Virginia Research Day 2021

Measuring Performance Outcomes in Second Year Medical Students Within the Neonatal Curriculum Design Utilizing High Fidelity Manikin Simulations Presenter: Carrie Baker, DO Researchers: Sofia-Abraham-Hardee DO/PhD, Carrie Baker DO, Watson Edwards BSN, Fred Rawlins DO FACEP, Kim Gittings BSN, Janella Looney MSHI, Ryan Martin HSOS

Abstract

INTRODUCTION

RESULTS

DISCUSSION

Using instructional design strategies and advancements in simulation technology, medical educators are bridging the gap between didactic lectures and clinical practice. The general purpose of our study is to compare the level of second year medical students’ understanding of neonatal resuscitation after didactic, online module, and simulation-based learning. Similarly, comparing the students’ exam performance to their ability to apply their knowledge clinically, was examined. In this longitudinal pretest-posttest design, along with a single quantitative evaluation, 163 second-year osteopathic medical students were evaluated during a college- approved neonatal simulation course. The students’ medical knowledge was assessed longitudinally through scheduled educational modalities. These modalities included a single lecture, an online educational module, an experiential neonatal resuscitation workshop, and a case simulation. A Wilcoxon rank-sum test for ordinary variables was used to compare the students’ knowledge during the pre- and post-test interventions. A McNemar test was used to compare the students’ overall knowledge gain from final post-test with their final performance simulation scores. There was significant difference between the pre-test and post-test scores of students through each prescribed educational modality (quiz1 vs pre p-value <0.001, quiz2 vs pre p-value <0.001, quiz3 vs pre p-value <0.001). There was no significant difference between the final post-test quiz result and the simulation assessment score (p-value: 0.8864). The instructional strategies employed during the neonatal simulation course promoted knowledge gains using the prescribed education modalities. It cannot be determined if gain in medical knowledge application benefited from these modalities. Similar research should be done in the future using a control (traditional didactics) and comparing this to simulation based learning in order to truly understand the value of simulation based learning.

• Students showed improvement in their scores after every intervention as depicted in the Test Score Summary graph. • There was a significant difference between the pretest and posttest scores of students through each prescribed educational modality (quiz1 vs pre p- value <0.001, quiz2 vs pre p-value <0.001, quiz3 vs pre p-value <0.001). • There was a statistical significance between the pretest and Quiz3 (p-value 0.000). • The McNemar test comparing academic and clinical performance showed there was no statistical significance between the two (p-value 0.8864).

• We can predict that the educational interventions done between each quiz attempt had a positive impact on the students’ scores. • However, we cannot determine if the cumulative affect of learning from each modality was more beneficial in solidifying medical knowledge, leading to subsequently increased student scores, than each intervention was independently. • Our original hypothesis was that if a student performed well on their quizzes, this would in turn lead them to perform better in the simulation. Based on our data, we can not infer that a high quiz 3 score means a student will perform well on a simulation performance assessment. We also can not infer that a student who performs poorly on quiz 3 will score poorly on simulation performance assessment.

• The Flexner report was the catalyst for change from traditional didactic based medical education to a more hands-on curriculum. • “High-fidelity” manikins have given the medical community the opportunity to learn in a realistic environment without risk to patient safety. • The first simulation-based training program in neonatal medicine was developed at Stanford University in 1997. • The success of this program sparked further research into the field of neonatal simulation-> the use of pediatric simulations has grown exponentially. • The AAP reports further research is needed to determine which instructional methods have the optimal impact. • Few studies comparing didactics and simulation (SIM) are readily available but these were not specific to the field of pediatrics. • Therefore, there is a lack of adequate research on a comprehensive curriculum that utilizes both didactics and high-fidelity simulations in the education of neonatal resuscitation to medical students. • Simulation at VCOM includes cardiopulmonary cases, pediatric cases, obstetric cases, and neonatal resuscitation cases. • We had never studied our pediatric simulations and their impact on the pediatric curriculum. • Our primary objective was to compare the level of second year medical students’ understanding of neonatal resuscitation after didactic, self- directed online modules, workshops and simulation based learning. • Our secondary objective was to compare the students’ academic knowledge, as evaluated with board style questions, to their applicable clinical knowledge which was demonstrated by their performance in the neonatal simulation scenarios.

CONCLUSIONS

• Each of the educational interventions (live lecture, workshop, online modules and simulation) contributed to the improvement in student scores on the quizzes. • We cannot infer a correlation between the score on the quiz to the score on the simulation performance assessment. • A multimodality approach to teaching can be valuable in the medical setting. • To truly understand the value of Simulation-based learning, further research will need to be done to compare a control (classic model of in classroom teaching) versus Simulation-based learning using a similar pre-post test design.

METHODS

REFERENCES

• Administered a six question pre-test to 163 second-year medical students prior to the start of the neonatal curriculum. • Administered identical post-tests after each teaching modality: didactic, self-directed online modules & workshops, and simulation based learning.

• Flexner A. Medical Education in the United States and Canada. The Carnegie Foundation for the Advancement of Teaching, Bulletin Number Four. 1910. • Lopreiato JO, Sawyer T. Simulation-based medical education in Pediatrics. Academic Pediatrics. 2015;15(2):134-42 • Campbell DM, Barozzino T, Farrugia M, Sgro M. High-fidelity simulation in neonatal resuscitation. Paediatr Child Health (Oxford). 2009; 14(1):19-23 • Halamek, LP. The simulated delivery-room environment as the future modality for acquiring and maintaining skills in fetal and neonatal resuscitation. Seminars in Fetal and Neonatal Medicine. (2008);13:448-53 • Cheng A, Auerbach M, Hunt EA, Chang TP, Pusic M, Nadkarni V, et al. Designing and conducting simulation-based research. Pediatrics. 2014;133;1091-1101 • McCoy CE, Menchine M, Anderson C, Kollen R, Langdorf MI, Lotfipour S. Prospective randomized crossover study of simulation vs. didactics for teaching medical students the assessment and management of critically ill patients. J Emerg Med. 2011;40(4):448-55 • Li CH, Kuan WS, Mahadevan M, Daniel-Underwood L, Chiu TF, Nguyen HB. A multinational randomized study comparing didactic lectures with case scenario in a severe sepsis medical simulation course. Emerg Med J. 2012; 29(7): 559-64 • Rubio-Gurung S, Putet G, Touzet S, Gauthier-Moulinier H, Jordan I, Beissel A, et al. In situ simulation training for neonatal resuscitation: an RCT. Pediatrics. (2014);134(3):e790-7 • McGaghie WC, Issenberg SB, Petrusa ER, Scalese RJ. A critical review of simulation-based medical education research: 2003-2009. Medical Education. (2010);44:50-63

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