A Simulator-Based Curriculum to Promote Comparative and Reflective Analysis in an Internal Medicine Clerkship

Abstract

To develop and evaluate a novel curricular framework using high-fidelity patient simulation in an internal medicine clerkship. Two 90-minute simulator-based modules of ischemic heart failure and hypoxemic respiratory failure were developed from adult and experiential learning principles. Three short simulated cases focused on each pathophysiologic concept were intermixed with two short teaching sessions and a period of comparative analysis. In 2002-03, the program was piloted among 90 third-year medical students at Harvard Medical School assigned to complete their core internal medicine clerk-ship. An entry and two follow-up questionnaires were used to assess the process. The instructors conducted quantitative and qualitative data analysis and directly observed students' performances. Instructors consistently noted students' ability to appropriately extract a history, perform a basic examination, and order appropriate tests. However, students demonstrated repeated errors in the application of knowledge to the clinical circumstance. A final comparative discussion was essential to new learning and students recognized this integrative analysis as the most critical component of the exercise. Every student reported the experience as useful. Ninety-four percent (n = 85) felt the simulator should become a routine part of the clerkship and 68% (n = 71) desired three or more sessions during their internal medicine clerkship. Simulator-based curricular modules are feasible in an internal medicine clerkship and can successfully complement existing curricula. By comparing similar cases in a compressed time frame, students may achieve enhanced efficiencies in reflective and meta-cognitive learning. As medical simulation is increasingly available, such a curriculum may represent valuable additions to the internal medicine educational environment.