Education, Research, and Quality Improvement: Education, Research, and Quality Improvement II |

Simulation-Enhanced Second-Year Medical Student Cardiology Curriculum FREE TO VIEW

Violet Kramer, MD; Adam H Skolnick; Kevin Felner; Brian Kaufman
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Monmouth Pulmonary Consultants, Eatontown, NJ

Copyright 2016, American College of Chest Physicians. All Rights Reserved.

Chest. 2016;150(4_S):630A. doi:10.1016/j.chest.2016.08.722
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SESSION TITLE: Education, Research, and Quality Improvement II

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 26, 2016 at 01:30 PM - 02:30 PM

PURPOSE: As part of an initiative to revolutionize the curriculum of the NYU School of Medicine, we hypothesized that a simulation-based workshop, structured to engage learners in many facets of cardiac pathophysiology and the approach to patients with cardiac disease, would improve medical student education both in learner satisfaction and in measurable improvements in knowledge.

METHODS: The second year medical school class was divided into small groups who rotated between two stations. The students worked together to obtain a history, perform a physical exam, interpret EKG and rhythm strips, and administer treatments with a facilitator from the division of cardiology. One case involved a man who developed in-stent thrombosis and ventricular fibrillation. The other case involved a woman with mitral stenosis who developed atrial fibrillation with rapid ventricular response and congestive heart failure. Discussion points included mechanisms of disease and medication action, differential diagnosis of chest pain and dyspnea, the cardiovascular physical exam, and elements of professionalism involved with treating acutely ill patients and working within a multidisciplinary team. The simulations were followed by a debriefing led by a cardiology attending and/or fellow. The students scored and commented on the experience. The students took a multiple choice exam, similar to exams given in previous years. The exams and scores on the individual test questions the year of the intervention and the year prior were obtained. Two critical care physicians (BK and VK), who were not involved in development of the test, reviewed the test questions and divided them into three categories based upon how related the item content was to the simulation content - very related, moderately related, and not related.

RESULTS: The overall percentage correct increased from 81.5% to 84.85%; this was not statistically significant by a Mann-Whitney analysis (p = 0.202). However, when focusing on the items that were either very or moderately related (22 and 17 questions on respective exams), there was a statistically significant improvement from 83.81% to 94.94% (p=0.02). The scores for the unrelated questions (52 and 53 questions on respective exams) went down from 82.43% to 81.62%; this was not statistically significant (p=0.92). The cardiology pathophysiology course received the highest rating for any pathophysiology course over the prior two years, higher than the score from the prior year.

CONCLUSIONS: Simulation-based medical education in the area of cardiac pathophysiology and clinical approach enhances knowledge as measured by a multiple choice exam. That there was a difference in the improvement between simulation sensitive and simulation insensitive test items suggests that this improvement was due to simulation rather than the quantity of education. Future efforts would include identifying other clinically relevant endpoints beyond multiple choice exams. The cardiology simulation workshop has been added permanently to the medical school curriculum.

CLINICAL IMPLICATIONS: Use of simulation can be a valuable addition to the pre-clinical medical school curriculum.

DISCLOSURE: The following authors have nothing to disclose: Violet Kramer, Adam H Skolnick, Kevin Felner, Brian Kaufman

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