MedEdPORTAL (May 2009)
A Simulation-Based Curriculum for 4th-Year Medical Students During an Internal Medicine Acting Internship
Abstract
Abstract Introduction This resource is a case-based simulation curriculum for fourth-year medical students during an internal medicine acting internship. Methods A case-based simulation uses a full simulation manikin to sharpen and document clinical reasoning, as well as provide discussion points during debriefing and didactic sessions. Body-part manikins are used to instruct learners in central venous catheter placement and performing lumbar punctures. Electrocardiograms presented during the case provide a context for electrocardiograms interpretation beyond the third-year student level. Results All 23 participants completed a short end-of-course questionnaire. Students rated the curriculum very highly, with a mean score of 4.3 when 1 = would not recommend and 5 = outstanding. The students felt that the curriculum improved their ability to formulate a plan and their clinical reasoning. The participants reported improvements in their ability to manage complex patients (M = 4.3) and their knowledge of hospital processes (M = 4.4). The simulation experiences improved the participants' confidence in placing central lines and performing lumbar punctures (M = 3.2). The learners reported that the residents and attendings acknowledged their plans to a significant degree (M = 4.7) and provided them with significant autonomy (M = 4.1). Finally, 85% of the learners reported that they are moderately or significantly more prepared for their intern year. Discussion While the case simulations were well received, the exercises can still be steps away from authenticity. In a future phase, we plan to combine the simulations with the standardized patient (SP) program. We intend for the clinical stem currently provided on a handout from a faculty member to be presented instead by a SP. With the involvement of the SPs, the evaluation possibilities can be expanded to include assessments of patient education, empathy, bedside manner, cultural sensitivity, and other components of professionalism.
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