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Board #228 - Program Innovation Focused Simulation Scenarios with Pre-clinical Medical Students (Submission #8716)

Objectives At Saint George’s University (SGU) School of Medicine, all medical students are scheduled in groups of six persons to spend a three-hour morning in the Sim Lab during a five-week period in the final term of Basic Sciences. The main goals are to foster team interaction and encourage empathy as students interact with ill patients, practice focused physical exams, reinforce heart and lung auscultation and communicate findings to colleagues and facilitators. High-fidelity manikins are used in the simulated acute care settings; therefore, trained facilitators are required for each scenario. American Heart Association Instructors and/or Simulation Specialists at SGU with prior experience in teaching have been trained to facilitate the small groups. The simulation scenarios have been streamlined to standardize the student approach to each patient when performing basic clinical skills.1 However, there is a need to investigate the extent to which simulation sessions met student needs and whether or not the sessions might improve their ability to perform in clinical settings and in subsequent standardized exams.2-3 Description Groups were provided a brief patient history, process for interacting with the patient, steps for stating or performing the appropriate physical exam, and distinctive learning objectives for each scenario. Students worked as a team to rotate through five different scenarios using deliberate practice and repetition in simulated cases to integrate what they saw or heard with theoretical material they learned previously. Emphasis was on doctor-patient interaction to perform a focused exam and communicate findings. Students were selected from each group to report key findings to a facilitator. Questions about physiology or clinical significance were referred to materials, professors, or clinicians from previous courses. Each 30-minute session concluded with a short debriefing so students could summarize their experience and plan for improvement. Bedside stations were comprised of three Laerdal 3G high-fidelity manikins, and one Laerdal VitalSim. A fifth station had three Cardionic SAM II manikins for auscultation of common heart and breath sounds. Facilitators evaluated their final student group on a Likert scale to address knowledge, assessment and integration, professionalism, and participation. At the end of the session students anonymously evaluated their Sim Lab experience. Conclusion In Spring 2014, 535 students submitted evaluations, with 523 students providing usable data on participation, degree that objectives were met and quality of feedback. Students generally ranked facilitators as excellent (average 93%). They noted regular opportunity to report findings to the facilitator (average 30%). At the conclusion, a short anonymous survey with Likert scale questions to query the extent of agreement or degree of comfort that a session in the Sim Lab may have had upon clinical skills and subsequent patient encounters. Of the 68 students providing detailed data, 34% strongly agreed and 47% agreed that simulation sessions provided them with practice in reporting of findings. Following their session in the Sim Lab, students reported greater comfort in seeing patients at Grenada General Hospital. In hearing heart sounds, breath sounds, and performing a focused exam, 46%, 53% and 66% respectively felt somewhat comfortable. One limitation was the low-response rate by students at end of term (13%). A future challenge will be to continue providing simulation sessions that contribute toward student success on USMLE exams and encourage safe, ethical patient care during clinical rotations, given the unknown availability of appropriate facilitators and external support. References 1. McCann TJ, Speake JR, Louison ML, et al. Streamlined simulation scenarios to enhance doctor-patient interaction and auscultation skills for pre-clinical medical students. Invited Poster, Innovative Works in Progress, SSIH 14th Annual International Meeting, January 25-29, 2014, San Francisco CA. 2. McGaghie WC, Issenberg SB, Cohen ER, et al. Does simulation-based medical education with deliberate practice yield better results than traditional clinical education? A meta-analytic comparative review of the evidence. Acad Med 2011; 86:706–711. 3. Butter J, McGaghie WC, Cohen ER, et al. Simulation-based mastery learning improves cardiac auscultation skills in medical students. J Gen Intern Med 2010; 25:780-785. Disclosures None