Simulation-based training to improve acute care skills in medical undergraduates

Abstract

Aim: Acquisition of clinical skills by medical undergraduates can be problematic, especially in the context of medical emergencies. Simulation using computerised manikins may be an effective and ethical solution. We assessed the ability of undergraduates to manage medical emergencies, and evaluated simulation as an educational and assessment tool. Method: Medical undergraduates were assessed in standardised, highly contextualised simulations of medical emergencies using both checklists and global ratings, and were reassessed following a simulation-based educational intervention to measure learning effect. The scores for groups at different levels of training were compared to test construct validity of global ratings of simulator performance. We explored student perspectives of simulation through thematic analysis of questionnaire responses. Results: Seventy-one students were studied. Final year students performed significantly better than fourth year students, but the ability to initiate management of medical emergencies was unsatisfactory in both groups. Performance improved significantly over the course of the simulation workshop. The learning processes in simulation-based education were perceived as more effective than traditional methods, and consistent with known principles of effective learning. Students felt the simulations were a reasonable measure of their abilities and 91% felt that such simulations should be included in their end-of-year assessment. Conclusion: Current medical undergraduate training does not ensure new graduates can intervene effectively in an emergency. Simulation-based workshops are effective and should be incorporated into the undergraduate curriculum both for education and assessment of competence in emergency management.