking and can lead to behavioral change, in this case thus enhancing the attitudes and understanding regarding pharmacological issues associated with ageing. Recommendations for future research in medical education about medication adherence are outlined.

Conference Didactic Planning and Structure: An Evidence-based Guide to Best Practices from the Council of Emergency Medicine Residency Directors

Emergency medicine residency programs around the country develop didactic conferences to prepare residents for board exams and independent practice. To our knowledge, there is not currently an evidence-based set of guidelines for programs to follow to ensure maximal benefit of didactics for learners. This paper offers expert guidelines for didactic instruction from members of the Council of Emergency Medicine Residency Directors Best Practices Subcommittee, based on best available evidence. Programs can use these recommendations to further optimize their resident conference structure and content. Recommendations in this manuscript include best practices in formatting didactics, selection of facilitators and instructors, and duration of individual sessions. Authors also recommend following the Model of Clinical Practice of Emergency Medicine when developing content, while incorporating sessions dedicated to morbidity and mortality, research methodology, journal article review, administration, wellness, and professionalism.

The Effect of Simulation Wars on EM Residents' Global Rating Scales and In-Training Examination Scores

Purpose

The Accreditation Council for Graduate Medical Education (ACGME) restricted the duty hours for residents training in 2004. With less time to learn medicine, residents may not develop the clinical reasoning skills needed. Simulation can provide a remedy for this lack of time by allowing residents to practice skills and develop clinical reasoning in a simulated environment. Simulation Wars (SimWars), a clinical reasoning simulation has been shown to improve clinical reasoning skills. The purpose of the study was to investigate the effect of Simulation Wars on In-Training Examination (ITE) Scores and Global Rating Scale (GRS) Scores in Emergency Medicine (EM) residents.

Methods

The Quasi-Experimental design was used in this retrospective study. The main comparison was between historical controls, the residents who did not participate in the Simulation Wars, and the intervention group comprised of residents who participated in the SimWars.

Results

A total of 127 residents were participants in this study including 70 from the intervention and 57 from the historical control group. There were no significant differences found in GRS scores between both groups except for Communication and Professionalism (p<0.001). No overall improvement in ITE scores for the control group and for the intervention group was found. Furthermore, within the intervention group, while comparing those residents who participated in certain subcategories of SimWars and those who did not, there was a significant improvement in ITE scores in the subcategories of Thoracic Disorders, Abdominal/Gastrointestinal, Trauma Disorders and OBGyn.

Conclusion

SimWars in the subcategories of Abdominal/Gastrointestinal, Thoracic, OBGyn and Trauma were found to be associated with improved ITE scores in those subcategories. Since Emergency Medicine utilizes extensive clinical reasoning skills, SimWars may provide better educational opportunities for EM residents.

The "Simulation Roulette" game

INTRODUCTION

"Simulation Roulette" is a new method of "on-the-fly" simulation scenario creation that incorporates a game-like approach to critical scenarios and emphasizes prescenario preparation. We designed it to complement our traditional anesthesia simulation curriculum, in which residents are exposed to predefined "critical" scenarios. During typical scenarios, trainees are often given minimum preparatory information; they then start the scenario knowing only that "something bad" is going to happen. As a result, trainees often report anxiety, which can be a barrier to learning. To overcome this barrier and to augment traditional critical incident training, we developed the "Simulation Roulette" game.

METHODS

"Simulation Roulette" consists of premade cards that are randomly selected to create a patient, another set of premade cards to assist in selecting "complications," worksheets to guide a thorough "prebrief" discussion before the scenario, and scoresheets to facilitate the "debrief" discussion at the end. Similar to traditional scenarios, it requires coordination by a facilitator to ensure plausible scenarios and evaluation of trainee performance.

RESULTS

Although we have not conducted formal testing, we believe that (1) incorporating an element of random chance to scenario selection, (2) using a game-like framework, and (3) emphasizing the "prebrief" portion of simulation all have the potential to decrease trainee anxiety.

CONCLUSIONS

We present the rationale for designing such a game; examples of instructions, cards, and scoresheets; and our initial experience with implementing this game within our simulation curriculum.

Using game format to teach psychopharmacology to medical students

BACKGROUND

Most psychiatric programs provide lectures on basic principles of psychopharmacology. Yet, this traditional approach has been criticized due to excessive information and passive transfer of expert knowledge. An alternative teaching method is the use of "academic games."

AIMS

To investigate medical students' acquisition of knowledge on psychopharmacology, and their perception of a game playing approach compared to traditional lectures.

METHODS

Two senior residents designed, implemented, and executed a randomized pretest-posttest study to teach psychopharmacology, using an academic game and a lecture format, to third-year medical students during a 6-week Psychiatry clerkship. Both didactic interventions were delivered concurrently for five consecutive weeks covering five psychopharmacology modules: antidepressants I (selective serotonin reuptake inhibitors and atypical antidepressants), antidepressants II (monoamine oxidase inhibitors and tricyclic antidepressants), mood stabilizers, antipsychotics, and anti-anxiety agents/sedatives/hypnotics. The game follows similar rules of the famous TV show, "Jeopardy" using a power point grid and a multiple choice question format.

RESULTS

Forty-three medical students participated (29 assigned to the game approach, 14 to the traditional lecture approach). None of the demographic variables (age, gender, years after graduation, Graduate Point Averages, and United States Medical Licensing Examination 1) were significantly associated with the pre/posttest score difference between groups. Both groups improved their knowledge on psychotropic drugs [(game group t = 10.86, p < 0.001); control t = 4.82, p < 0.001)] throughout the 6-week Psychiatry rotation. Students in the game group had a better perception of this educational method as measured by perceived enjoyment, increased knowledge of psychopharmacology, and stimulating interest in the subject compared to those in the lecture group (p < 0.05).

CONCLUSIONS

Teaching psychopharmacology in medical students by using academic games can make the learning experience more enjoyable and motivating; however, future studies with higher quality methodology and design are needed to determine the role of educational games in acquiring new psychopharmacological knowledge.

Highlights in emergency medicine medical education research: 2008

OBJECTIVES

The purpose of this article is to highlight medical education research studies published in 2008 that were methodologically superior and whose outcomes were pertinent to teaching and education in emergency medicine.

METHODS

Through a PubMed search of the English language literature in 2008, 30 medical education research studies were independently identified as hypothesis-testing investigations and measurements of educational interventions. Six reviewers independently rated and scored all articles based on eight anchors, four of which related to methodologic criteria. Articles were ranked according to their total rating score. A ranking agreement among the reviewers of 83% was established a priori as a minimum for highlighting articles in this review.

RESULTS

Five medical education research studies met the a priori criteria for inclusion and are reviewed and summarized here. Four of these employed experimental or quasi-experimental methodology. Although technology was not a component of the structured literature search employed to identify the candidate articles for this review, 14 of the articles identified, including four of the five highlighted articles, employed or studied technology as a focus of the educational research. Overall, 36% of the reviewed studies were supported by funding; three of the highlighted articles were funded studies.

CONCLUSIONS

This review highlights quality medical education research studies published in 2008, with outcomes of relevance to teaching and education in emergency medicine. It focuses on research methodology, notes current trends in the use of technology for learning in emergency medicine, and suggests future avenues for continued rigorous study in education.

The use of simulation in medical education to enhance students' understanding of basic sciences

Simulation! The deans talk about its use in medical education regularly. But how can it be used to teach the basic sciences to first- and second-year medical students? This article will help answer that question by providing information about various types of simulation activities being used in medical education and examples of their application to basic science education. The next step depends on your creativity.