Simulationbased training has been extensively evaluated in nonmedical disciplines, and has been shown to have value in procedurebased medical education. However, fewer data are available with respect to the role of simulation in teaching clinical decision making. In this study, we compared simulationbased instruction to conventional lecturebased didactic instruction of clinical management of common urgent hospital situations among internal medicine residents.
Two semiemergent conditions, status epilepticus and atrial fibrillation with rapid ventricular response, were selected on the basis of relevance to hospital medical care. Core principles specific to each topic were identified and incorporated into a casebased didactic lecture on each condition. Simulation scenarios for each topic using an automated clinical mannequin in our institution’s simulation lab were designed to simulate a clinical situation wherein participants were required to apply core principles to acute management of the patient. The lecture was standardized and presented to the residents on each occasion by a content expert. Prior to the lecture, a knowledge assessment of core principles and a brief Likerttype survey evaluating participants’ level of confidence in managing each condition were administered. These metrics were readministered at a midpoint several days after the didactic and before the simulation. The simulation was then performed one week after the didactic lecture, and included a postsimulation debriefing. Following simulation, the posttest and survey were readministered.
In both atrial fibrillation and seizure management, the didactic lecture resulted in increases in both knowledge (Afib 39.6%; Seizure 32.8%) and clinical confidence (Afib 18.1%; Seizure 23.3%) compared to baseline. The simulationbased instruction resulted in additional improvement in knowledge (13.8%; Seizure 15.1%) and clinical confidence (Afib 12.4%; Seizure 19.6%). The combination of lecturebased instruction followed by simulation resulted in significant summative educational benefit in both clinical knowledge (Afib 58.8%; Seizure 52.8%) and clinical confidence (Afib 32.8%; Seizure 47.6%).
Conventional didactic teaching improves both knowledge and clinical confidence in managing urgent inhospital conditions. However, the addition of novel simulationbased instruction significantly augmented learning and improved the learners’ comprehension of core principles and confidence in applying them to reallife situations.
To cite this abstract:Webb B, Vucicevic D, Mookadam F, Charles J, Barr P. Simulationbased Education Improves Clinical Knowledge and Confidence in Management of Common Urgent Inpatient Conditions. Abstract published at Hospital Medicine 2012, April 1-4, San Diego, Calif. Abstract 97622. Journal of Hospital Medicine. 2012; 7 (suppl 2). https://www.shmabstracts.com/abstract/simulationbased-education-improves-clinical-knowledge-and-confidence-in-management-of-common-urgent-inpatient-conditions/. Accessed May 23, 2019.