Abstract
BackgroundMany commencing junior doctors worldwide feel ill-prepared to deal with their new responsibilities, particularly prescribing. Simulation has been widely utilised in medical education, but the use of extended multi-method simulation to emulate the junior doctor experience has rarely been reported.MethodsA randomised controlled trial compared students who underwent two, week-long, extended simulations, several months apart (Intervention), with students who attended related workshops and seminars alone (Control), for a range of outcome measures.ResultsEighty-four third year students in a graduate-entry medical program were randomised, and 82 completed the study. At the end of the first week, Intervention students scored a mean of 75% on a prescribing test, compared with 70% for Control students (P = 0.02) and Intervention teams initiated cardiac compressions a mean of 29.1 seconds into a resuscitation test scenario, compared with 70.1 seconds for Control teams (P < 0.01). At the beginning of the second week, an average of nine months later, a significant difference was maintained in relation to the prescribing test only (78% vs 70%, P < 0.01).At the end of the second week, significant Intervention vs Control differences were seen on knowledge and reasoning tests, a further prescribing test (71% vs 63% [P < 0.01]) and a paediatric resuscitation scenario test (252 seconds to initiation of fluid resuscitation vs 339 seconds [P = 0.05]).ConclusionsThe study demonstrated long-term retention of improved prescribing skills, and an immediate effect on knowledge acquisition, reasoning and resuscitation skills, from contextualising learning activities through extended multi-method simulation.
Highlights
Many commencing junior doctors worldwide feel ill-prepared to deal with their new responsibilities, prescribing
We report on a randomised controlled trial undertaken to determine the educational impact of extended immersion in multi-method continuing clinical simulation undertaken in order to prepare medical students for their role as junior doctors
Medical students are clearly deeply invested in becoming competent junior doctors and extended simulated patient care experiences, where the consequences of their skill and knowledge gaps can be demonstrated safely, might be expected to generate a powerful ‘tension to learn’
Summary
Many commencing junior doctors worldwide feel ill-prepared to deal with their new responsibilities, prescribing. Hilmer’s group reported that Australian graduates from multiple medical schools appear, both subjectively and objectively, to be poorly equipped for this task, giving rise to real concern about patient safety [12]. These findings were echoed in several of the recent broader studies of intern preparedness from other settings [4,9,10,13], as well as earlier specific prescribing studies by Pearson and colleagues [14,15]
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