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Alsulimani LK, Al-Otaiby FM, Alnofaiey YH, Binobaid FA, Jafarah LM, Khalil DA. Attitudes Towards Introduction of Multiple Modalities of Simulation in Objective Structured Clinical Examination (OSCE) of Emergency Medicine (EM) Final Board Examination: A Cross-Sectional Study. Open Access Emerg Med 2020; 12:441-449. [PMID: 33299360 PMCID: PMC7720994 DOI: 10.2147/oaem.s275764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 11/17/2020] [Indexed: 12/05/2022] Open
Abstract
Purpose Objective Structured Clinical Examination (OSCE) is the current modality of choice for evaluating practical skills for graduating emergency medicine residents of final Saudi board examination. This study aims to evaluate the attitudes of both residents and faculty towards the idea of utilizing multiple modalities of simulation in a high-stakes emergency medicine (EM) examination. The goal is to propose a method to improve the process of this examination. Participants and Methods The data were obtained using a cross-sectional survey questionnaire that was distributed to 141 participants, including both EM residents and instructors in the Saudi Board of Emergency Medicine. An online survey tool was used. The data were collected and subsequently analyzed to gauge the general and specific attitudes of both residents and instructors. Results Of the 141 participants, 136 provided complete responses; almost half were residents from all years, and the other half were primarily instructors (registrars, senior registrars, or consultants). Most of the participants from both groups (70% of the residents and 86% of the instructors) would like to see simulation incorporated into the final EM board OSCEs. Most of the participants (78%), however, had no experience with using multiple modalities of simulation in OSCEs. Overall, the majority (74.82%) expressed the belief that simulation-based OSCEs would improve the assessment of EM residents’ competencies. The modalities that received the most support were part-task trainers and hybrid simulation (70.71% and 70%, respectively). Conclusion From this study, we can conclude that both parties (residents and instructors) are largely willing to see multimodality simulation being incorporated into the final board examinations. Stakeholders should interpret this consensus as an impetus to proceed with such an implementation of multimodality simulation. Input from both groups should be considered when planning for such a change in this high-stakes exam.
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Affiliation(s)
- Loui K Alsulimani
- Department of Emergency Medicine,Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia.,Department of Medical Education, King Abdulaziz University, Jeddah, Saudi Arabia.,Clinical Skills and Simulation Center, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Fayhan M Al-Otaiby
- Department of Emergency Medicine, International Medical Center, Jeddah, Saudi Arabia
| | - Yasser H Alnofaiey
- Department of Emergency Medicine, Faculty of Medicine, Taif University, Taif, Saudi Arabia
| | - Fares A Binobaid
- Department of Emergency Medicine, King Abdulaziz Hospital, Makkah, Saudi Arabia
| | - Linda M Jafarah
- Department of Emergency Medicine, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Daniyah A Khalil
- Primary Healthcare Center, King Fahad General Hospital, Jeddah, Saudi Arabia
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Shen X, Tay BWR, Tan BYQ, Ngiam NJ, Mok JSR, Mok SF, Yap ES, Khoo SM. Effectiveness of near-peer simulation for managing the acutely deteriorating patient among residents of an internal medicine junior residency programme. Singapore Med J 2020; 61:34-38. [PMID: 31197379 PMCID: PMC7900809 DOI: 10.11622/smedj.2019056] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/27/2023]
Abstract
INTRODUCTION Near-peer teaching is gaining popularity as a teaching modality, as it improves the learner's understanding, is targeted at an appropriate level and promotes familiarisation. This study was initiated to evaluate the effectiveness of incorporating near-peer instruction into simulation-based training within a junior residency programme. METHODS 42 first-year residents from an internal medicine junior residency programme were recruited. Participants underwent a simulation-based training programme conducted over five weeks. Each week involved either an emergency or acute clinical scenario. A structured questionnaire was administered prior to and after the course to compare participants' perceived knowledge, experience and confidence in managing the clinical scenarios. RESULTS In our study, 83% of participants agreed/strongly agreed that the scenarios were realistic. There were improvements in perceived knowledge, experience and confidence after the course. The greatest improvement was seen for experience (post-simulation: median 7.00 [interquartile range (IQR) 6.00‒8.00] vs. pre-simulation: median 5.00 [IQR 3.00-6.25]). 65% of participants were keen to help with future training. CONCLUSION Near-peer simulation training was found to be a viable and valuable method of instruction for first-year residents for increasing experience, instilling confidence and improving perceived knowledge. Integration of such programmes within medical education curricula shows good promise of continuity, with many first-year residents inspired to organise subsequent sessions.
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Affiliation(s)
- Xiayan Shen
- Department of Medicine, National University Health System, Singapore
| | | | | | | | | | - Shao Feng Mok
- Department of Medicine, National University Health System, Singapore
| | - Eng Soo Yap
- Department of Laboratory Medicine, National University Hospital, Singapore
| | - See Meng Khoo
- Department of Medicine, National University Health System, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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Yang CW, Ku SC, Ma MHM, Chu TS, Chang SC. Application of high-fidelity simulation in critical care residency training as an effective learning, assessment, and prediction tool for clinical performance. J Formos Med Assoc 2018; 118:1347-1355. [PMID: 30584004 DOI: 10.1016/j.jfma.2018.12.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Revised: 10/09/2018] [Accepted: 12/05/2018] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND/PURPOSE This study was conducted to assess: 1) the impact of the HFS curriculum on residents' knowledge and skills, and 2) the correlation between learning outcomes and the clinical performance. METHODS An HFS-based curriculum was implemented for junior residents prior to their ICU rotations. Residents completed written tests before (pre-test) and after (post-test) the curriculum and were assessed on their performance during the simulation sessions. Clinical performance was evaluated using global rating for knowledge, clinical skills, and leadership and decision-making skills. RESULTS Complete data on pre-, post-test, simulation performance assessment, and clinical performance evaluation were available for 69 residents. Residents scored higher on their written post-test (64.6) compared with the pre-test (57.0) (p < 0.01). The simulation performance of residents improved between their first (3.43) and second (3.60) sessions (p < 0.05). Post-test scores correlated poorly with simulation performance (r = 0.03-0.28). Multivariable linear regression analysis revealed that clinical performance correlated better and significantly with simulation performance than the post-test for knowledge and clinical skills. CONCLUSION HFS is an effective training strategy, and can also be a complementary assessment tool to the written examinations and has better correlation with clinical performance.
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Affiliation(s)
- Chih-Wei Yang
- Department of Medical Education, National Taiwan University Hospital, Taipei, Taiwan; Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan; Department and Graduate Institute of Medical Education and Bioethics, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Shih-Chi Ku
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
| | - Matthew Huei-Ming Ma
- Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan; Department of Emergency Medicine, National Taiwan University Hospital Yun-Lin Branch, Douliou City, Taiwan
| | - Tzong-Shinn Chu
- Department of Medical Education, National Taiwan University Hospital, Taipei, Taiwan; Department and Graduate Institute of Medical Education and Bioethics, College of Medicine, National Taiwan University, Taipei, Taiwan; Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
| | - Shan-Chwen Chang
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan; Department of Medicine, National Taiwan University, College of Medicine, Taipei, Taiwan
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Ramchandani N, Maguire LL, Stern K, Quintos JB, Lee M, Sullivan-Bolyai S. PETS-D (parents education through simulation-diabetes): Parents' qualitative results. PATIENT EDUCATION AND COUNSELING 2016; 99:1362-7. [PMID: 27021779 PMCID: PMC4931973 DOI: 10.1016/j.pec.2016.03.019] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/03/2015] [Revised: 03/12/2016] [Accepted: 03/18/2016] [Indexed: 06/05/2023]
Abstract
OBJECTIVE Parents who have a child newly diagnosed with type 1 diabetes (T1D) must quickly learn daily diabetes self-management. An RCT was conducted using human patient simulation (HPS) to enhance parents learning diabetes self-management with children with new-onset T1D. The purpose of this study was to describe parents' perspectives of using HPS to augment diabetes education. METHODS A qualitative descriptive design was used with open-ended in-depth interviews of parents (n=49) post-intervention. Qualitative directed content analysis was used. RESULTS The majority of parents were positive about learning with HPS. Although a few parents said the HPS was "hokey" or "creepy," most reported the visual and hands-on learning was realistic and very beneficial. Seeing a seizure increased their fear although they would have panicked if they had not had that learning experience, and it helped build their diabetes self-management confidence. Recommendations included teaching others with the HPS (grandparents, siblings, babysitters, and school nurses). CONCLUSION HPS-enhanced education is an acceptable and viable option that was generally well-received by parents of children with new-onset T1D. PRACTICE IMPLICATIONS The technique should be studied with parents of children with other chronic illnesses to see if the benefits found in this study are applicable to other settings.
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Affiliation(s)
| | | | - Kailyn Stern
- New York University College of Nursing, NY, NY, USA
| | | | - Mary Lee
- University of Massachusetts Worcester, Worcester, MA, USA
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Lighthall GK, Barr J. The Use of Clinical Simulation Systems to Train Critical Care Physicians. J Intensive Care Med 2016; 22:257-69. [PMID: 17895484 DOI: 10.1177/0885066607304273] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Intensive care units are complex and dynamic clinical environments in which the delivery of appropriate and timely care to critically ill patients depends on the integrated and efficient actions of providers with specialized training. The use of realistic clinical simulator systems can help to facilitate and standardize the training of critical-care physicians, nurses, respiratory therapists, and pharmacists without having the training process jeopardize the well-being of patients. In this article, we review the current state of the art of patient simulator systems and their applications to critical-care medicine, and we offer some examples and recommendations on how to integrate simulator systems into critical-care training.
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Affiliation(s)
- Geoffrey K Lighthall
- Department of Anesthesia, Stanford University School of Medicine, Stanford, CA, USA.
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Increasing pediatric resident simulated resuscitation performance: A standardized simulation-based curriculum. Resuscitation 2014; 85:1099-105. [DOI: 10.1016/j.resuscitation.2014.05.005] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2013] [Revised: 04/24/2014] [Accepted: 05/01/2014] [Indexed: 11/24/2022]
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Mundell WC, Kennedy CC, Szostek JH, Cook DA. Simulation technology for resuscitation training: A systematic review and meta-analysis. Resuscitation 2013; 84:1174-83. [DOI: 10.1016/j.resuscitation.2013.04.016] [Citation(s) in RCA: 115] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2013] [Accepted: 04/17/2013] [Indexed: 10/26/2022]
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Littlewood KE, Shilling AM, Stemland CJ, Wright EB, Kirk MA. High-fidelity simulation is superior to case-based discussion in teaching the management of shock. MEDICAL TEACHER 2013; 35:e1003-10. [PMID: 23126242 DOI: 10.3109/0142159x.2012.733043] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/18/2023]
Abstract
BACKGROUND Case-based discussion (CBD) is an established method for active learning in medical education. High-fidelity simulation has emerged as an important new educational technology. There is limited data from direct comparisons of these modalities. AIMS The primary purpose of this study was to compare the effectiveness of high-fidelity medical simulation with CBD in an undergraduate medical curriculum for shock. METHODS The subjects were 85 third-year medical students in their required surgery rotation. Scheduling circumstances created two equal groups. One group managed a case of septic shock in simulation and discussed a case of cardiogenic shock, the other group discussed septic shock and experienced cardiogenic shock through simulation. Student comprehension of the assessment and management of shock was then evaluated by oral examination (OE). RESULTS Examination scores were superior in all comparisons for the type of shock experienced through simulation. This was true regardless of the shock type. Scores associated with patient evaluation and invasive monitoring, however, showed no difference between groups or in crossover comparison. CONCLUSIONS In this study, students demonstrated better understanding of shock following simulation than after CBD. The secondary finding was the effectiveness of an OE with just-in-time deployment in curriculum assessment.
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Spooner N, Hurst S, Khadra M. Medical simulation technology: educational overview, industry leaders, and what's missing. Hosp Top 2012; 90:57-64. [PMID: 22989223 DOI: 10.1080/00185868.2012.714685] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Modern medical simulation technology (MST) debuted in 1960 with the development of Resusci Annie (Laerdal 2007), which assisted students in the acquisition of proper ventilation and compression techniques used during basic life support. Following a steady stream of subsequent technological advances and innovations, MST manufacturers are now able to offer training aids capable of facilitating innovative learning in such diverse areas as human patient simulators, simulated clinical environments, virtual procedure stations, virtual medical environments, electronic tutors, and performance recording. The authors list a number of the most popular MSTs presently available while citing evaluative efforts undertaken to date regarding the efficacy of MST to the medical profession. They conclude by proposing a variety of simulation innovations of prospective interest to both medical and technology personnel while offering healthcare administrators a series of recommended considerations when planning to integrate MST into existing medical systems.
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Affiliation(s)
- Nicholas Spooner
- Nepean Hospital, Nepean Clinical School, The University of Sydney, Australia
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Hayden EM, Navedo DD, Gordon JA. Web-conferenced simulation sessions: a satisfaction survey of clinical simulation encounters via remote supervision. Telemed J E Health 2012; 18:525-9. [PMID: 22827475 DOI: 10.1089/tmj.2011.0217] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE A critical barrier to expanding simulation-based instruction in medicine is the availability of clinical instructors. Allowing instructors to remotely observe and debrief simulation sessions may make simulation-based instruction more convenient, thus expanding the pool of instructors available. This study compared the impact of simulation sessions facilitated by in-person (IP) faculty versus those supervised remotely using Web-conferencing software (WebEx(®), Cisco [ www.webex.com/ ]). SUBJECTS AND METHODS A convenience sample of preclinical medical students volunteered to "care for" patients in a simulation laboratory. Students received either standard IP or Web-conferenced (WC) instruction. WC sessions were facilitated by off-site instructors. A satisfaction survey (5-point Likert scale, where 1=strongly disagree and 5=strongly agree) was completed immediately following the sessions. RESULTS Forty-four surveys were analyzed (WC n=25, IP n=19). In response to the question "Was the communication between faculty and students a barrier to understanding the case?," the average student responses were 2.8 (95% confidence interval [CI] 2.4-3.2) for WC and 4.5 (95% CI 4.0-5.0) for IP (p<0.0001). In response to the question "Would you participate again in such a session?," the average student responses were 4.2 (95% CI 4.0-4.5) for WC and 4.9 (95% CI 4.6-5.2) for IP (p=0.0003). Both groups agreed that they acquired new skills (4.2 for WC, 4.5 for IP; p=0.39) and new knowledge (4.6 for WC, 4.7 for IP; p=0.41). CONCLUSIONS Telecommunication can successfully enhance access to simulation-based instruction. In this study, a Web interface downgraded the quality of student-faculty communication. Future investigation is needed to better understand the impact of such an effect on the learning process and to reduce barriers that impede implementation of technology-facilitated supervision.
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Affiliation(s)
- Emily M Hayden
- Gilbert Program in Medical Simulation, Harvard Medical School, Boston, Massachusetts, USA.
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Abstract
INTRODUCTION A long and rich research legacy shows that under the right conditions, simulation-based medical education (SBME) is a powerful intervention to increase medical learner competence. SBME translational science demonstrates that results achieved in the educational laboratory (T1) transfer to improved downstream patient care practices (T2) and improved patient and public health (T3). METHOD This is a qualitative synthesis of SBME translational science research (TSR) that employs a critical review approach to literature aggregation. RESULTS Evidence from SBME and health services research programs that are thematic, sustained, and cumulative shows that measured outcomes can be achieved at T1, T2, and T3 levels. There is also evidence that SBME TSR can yield a favorable return on financial investment and contributes to long-term retention of acquired clinical skills. The review identifies best practices in SBME TSR, presents challenges and critical gaps in the field, and sets forth a TSR agenda for SBME. CONCLUSIONS Rigorous SBME TSR can contribute to better patient care and improved patient safety. Consensus conference outcomes and recommendations should be presented and used judiciously.
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Ko PY, Scott JM, Mihai A, Grant WD. Comparison of a modified longitudinal simulation-based advanced cardiovascular life support to a traditional advanced cardiovascular life support curriculum in third-year medical students. TEACHING AND LEARNING IN MEDICINE 2011; 23:324-30. [PMID: 22004316 DOI: 10.1080/10401334.2011.611763] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
BACKGROUND Simulation is an effective tool for teaching medical students in cardiac arrest management. PURPOSE The purpose of this article is to compare the efficacy of a traditional Advanced Cardiovascular Life Support (ACLS) course versus a modified longitudinal ACLS course using high-fidelity simulation in medical students. METHODS One group enrolled in a 2-day traditional ACLS course while another group participated in independent learning over 2 weeks and 2 simulation sessions using Laerdal Sim-Man. The modified curriculum also included environmental fidelity with simulation, access to materials electronically, smaller class sizes, and integration of real experiences in the Emergency Department into their learning. Student performance was measured with a scripted, videotaped mega code, followed by a survey. RESULTS We enrolled 21 students in a traditional ACLS program and 29 students in the simulation-based program (15 and 26 videos available for analysis). There was no difference in Time to Initiate CPR or Time to Shock between the groups, but the modified curriculum group demonstrated higher performance scores. They also felt better prepared to run the code during a simulation and in a hospital setting compared to students in the traditional ACLS curriculum. CONCLUSIONS Students in a modified longitudinal simulation-based ACLS curriculum demonstrated better proficiency in learning ACLS compared to a traditional curriculum.
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Affiliation(s)
- Paul Y Ko
- Department of Emergency Medicine, Upstate Medical University, Syracuse, New York, USA.
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Long-term educational impact of a simulator curriculum on medical student education in an internal medicine clerkship. Simul Healthc 2010; 5:75-81. [PMID: 20389232 DOI: 10.1097/sih.0b013e3181ca8edc] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND Medical simulation is frequently used in postgraduate medical training, but its value and sustainability in medical student education are less clear. We report the first long-term experience of mannequin simulation in an internal medicine clerkship. METHODS During a 6-year period (2002-2009), 327 Harvard medical students participated in a simulator-based teaching experience designed to expose students to the principles of myocardial infarction (MI). This experience was additive to a 12-week clerkship curriculum. Through blinded survey instruments, we sought to determine how the simulator exercise modified student exposure to a core curricular objective in the traditional clerkship. We also sought student and faculty perception of this educational tool and factors important to sustainability. RESULTS Three hundred twenty-seven consecutive students were exposed to the simulation exercise and their experiences evaluated. Three hundred twenty-six students (99%) described the simulation experience as valuable, with >69% requesting multiple sessions be provided during each clerkship. Although a core objective, only 78% of students reported having a didactic teaching session on MI during the clerkship, and only 47% of students reported exposure to a live patient with MI. Furthermore, only 15% of students reported exposure to at least two different clinical presentations of MI, allowing comparison and reflection. Thus, the simulation exercise provided the only exposure to this topic for 22% of students and facilitated comparisons of different clinical presentations for 85% of students. When students participated in both the simulator and the didactic sessions, 74% favored the simulation exercise. Faculty cited small group size, once monthly delivery and focused curricula as key points for sustainability of this effort. CONCLUSION Mannequin simulation is a valuable and sustainable addition to a third-year internal medicine clerkship. For some students, simulation provides otherwise unavailable exposure to core content material. For the majority of students, simulation also provides the only means of exposure to multiple presentations of a single illness. Together, these data strongly suggest that simulation promotes both experiential learning and comparative analysis in a clerkship setting.
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Ten Eyck RP, Tews M, Ballester JM, Hamilton GC. Improved Fourth-Year Medical Student Clinical Decision-Making Performance as a Resuscitation Team Leader After a Simulation-Based Curriculum. Simul Healthc 2010; 5:139-45. [DOI: 10.1097/sih.0b013e3181cca544] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Heitz C, Brown A, Johnson JE, Fitch MT. Large group high-fidelity simulation enhances medical student learning. MEDICAL TEACHER 2009; 31:e206-e210. [PMID: 19811125 DOI: 10.1080/01421590802637990] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
BACKGROUND Previous work shows feasibility for large group high-fidelity simulation with correlation to basic science in the preclinical curriculum. AIMS This project studies whether large group simulation leads to enhanced basic science learning. METHODS This was an educational performance study before and after high-fidelity simulation for first-year medical students. Basic neuroscience concepts were reinforced with simulation, and pretesting and posttesting were analysed along with summative exam results. The number correct was compared on a contingency table using the Mantel-Haenszel chi-squared test and same student correlation was accounted for with a 'Generalized Estimating Equations' model. RESULTS The study included 112 students; three were excluded for missing data. Students showed statistically significant improvement on two of the four questions, and a nonsignificant improvement or equivalent performance on two questions. Students were significantly more likely to get all four responses correct on the posttest than on the pretest. Summative testing 11 days later had >80% correct responses for three factual recall questions and 58% correct responses for a single knowledge application question. CONCLUSIONS Simulation is an effective teaching method for preclinical basic science education. Students demonstrated significant improvements after participating in a live interactive simulation scenario.
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Toward a sustainable future for simulation-based critical care training: facing a few "inconvenient truths". Pediatr Crit Care Med 2009; 10:264-5. [PMID: 19265365 DOI: 10.1097/pcc.0b013e31819a3aad] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Can a simulated critical care encounter accelerate basic science learning among preclinical medical students? A pilot study. Simul Healthc 2009; 1 Spec no.:13-7. [PMID: 19088567 DOI: 10.1097/01266021-200600010-00005] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
PURPOSE To explore whether a simulated critical care encounter can accelerate basic science learning among preclinical medical students. METHOD Using a high-fidelity patient simulator, we "brought to life" a paper case of a myocardial infarction among a convenience sample of first-year medical students (n=22 [intervention]). Students discussed the case as part of a routine tutorial session, and then managed the case in the simulator laboratory. Using an identical six-item test of cardiac physiology, students were evaluated immediately after the simulator session and at 1 year (n=15). Performance was compared with controls (case discussion but no simulator session) at both baseline (n=37) and 1 year (n=48). RESULTS Performance among simulator-exposed students was significantly enhanced on immediate testing (mean score 4.0 [control], 4.7 [intervention], P = .005). Gains among the simulator cohort were maintained at 1 year (mean score 4.1 [control], 4.7 [intervention], P = .045). Multivariable analysis confirmed that the intervention was a significant determinant of performance across time (P = .001). CONCLUSION Compared with controls in this pilot study, an additional simulation exercise improved immediate performance on a short written test of cardiovascular physiology. Enhanced performance was again seen at 1 year, raising the possibility that the extra teaching session produced accelerated and sustained learning compared with the routine teaching method. Given the preliminary nature of this investigation, further study is required to distinguish transient from lasting effects of simulation versus alternative teaching approaches in the basic medical sciences.
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Hedrick TL, Young JS. The use of "war games" to enhance high-risk clinical decision-making in students and residents. Am J Surg 2008; 195:843-9. [PMID: 18440485 DOI: 10.1016/j.amjsurg.2007.06.032] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2007] [Revised: 06/13/2007] [Accepted: 06/17/2007] [Indexed: 10/22/2022]
Abstract
BACKGROUND Initial studies found that residents and students performed poorly in simple clinical scenarios. We hypothesized that repeated simulations in the "war games" format would improve performance. METHODS Participants included medical students and residents on the trauma and surgical intensive care unit (SICU) services. Subjects were given a nursing report of an unstable patient and asked to verbalize management of the situation. Responses were transcribed and graded. RESULTS Eighty subjects and 5 experts participated in 227 simulations. Naive medical students, postgraduate year (PGY)-1, and PGY-2+ subjects performed worse than experts (P <.05). After participation in >/=3 war games sessions, trainees' scores were similar to experts. Subjects with the least amount of clinical experience demonstrated the most improvement. DISCUSSION We have designed an educational system that rapidly enhances the cognitive performance of students and residents. This may represent an important tool in assessing and enhancing the competencies of medical trainees in a safe environment.
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Affiliation(s)
- Traci L Hedrick
- University of Virginia Cognitive Research Laboratory, University of Virginia Health System, Charlottesville, VA 22906-0709, USA
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Chamberlain LJ, Wang NE, Ho ET, Banchoff AW, Braddock CH, Gesundheit N. Integrating collaborative population health projects into a medical student curriculum at Stanford. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2008; 83:338-344. [PMID: 18367891 DOI: 10.1097/acm.0b013e318166a11b] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
The authors describe the population health curriculum at the Stanford University School of Medicine from 2003 to 2007 that includes a requirement for first-year medical students to engage in community-based population health projects. The new curriculum in population health comprises classroom and experiential teaching methods. Population health projects, a key component of the curriculum, are described and classified by topic and topic area (e.g., health education; health services) and the intended outcome of the intervention (e.g., establishing new policies; advocacy). During the past four years, 344 students have entered the curriculum and have participated in 68 population health projects. The projects were determined both by students' interests and community needs, and they represented diverse topics: 51% of the 68 projects addressed topics in the area of disease prevention and health promotion; 28% addressed health care access; 15% addressed health services; 4% addressed emergency preparedness; and 1% addressed ethical issues in health. Each project had one of three targets for intervention: community capacity building, establishing policies and engaging in advocacy, and bringing about change or improvement in an aspect of the health care system. Projects represented diverse stages in the evolution of a community-campus partnership, from needs assessment to planning, implementation, and evaluation of project outcomes. Experience to date shows that classroom-based sessions and experiential learning in the area of population health can be successfully integrated in a medical school curriculum. When contextualized in a population health curriculum, population health projects can provide future physicians with an experiential counterpart to their classroom learning.
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Ogden PE, Cobbs LS, Howell MR, Sibbitt SJB, DiPette DJ. Clinical simulation: importance to the internal medicine educational mission. Am J Med 2007; 120:820-4. [PMID: 17765056 DOI: 10.1016/j.amjmed.2007.06.017] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2007] [Revised: 04/06/2007] [Accepted: 06/01/2007] [Indexed: 11/16/2022]
Affiliation(s)
- Paul E Ogden
- Department of Internal Medicine, Scott & White Memorial Hospital and Clinic, Scott, Sherwood and Brindley Foundation, The Texas A&M University System Health Science Center College of Medicine, Temple 76508, USA.
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Passman MA, Fleser PS, Dattilo JB, Guzman RJ, Naslund TC. Should simulator-based endovascular training be integrated into general surgery residency programs? Am J Surg 2007; 194:212-9. [PMID: 17618806 DOI: 10.1016/j.amjsurg.2006.11.029] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2006] [Revised: 11/12/2006] [Accepted: 11/14/2006] [Indexed: 01/22/2023]
Abstract
BACKGROUND The impact of high-fidelity simulators as an adjunct for endovascular training of general surgery residents has not yet been defined. The purpose of this study was to evaluate general surgery resident perspectives on the value of a simulator-based endovascular training program by using various measurement tools. METHODS General surgery residents in postgraduate years 1 to 5 (n = 50) participated in a focused endovascular training course covering aortoiliac, renal, and carotid artery disease. The components of the course included didactic lecture, self-learning course material and computer training modules, hands-on exposure to endovascular instruments, and endovascular procedure simulation using a mobile SimSuite unit (Medical Simulation Corporation, Denver, CO). Course participants completed pre- and postcourse questionnaires, knowledge-based testing, and endovascular simulator metric testing. RESULTS Of the 50 general surgery residents who completed the precourse questionnaire and knowledge-based testing, 41 completed the entire program including the postcourse questionnaire and knowledge-based testing, and 33 completed endovascular simulation metric testing. Subjective responses from pre- and postcourse surveys highlighting the residents' perceptions of the potential role of endovascular simulation as part of general surgery residency training showed favorable responses. On completion of the course, mean knowledge-based test scores had statistically significant improvement (pretest, n = 50, 59.5% +/- 12.1% correct and posttest, n = 41, 69.1% +/- 15.4% correct [P = .003]). For metric testing of a simulated endovascular procedure (n = 33), 93.9% completed all of the defined tasks within the allotted time period (mean time, 12.2 +/- 4.36 minutes; range, 4.1-26.6 minutes; 95% confidence interval for mean 10.8-13.6 minutes). CONCLUSIONS Based on subjective and objective measures, general surgery residents found valuable and benefited in knowledge base from a focused simulator-based endovascular training program. Integrating endovascular simulation into general surgery resident training and its influence on resident interest in vascular specialization as a career choice holds future potential.
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Affiliation(s)
- Marc A Passman
- Section of Vascular Surgery, University of Alabama at Birmingham, BDB 503, 1808 7th Avenue South, Birmingham, AL 35294-0012, USA.
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Bergus G, Kreiter C, Woodhead J, Lawrence J, Franklin E. Using infant mannequins in objective standardized clinical examinations: are there unintended consequences? ACTA ACUST UNITED AC 2006; 6:235-8. [PMID: 16843257 DOI: 10.1016/j.ambp.2006.03.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2005] [Revised: 02/22/2006] [Accepted: 03/03/2006] [Indexed: 11/20/2022]
Abstract
OBJECTIVE In objective standardized clinical examination (OSCE) of infants, real infants are generally not used. Instead, the standardized patient portrays a parent who answers a student's questions, and there is no physical examination. One way to assess physical examination skills in these encounters is to have students demonstrate the appropriate examination on a mannequin. But before using this approach, we wanted to assess whether having students examine mannequins affects their history-collecting or communication skills. METHODS Third-year medical students were randomized to 2 versions of an infant OSCE case. During the encounter, controls were handed a printed listing of all physical examination (PE) findings. Students in the mannequin group were told relevant PE findings only after the students had examined a part of the mannequin. Student performances on the OSCE case and perceptions about the case were compared. RESULTS Thirty-two students were in the control group, and 35 students examined mannequins. No differences were found in total case score (P = .78), or on history-gathering skills (P = .86) and communication skills subscales (P = .78). In addition, questionnaires completed by students after the encounter indicated that the infant mannequins did not affect student perceptions about the realism of the case (P = .91). CONCLUSIONS Student performances at collecting the clinical history or communicating with the standardized patient were not adversely affected by inclusion of an infant mannequin. This suggests mannequins can be used to assess students' knowledge of the relevant case-specific PE without adverse effect.
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Affiliation(s)
- George Bergus
- Department of Family Medicine and the Office of Student Affairs and Curriculum, University of Iowa Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City, Iowa 52242, USA.
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Abstract
Procedural simulation will be a revolutionary change in how health care providers maintain their proficiency and skill. Visionary leaders are already examining how this educational technique will be integrated into traditional curricula, and interventional specialties will be at the leading edge of this revolution. The role must be defined that simulation will play, new educational models must be developed around it, and studies must be performed that will meet the demands of a skeptical profession. Only then will the first truly revolutionary change in medical learning have been achieved since the advent of animal experimentation nearly 1,000 years ago.
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Affiliation(s)
- Steven Dawson
- Department of Radiology, Massachusetts General Hospital, and Harvard Medical School, Boston, Massachusetts 02114, USA.
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How Do Clinical Clerkship Students Experience Simulator-Based Teaching? A Qualitative Analysis. Simul Healthc 2006; 1:215-9. [DOI: 10.1097/01.sih.0000245787.40980.89] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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