Board 309 - Research Abstract Comparison of High-Fidelity Simulation and Case Discussion for Teaching Medical Students Pediatric Emergencies (Submission #573)

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Introduction/Background Simulation allows deliberated practice and guided reflection. It provides a safe environment for teaching and practicing technical skills1. It is of special interest in pediatric emergencies, due to the limited exposure of students to critically ill patients and the life-saving skills needed to manage them.2 Ali et al demonstrated improvement on student performance on post-test when adding simulation to a trauma course.3 Gordon4 and Bassily-Marcus5 failed to find difference in test performance after simulation compared to traditional lecture. Bassily-Marcus found no knowledge retention difference one year after simulation.6 Using multiple simulations, Eyck demonstrated better immediate test performance and satisfaction in the simulation group.7 Compare high fidelity simulation with case discussion regarding post-test performance, satisfaction with teaching method and knowledge retention. Students would score as well in the posttest for both groups but would have a higher satisfaction and retention of knowledge score. Methods One hundred and eight last year medical students from Faculdade de Medicina da Universidade de São Paulo voluntarily participated in this study taking part of a simulation (SIM) and a case discussion (CD) during their rotation on the pediatric emergency department. Two themes were chosen - Anaphylaxis and Supraventricular tachycardia (SVT)Themes chosen for being pertinent but not exclusive to pediatrics, with diagnosis based on few ancillary exams and specific clinical skills and knowledge needed for managment.8,9 All students did a pretest for each themeAfter each activity they filled a satisfaction form, adapted from Cheng et al.10, containing questions regarding the activity in a 1-5 Likert scale At the end of their rotation they were tested again (post-test)Follow-up knowledge retention test four to six months later. Forty three students participated on Anaphylaxis simulation (ANA-SIM) and SVT case discussion (SVT-CD). Sixty five participated on SVT simulation (SVT-SIM) and Anaphylaxis case discussion (ANA-CD). SIMs were performed on the simulation lab, using Laerdal’s SimMan (ANA) and SimBaby (SVT) Groups of four to eight students participated in each simulation CDs were conducted with groups of 12-16 students. Results Mean pretest average for was 43.6% ANA-SIM and ANA-CD 46.6%, with no statistically significant difference between groups (p=0.42). Post-test was 63.5% ANA-SIM and ANA-CD 67,8%, with no statistically significant difference (p=0.13). Knowledge retention test was 61.5% ANA-SIM and ANA-CD 65.5% with no statistically significant difference (p=0.19). Mean pretest average for was 33.9% SVT-SIM and SVT-CD 31.6%, with no statistically significant difference between groups (p=0.44). Post-test was 42.5% SVT-SIM and SVT-CD 47.7%, with no statistically significant difference (p=0.09). Knowledge retention test was 41.5% SVT-SIM and 39.5%SVT-CD with no statistical significant difference (p=0.47). Satisfaction with each method was overall higher for SIM compared with CD in a paired samples test, with a significant higher rating for most affirmatives; “case presented realistic” (4.66 vs. 4.35), “heart pumping during activity”(3.56 vs. 1.89), “instructor knowledgeable” (4.86 vs. 4.69), “positive experience” (4.88 vs. 4.5), “useful for my profession” (4.89 vs. 4.51) and “should be mandatory for my education” (4.9 vs. 4.27) all with a p<0.05. Two affirmatives had similar ratings, with no significant difference between SIM and CD; “Radiographs, ECG, photos, and videos were helpful” and “safe learning environment” both with p>0.05. Conclusion There was no difference on the immediate knowledge gain or retention after four to six months. Higher satisfaction was found with the simulation. As a single teaching intervention, simulation appears to be equivalent to case discussion on acquisition and retention of knowledge. The higher satisfaction implies possible unmeasured gains. The pre and post-test might not be the ideal instrument to access learning gains with simulation, as it does not evaluate acquisition of skills and attitude learning.