Education/Outcomes ResearchEffective use of human simulators in surgical education1
Introduction
Our institution requires the successful completion of a required fourth-year surgical clerkship based largely in the Surgical ICU and Trauma Service (Senior Surgery) [1]. Senior Surgery is designed to provide higher level experience in managing acutely ill surgical patients. Students are evaluated at the end of the clerkship with an Objective Structured Clinical Evaluation (OSCE) composed of patient management scenarios [2]. The faculty and resident supervised didactic sessions avoid traditionally formatted lectures, instead employing case-based learning modules.
We have utilized a variation of the RIME format to assist students in evaluating complex patients in these case-based sessions [3]. Students are instructed to evaluate an ICU flow sheet by identifying the abnormal and normal data (reporter), developing a systems based problem list (interpreter), and producing management recommendations (manager). To improve student skills specific to the evaluation of patients in shock, we initiated a simulation module using a full-scale computerized mannequin, midway through 2001–2002. This session with a human patient simulator (HPS) replaced a faculty-led case-based learning module focused on shock. Both of these modules were group sessions lasting approximately 1 h. This study tested the hypothesis that student performance on the OSCE would improve following learning with the HPS in comparison with student performance following the traditionally structured case-based module, which preceded the introduction of the HPS. Other factors that were likely to predict student performance were also evaluated.
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Materials and methods
The administrative center of Robert Wood Johnson Medical School, located in Piscataway, NJ, is where students receive their first 2 years of basic science education. The student body is then divided into two campuses for completion of the two clinical years. Cooper Hospital in Camden is one center, and the other is located at Robert Wood Johnson University Hospital in New Brunswick. This article focuses on the students centered in New Brunswick. The Senior Surgery Clerkship located in New
Results
Fifty-four of fifty-nine students that were offered the HPS session completed the module. Student performance on the shock stations of the OSCE was dependent on the HPS session by ANOVA (Table 1). Total C scores with the HPS were 105.4 ± 2.2 vs 90.8 ± 2.5, P < 0.05. The scores on all three shock stations were significantly improved following implementation of the HPS module. Of concern, there was also a significant effect of clerkship site on OSCE scores (Table 1). The total C scores were
Discussion
A transition occurs during the education of medical students. The initial, basic science portion of the curriculum in medical schools still is largely delivered through traditional teaching methods in classrooms: faculty-identified topics delivered via lecture. Historically, the last portion of medical school is largely an immersion experience in the clinic. Medical students are incorporated into patient care teams in the multitude of medical specialties and expected to develop clinical skills
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