Virginia Research Day 2021

Cardiac Dysrhythmia Management Simulation with Undergraduate Medical Students: Improving Student Performance Through Curricular Design Nirav Patel (OMS3), Sarah Astrab (OMS3), Watson Edwards, BSN CHSE, Fred Rawlins, DO FACEP, Ning Cheng, PhD, Kim Gittings, BSN, Janella Looney, MSHI, Ryan Martin, HSOS

v INTRODUCTION

DISCUSSION

ABSTRACT

• Simulation-based trainings have shown to better prepare residents and help them improve the quality of care in real ACLS scenarios. • Using these “high-fidelity” manikins as part of student’s curriculum is a beneficial way to learn in a realistic environment without risk to patient safety. • Further testing and statistical exploration need to be done to better compare the difference between the pre/post tests and stimulation assessment.

• Through its demand to produce higher quality physicians, the publication of the Flexner report was the catalyst for change from the traditional didactic based medical education to a more hands-on curriculum. • Traditionally, simulated patients were rigid, unresponsive, non-interactive manikins which allowed for practicing procedures or mock codes. • With the advancement of technology, simulation labs have become more realistic and one plausible solution to bridging the gap in medical education between didactics and clinical practice. • The goal of any medical school is to effectively prepare its students for residency and the high stress scenarios they will encounter. According to the research published by Mount Sinai School of Medicine, further research is needed to determine which methods have the optimal impact on specific learning objectives, learner groups, and learning environments to improve patient outcomes. Few studies evaluating didactics and simulation are readily available. • In this study we were able to compare first year medical student’s understanding of cardiac dysrhythmias and their ability to apply their knowledge clinically after simulation- based learning. • The study was conducted using 161 first-year osteopathic students in a longitudinal pretest-posttest design. • Students were enrolled in a Clinical Medicine Cardiopulmonary Course which encompasses an EKG module, lectures, and a manikin-simulation assessment. • All students were required to navigate through an EKG module and complete three EKG quizzes. EKG quiz #2 directly acted as a pre-test to the cardiac rhythms presented during the in-classroom simulation workshop and small group break-out sessions. The quizzes are hosted on ExamSoft, a secure computer-based exam software. • All students were required to attend the in-classroom simulation and small group break-out sessions to learn more about the interpretation of these rhythms as well as their management. Additionally, students were oriented to the features of the simulators and equipment to be used during the simulation. • Following the pre-test and in-classroom simulation, students participated in one 20-minute graded simulation activity in which they managed four distinct cardiac dysrhythmias and self-directed debriefing on each of the rhythms. The simulation checklist was hosted electronically through a simulation software platform, SIMULATIONiQ, which was completed by trained evaluators. • Following the simulation, students completed the post-test on Examplify in the simulation center. METHODS

The goal of any medical school is to effectively prepare students for residency and have them enter the clinical setting with confidence in their skills. The development and advancement of simulation labs has been useful in connecting the interface between the classroom and the clinical world. With advances in technology, simulated patients can closely mimic human patients, allowing students to practice complex procedures such as cardiac dysrhythmias. The purpose of this study was to compare first year medical student’s understanding of cardiac dysrhythmias and their ability to apply their knowledge clinically after simulation-based learning. The study was conducted using 161 first-year osteopathic medical students in a longitudinal pretest-posttest design. Students were assessed with a 15-question quiz prior to simulation-based learning and another similar quiz after completing the stimulation assessment. Students were also assessed with one quantitative evaluation during a medical school-approved cardiopulmonary cardiac dysrhythmia stimulation course. All participants were provided with didactics, self-directed learning modules, and a live experimental cardiac dysrhythmia stimulation workshop. These educational modalities were focused on teaching correct algorithms involved in treating various dysrhythmias. Students were presented with four cardiac dysrhythmia scenarios and evaluated on their ability to manage them correctly utilizing appropriate equipment and algorithms. Scores were calculated using a completion check-list outlining each step in the treatment and then tallied. Student’s performance on each test was related to the educational steps completed prior to the test and compared to each other. A McNemar test was used to compare the pretest scores with students’ overall knowledge gain from the posttest. We also measured their final performance simulation scores with the quiz pretest and posttest results. We categorized scores as either “good” if they scored 14/15 or 90% on the quiz or “poor” for all other scores. Setting strict criteria for “good” and “poor” was based on the fact that VCOM aims to educate students at a ready to practice level and cardiac dysrhythmias require timely life-saving interventions. When comparing pretest to posttest, data was statistically significant with a McNemars Test p-value <.0001. The instructional strategies employed during the cardiac dysrhythmia course promoted knowledge gains shown by the improvement in scores.

CONCLUSION

• The instructional strategies employed during the cardiac dysrhythmia course promoted knowledge gains shown by the improvement in post-test scores. • With the advances in technology, manikins and simulation labs should be used to allow students to practice complex procedures, such as cardiac dysrhythmias, before entering the clinical setting.

Table 1: Pre-test / Post-test

Good Poor Total

% Good % Poor McNemar's Test p-value

Pre-test Post-test

26 72

<.0001

135 161 16.15 83.85 89 161 44.72 55.28

Total

98 224 322

Table 2: Pre-test / Sim Performance

Good Poor

Total

% Good % Poor McNemar's Test p-value

Pre-test

26 135 161 16.15 83.85 113 48 161 70.19 30.43

0.1823

Simulation

Total

139 183 322

Table 3: Post-test/Sim Performance

Good Poor 72 89 113 48 185 137

Total

% Good % Poor McNemar's Test p-value

Post-test Simulation

161 44.72 55.28 161 70.19 30.43

0.1054

Total

322

RESULTS

REFERENCES

• 161 first-year osteopathic medical students participated in a longitudinal pretest-posttest curriculum design study • Student’s performance on each test was related to the educational steps completed prior to the test (online modules, classroom-based simulation, and a small breakout session with an instructor) and compared to each other. • Results revealed there was a statistical significance when comparing pretest to posttest data with a McNemars Test p-value <.0001. • During the pre-test, 26 students scored “good”, while 72 students scored “good” on the post-test; a 28.57% improvement.

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