Education/Outcomes Research
Effective use of human simulators in surgical education1

1 Presented at the 36th Annual Meeting of the Association For Academic Surgery, November 7–9, 2002, Marriott Copley Place, Boston, MA.
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Abstract

Background

We initiated a teaching module utilizing a human simulator midway through 2001–2002 to improve student skills specific to the evaluation of patients in shock during a required clerkship in surgery for fourth-year medical students. We tested the hypothesis that student skills would improve after implementation of this module and identified factors that predicted student performance.

Materials and methods

Students (n = 86) chose one of two hospital sites for a clerkship that focuses on the care of acutely ill surgical patients. A case-based lecture focusing on the diagnosis and management of a patient in shock was replaced midway through the academic year by a simulator session with a computerized life-sized mannequin. A standardized clinical final evaluation (OSCE) was used to assess student skills. We evaluated the effect of the simulator session and other factors on student exam performance using univariate and multivariate analysis.

Results

The site of the clerkship and the simulator session were significant factors affecting the OSCE score identified by ANOVA, P < 0.05. A stepwise multiple regression analysis testing the effect of simulator module, site, time of year, prior NBME subject exam, and prior OSCE during the third year clerkship identified that the simulator module was the only independent factor that modeled performance on all shock stations, P < 0.01.

Conclusions

In a clerkship that already emphasized faculty facilitated case-based learning, the use of a teaching module employing a human simulator significantly improved test scores. This study supports the efficacy of human simulators to improve student skills related to the management of complex critically ill patients.

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.

Section snippets

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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