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ePoster
SimPhys: A pilot study using simulation to teach basic cardiovascular physiology

Authors

  • Dr Elizabeth Good
  • Dr Charles Butcher

Theme

eLearning

INSTITUTION

University College London, UK
Royal Free Hopsital, London, UK
Harefield Hospital, Uxbridge, UK

Background

  

Simulation is increasingly used as a teaching tool for trainee doctors and clinical medical students, but is not often used to teach medical students in the early stages of training. There have been several interesting studies in the United States, for example Gordon et al (2010) discussed the use of a patient simulator to teach Harvard pre-clinical medical students. These authors highlight the importance of the emotional activation that occurs when dealing with a dynamic clinical case, real or simulated, and argue that this improves learning. In addition to the emotional component of simulation, the practical involvement with the case ties in with Kolb’s (1984) notion of experience within a learning cycle.

The renowned American medical education reformer, Flexner (1910), described the importance of applying knowledge:

“There is no cement like interest, no stimulus like the hint of a

coming practical application.”

It seems likely that if simulation, as a safe way for students to apply basic knowledge, had existed in the early 1900s, Flexner would have encouraged its use with early years medical students.

  

Summary of Work

SimPhys is a method of teaching basic physiology using a high fidelity mannequin to simulate a real-time clinical scenario. Students are guided through the scenario with the focus on the underlying physiology. The pilot sessions  looked at hypovolaemia and heart failure. The physiology leading to the observed clinical signs (such as tachycardia, hypotension, raised respiratory rate, falling oxygen saturations, reduced urine output etc.) was discussed as they occurred.

Twelve first year medical students volunteered for SimPhys, and two sessions were run. A focus group followed each session and explored the students' experiences of the session and their opinions on the potential for Simulated Physiology within the curriculum in the future.

 

Further details of the methodology can be found by clicking on the 'more detail' tab.

Summary of Results

Four main themes were identified; the impact of SimPhys on learning, potential uses of SimPhys, aspects of the SimPhys session itself and suugestions for the future of SimPhys.

These themes were further subdivided as shown below:

 

Quotes from students to illustrate the themes above are included as further details, within the tab below.

Conclusion

  This small study shows that the students involved felt that SimPhys had improved their understanding and memory of the basic cardiovascular physiology covered in the session. They also believed that context and motivation to learn were important factors.

These sessions ran close to examinations and revision was another key theme. Participants were enthusiastic about SimPhys as a revision tool, consolidating knowledge learnt in lectures.

There is an on-going drive within medical education to integrate pre-clinical and clinical curricula, yet many emphasise the importance of learning basic sciences. This pilot study suggests that simulation is a useful and safe environment to provide clinical context to basic sciences, which may enhance learning. 

This study also adds to the simulation literature by showing that simulation can be used successfully within the earliest years of medical training.

 

Take-home Messages

 

   Simulation can be a useful tool for teaching undergraduate as well as postgraduate learners.

Simulated Physiology may be a useful way to give basic sciences context, without needing to fully integrate curricula

The SimPhys programme has been extended this year and further findings will be published in due course.

 

  

References

Flexner, A (1910) Medical Education in the United States and Canada: A Report to the Carnegie Foundation for the Advancement of Teaching. Bulletin No. 4. Boston: Updyke; 1910. 

 

Gordon J, Hayden E, Ahmed R, Pawlowski J, Khoury K, Oriol N (2010) Early bedside care during preclinical medical education: can technology-enhanced patient simulation advance the Flexnerian ideal? Acad Med 2010 Feb;85(2):370-7

 

Kasturi R, Heimberger G, Nelson E, Phero J, Millard R (2009) Does Human Simulator-Aided Learning mprove Long-Term Retention of Autonomic Pharmacology Concepts and Facts by Year II Medical Students? JIAMSE Vol 19 (3)

 

Kneebone R and Nestel D (2005) Learning clinical skills the place of simulation and feedback Clinical Teacher Vol 2 (86-90)

 

Kolb, D. (1984) Experiential Learning: Experience as the Source of Learning and Development. Englewood Cliffs: Prentice Hall

Background
Summary of Work

  

 

 

Research question

 

What were the opinions of 1st year medical students about a session that used simulation to teach basic cardiovascular physiology?

 

There were several research objectives:

1.     To evaluate the usefulness of PhysSim as a learning experience

2.     To understand which aspects of simulation were and were not useful for learning physiology, and why

3.     To assess the need for further research in this area

 

 

Project methods

Sampling

A simulation session was offered to all 1st year medical students at the university to obtain a volunteer sample. Whilst a volunteer sample is not necessarily representative of 1st year medical students in general, it is nonetheless interesting to hear the opinions of this group. The self-selected group are likely to be well motivated and keen to help improve their education. There were 12 participants who each took part in one of two SimPhys sessions, with subsequent focus group.

 

Data collection and analysis

Focus groups were used to collect qualitative data and were chosen as they allow the researcher to explore opinions and probe more deeply than is possible with a questionnaire. The numbers in each session (4 and 8 respectively) were well suited to focus groups and the discussion between students is an advantage over an interview technique. The researcher was not involved in other teaching or assessment of students but there is the possibility of bias towards giving positive feedback which must be considered during data analysis.

 

Focus group discussion was recorded on a digital dictaphone and professionally transcribed. The two focus groups lasted 31 minutes and 43 minutes respectively.

 

Data was analysed by a process of iterative thematic analysis. Transcripts were initially coded and then sorted and resorted into themes until all data could be accounted for within the framework.

 

Ethics

The data was stored anonymously and recordings erased after transcription. No personal or demographic data was collected.

There was no patient involvement in this study and no patient data was used.

The main ethical issue was providing an educational opportunity with the potential to improve performance on assessments; hence the opportunity was offered to all students in the year.

 

  

Summary of Results

 Impact on learning

 

 

            “…if you learn something and you think this is going to help save someones life, I think youre more likely to remember it…”

 

The sub-theme context incorporates seeing the bigger picture and highlighting the important concepts.

 

Another impact was improved understanding, such as how different systems linked together:

           

            I liked seeing.how they all interlinked because we do learn them quite separately…”

 

Whilst there was disagreement about whether the session should include pharmacology, some students found it beneficial to their understanding.

 

            (Knowing treatments) “…did consolidate how you got to the pathology in the first place

 

Memorability of knowledge was identified as a benefit of SimPhys, particularly because it was a visual experience. The clinical context might aid memory as illustrated by this experience:

 

            “…from work experience I had, I always remember it

 

Insight into their own understanding was also noted:

 

            when youre asked to apply it (knowledge) thats when you actually realise whether you understand it or not

 

Uses

Many participants endorsed SimPhys as a useful revision session and noted better mapping of the session to some examination questions than current teaching:

 

            “…its almost exactly like an exam question, but taken through in a more practical way which is good

 

            they dont teach things in the scenario way, they just give you the question and we work your brain around it

 

The content was discussed, with the predominant sentiment that it was nice to do something that felt clinical. Probing further, participants felt it might prepare them for the future and they enjoyed the doctor mind-set having always wanted to be a doctor.

 

Participants spoke about their current course, raising positive and negative comments.  Some perceived deficiencies in the course where they felt SimPhys could be useful were:

It is discouraging to learn pathology without fixes

            Hard to ask questions in lectures

            Lectures lose sight of how things link together

            Hard to tell whats important from lectures

            Systems taught separately

            Science is very separate to clinicals

            Not enough tutorials and too many students

 

The session

Participants felt that the clinical setting was important, independently of the content of the session.

 

            if there was no clinical setting, I wouldnt think of as many questions

 

There was some disagreement as to whether the presence of a sim-man was important, compared with, e.g. a tutor group with a clinical scenario. Several students felt sim-man made it more realistic and illustrated the dynamic nature of patient deterioration or response to treatment. One participant also thought sim-man prompted patient interaction.

 

Three of eight students in one group, however, felt that sim-man was not essential.

 

            I think you could probably get just as much out of a session with one of us volunteering lying down

 

The group sizes were 4 and 8 students, and participants were vocal about benefits of small group teaching and interactivity. There was no consensus on ideal group size but many thought it was more interactive and easier to ask questions than when taught in a larger group.

 

            because this is more interactive youre not as lethargic

 

            “…everyone saysI dont want to be picked onbutyoull learn better because youre put under that pressure

 

            I think you can draw on other peoples understanding

 

Participants also discussed pros and cons of teaching methods including lectures, problem based learning and simulated patients; concluding that people learn in different ways. 

Conclusion
Take-home Messages
References

References

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Cohen, L., & Manion, L. (2000). Research methods in education. Routledge. p. 254. (5th edition).

Dyrbye LN, Harris I, Rohren CH. (2007) Early clinical experiences from students' perspectives: a qualitative study of narratives. Acad Med. 2007 Oct;82(10):979-88.

Engestrom, Y, Brown, K, Christopher, LC, Gregory, J (1991) Coordination, cooperation and communication in the court: Expansive transitions in legal work Q Newsletter Laboratory Comparative Human Cognition 13: 88-96

Fitch, MT Using high-fidelity emergency simulation with large groups of preclinical medical students in a basic science course Med Teach 2007 Mar;29(2-3):261-3

Fleming, N (1995) Im different: not dumb. Modes of presentation (VARK) in the tertiary classroom, in Zelmer, A, Research and Development in Higher Education, Proceedings of the 1995 Annual Conference of the Higher Education and Research Development Society of Australasia, HERDSA, Volume 18, 308-313.

Flexner, A (1910) Medical Education in the United States and Canada: A Report to the Carnegie Foundation for the Advancement of Teaching. Bulletin No. 4. Boston: Updyke; 1910. Available at: http://www.carnegiefoundation.org/sites/default/files/elibrary/Carnegie_Flexner_Report.pdf. Accessed 1st August 2012.

Gordon J, Brown D, Armstrong E (2006) Can a simulated critical care encounter accelerate basic science learning among pre-clinical medical students? A pilot study Simul Healthc. 2006 Jan;1 (13-7)

Gordon J, Hayden E, Ahmed R, Pawlowski J, Khoury K, Oriol N (2010) Early bedside care during preclinical medical education: can technology-enhanced patient simulation advance the Flexnerian ideal? Acad Med 2010 Feb;85(2):370-7

Heitz C, Brown A, Johnson JE, Fitch MT (2009) Large group high fidelity simulation enhances medical student learning Med Teach 2009 May;31(5):e206-10

Issenberg SB, McGaghie WC, Petrusa ER, Lee Gordon D, Scalese RJ. (2005) Features and uses of high-fidelity medical simulations that lead to effective learning: a BEME systematic review. Med Teach. 2005 Jan;27(1):10-28.

Jonas, Harry S., Sylia I. Etzel and Barbara Barzansky (1989). Undergraduate Medical Education. JAMA, Aug. 25 1989. 262(8): 1018-1019.

Kasturi R, Heimberger G, Nelson E, Phero J, Millard R (2009) Does Human Simulator-Aided Learning mprove Long-Term Retention of Autonomic Pharmacology Concepts and Facts by Year II Medical Students? JIAMSE Vol 19 (3)

Kneebone R and Nestel D (2005) Learning clinical skills the place of simulation and feedback Clinical Teacher Vol 2 (86-90)

Kolb, D. (1984) Experiential Learning: Experience as the Source of Learning and Development. Englewood Cliffs: Prentice Hall

Lave, J and Wenger, E (1991) Situated learning. Legitimate peripheral participation. Cambridge: University of Cambridge Press

Vygotsky, L (1978) Mind and Society: The development of higher mental processes. Cambridge, MA:   Harvard University Press

Wood, F (2003) Problem based learning BMJ (326) 328-330

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