Board 385 - Research Abstract Exposure to a High-Fidelity Simulation of Cardiovascular Physiology Improves First-Year Medical Students

Abstract

Introduction/Background The Human Patient Simulator is being increasingly utilized in medical education. It is generally acknowledged that simulation is an effective tool for teaching clinical scenarios to medical students,1 but research on its effectiveness for teaching the basic sciences is scarce.2 We hypothesize that supplementation of standard physiology curriculum with high-fidelity simulation (HFS) improves medical student performance on written tests of physiology knowledge. Methods A pilot cardiac physiology HFS lab experience was offered to the Ohio State University first year medical student class. Twelve one hour labs were proctored by one of four anesthesiology faculty trained in simulation instruction and the specific course objectives. The HFS provided real-time illustration of hemodynamics to facilitate understanding of basic diagnostic and pathophysiologic principles of cardiovascular physiology utilizing the CAE® HPS manikin-based simulator. Students start with a basic cardiovascular physical examination and progress to interpretation of external and invasive hemodynamic monitoring to integrate basic science concepts with clinical applications.3 Afterwards, students completed a survey assessing their perception of the utility of the HFS using a standard Likert scale. Results of the student’s cardiovascular physiology examination (held one week following the HFS) were analyzed in order to compare those who participated to those who did not. Comparisons were made between both a subset of exam questions identified as directly emphasized in the HFS and examination scores as a whole. MCAT scores of the two groups were then compared to provide a measure of baseline student aptitude prior to participation. Results Of 183 first year medical students, 93 (50.8%) participated in the HFS. Group size ranged from 5-12 students over the 12 sessions. Mean Likert scale scores ranged from 4.26 to 4.74 out of 5 in response to survey questions assessing the quality, relevance and utility of the HFS. Mean MCAT scores between participants (34.37) and non-participants (33.43) were not significantly different (p = .082). For the subset of examination questions dealing with concepts directly addressed in the HFS, participants scored higher (78.14%) than non-participants (72.41%; p = 0.05). For the examination as a whole, participants scored higher (83.91%) than non-participants (81.08%; p = 0.018). Conclusion We have shown an improvement in medical student performance on their cardiovascular physiology final written examination following exposure to a HFS supplement to their standard curriculum compared to their peers. We believe the lack of any difference in MCAT scores demonstrates a potential absence of a selection bias despite the voluntary nature of participation as opposed to randomization. However, the superior performance on the test as a whole could be interpreted as evidence that a selection bias does exist in the motivation between the two groups. We would point out that while the participants mean total score was roughly three points higher than non-participants, for means on the subset of questions dealing with concepts directly addressed participants scored roughly six points higher. Examination questions dealing with concepts not directly addressed in the HFS would still peripherally involve issues of basic cardiovascular physiology such as those our simulator faculty reviewed. Some may interpret superior performance on the test as a whole as a difference in motivation between the two groups at baseline. We would argue that exposure to simulation in itself can prove to be a motivating “shot in the arm” when provided during the non-clinical years of medical education. Therefore, HFS as teaching tool can be an important adjunct for medical students even during the basic science curriculum.