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Title:
A Simulation-Based Curriculum For 4th Year Medical Students During An Internal Medicine Acting Internship
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MedEdPORTAL ID#:
1687
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Version:
1
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Resource Type:
Desktop Application
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Description:
We describe the development of a curriculum. A single site, four-week acting internship curriculum underwent a process of curriculum redesign. The first phase involved developing goals and objectives of the course, redesigning new didactic sessions in response to a targeted needs assessment. The second phase involved the integration of a simulator-based curriculum. A case-based simulation uses a full simulation manikin to sharpen and document clinical reasoning as well as to 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. ECG presented during the case-simulation provides a context for ECG interpretation beyond the 3rd-year student level.
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Author Institution:
George Washington University Sch of Med and Health Sciences
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Primary Author:
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Chayan Chakraborti, MD
George Washington University Sch of Med and Health Sciences
George Washington University Hospital
900 23rd Street NW
Washington,
DC
20037
USA
202-715-5109
cchakra@gmail.com
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Resource File(s):
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Download File: MEP_1687_1 / 420.0 KB
- This resource is comprised of multiple files that have been zipped into a single file for quick and easy download.
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Additional Resource File Information:
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1 .zip file containing:
1. Simulation_Template.doc
2. AI_Expectations_&_Objectives.pdf
3. Appendix-A_SimMan_Details.pdf
4. Appendix-B_Case_Scenario.pdf
5. Appendix-C_AI_Evaluation.pdf
6. Copyright_License.pdf
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AAMC Hot Topics:
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Medicine: Communication Skills
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Content Last Updated:
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| 03/25/2008 |
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Specialty/Discipline:
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Medicine: Internal Medicine
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Educational Objectives:
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Primary Case Simulation:
1.) To teach and reinforce the skills required to perform a comprehensive evaluation and develop a treatment plan for a patient being admitted to the hospital.
2.) To identify the required level of care by obtaining appropriate information using history, physical exam findings, and other sources (labs/studies).
3.) To demonstrate clinical reasoning by integrating the obtained information.
4.) To institute immediate interventions as required.
5.) To form a short-term assessment and plan of care that prioritizes actions.
6.) To document clinical reasoning by writing a brief assessment of the situation and a plan of care and admission orders for treatment and subsequent studies.
Secondary Case Simulation:
1.) To recognize the severely ill.
2.) To recognize the mechanics of providing care, including appropriate and professional interactions with co-workers.
Procedure Modules:
1.) To describe the risks benefits, indications, and methods for central venous catheter placement and lumbar punctures.
2.) To describe the risks benefits and indications for central venous catheter placement and lumbar puncture.
3.) To describe the sterile procedures, universal precautions, landmark identification, and steps for prepping and draping a site prior to central venous catheter placement or lumbar puncture.
4.) To place central venous catheter by the subclavian route on a torso manikin.
5.) To perform lumbar puncture on a torso manikin.
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Resource Keyword/Symptom:
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Case-Simulation
Clinical Reasoning
Dyspnea
Acting Internship
Patient Simulation (MeSH)
Clinical Competence (MeSH)
Dyspnea (MeSH)
Internship and Residency (MeSH)
Catheterization (MeSH)
Spinal Puncture (MeSH)
Electrocardiology (MeSH)
Manikins (MeSH)
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Accreditation Council for Graduate Medical Education (ACGME) Competencies Addressed:
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Patient Care
Interpersonal and Communication Skills
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Intended Learner Audience:
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4th Year Medical/Dental Students
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Intended Faculty Audience:
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Clinical Science Faculty
Clerkship Director / Clinical Science Course Director
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Effectiveness and Significance of Publication:
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All 23 participants completed a short end of course questionnaire. Students rated the rotations very highly (mean 4.3, 1 = would not recommend, 5 = outstanding). The students felt that the rotation improved their ability to formulate a plan (mean 3.8), and their clinical reasoning (mean 4.2). The participants reported improvements in their ability to manage complex patients (mean 4.3) and their knowledge of hospital processes (mean 4.4).
The simulation experiences improved the participants' confidence in placing central lines and performing lumbar punctures (mean 3.2). The learners reported that the residents and attendings acknowledged their plans to a significant degree (mean 4.7) and provided them with significant autonomy (mean 4.1). Finally, 85% of the learners reported that they are moderately or significantly more prepared for their intern year.
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Special Implementation Requirements or Guidelines:
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| This curriculum requires the use of a manikin simulator and several "body part" trainers for the procedural modules. |
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Lessons Learned:
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The case-simulations are well received but the exercises still can be steps away from authenticity. In a future phase, we plan to combine the simulations with the standardized patient program. We intend for the "clinical stem" currently provided on a handout from a faculty member to be presented instead by a standardized patient. With the involvement of the standardized patients, the evaluation possibilities can be expanded to include assessments of patient education, empathy, bedside manner, cultural sensitivity, and other components of professionalism.
Resources, such as time and cost, require more advance consideration. The simulator evaluations take approximately 40 minutes. With up to 10 AIs per month, the evaluation sessions require over 6.5 hours of time taken away from other duties for both AIs and faculty. During four months of piloting, maintenance and replacement parts for the manikins have resulted in unanticipated costs.
We have built on the simulation experiences that the students accrue through their first several years. However, a simulation curriculum that is integrated with a residency program will offer more curriculum integration and allow for greater peer teaching opportunities. This strategy may be mutually beneficial by providing house staff more simulator time while having residents assist with the instruction duties of the two course faculty members. The internal medicine chief residents already assist with instruction; greater involvement with the residency will facilitate the role of new chief residents each year.
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Publications, Presentations, and/or Citations For This Publication:
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| Chakraborti, C. A Novel Simulation-Based Evaluation for 4th year Acting Internship Curriculum. Presented at the Society of General Internal Medicine National Meeting, Pittsburg, Pennsylvania. April, 2008. |
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Sponsorship (Funding Source):
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| None. |
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Citation Formats:
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NLM:
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Chakraborti C ,
A Simulation-Based Curriculum For 4th Year Medical Students During An Internal Medicine Acting Internship. MedEdPORTAL;
2009.
Available from: http://services.aamc.org/30/mededportal/servlet/s/segment/mededportal/?subid=1687
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APA:
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Chakraborti, C.,
(2009).
A Simulation-Based Curriculum For 4th Year Medical Students During An Internal Medicine Acting Internship. MedEdPORTAL:
http://services.aamc.org/30/mededportal/servlet/s/segment/mededportal/?subid=1687
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