Experiential Learning: Integrating Simulation in Teaching Undergraduate Medical Physiology

Abstract

INTRODUCTIONMany medical students struggle to connect the fundamental knowledge from didactic lectures with clinical aspects of patient care. Experiential learning, which can be effectively achieved by simulation, is an active process during which the learner constructs knowledge by linking new information and novel experiences with existing knowledge and understanding. Accordingly, we have introduced multiple activities within the first year undergraduate medical physiology curriculum intended to develop student's diagnostic reasoning skills.METHODSThe first step in the sequential approach involves teaching point‐of‐care ultrasound (POCUS) assessment of anatomical structure with the eventual objective of identifying pathological presentations. This involves interactive sessions in which students perform imaging of each of the major organ systems in Standardized Patients. We build upon this foundation with simulated patient encounters using high‐fidelity manikins to demonstrate compensatory physiological mechanisms evoked in response to disease. The initial encounters are straight forward (e.g., trauma with blood loss or tension pneumothorax). However, a progressive increase in realism and clinical relevance is achieved by introducing progressively more complex cases. Pertinent examples include acute pancreatitis and diabetic ketoacidosis. Patient interactions/examinations are challenging skills for pre‐clerkship students to master. However, medical simulation allows the acquisition of clinical skills through deliberate practice rather than relying on the traditional apprentice style of learning. Practicing assessment of patients relying on history and physical examination, ordering relevant diagnostic laboratory testing and obtaining POCUS images facilitates students analyzing the potential differential diagnoses to arrive at the correct diagnosis and treatment plan.RESULTSThe use of clinical simulations of increasing complexity followed by debriefing has allowed us to substantially reduce the number of formal lecture hours over the last 5 years without compromising students' performance on either in‐house or standardized examinations. We have refined the delivery of content to routinely require as few as 4 facilitators for 196 students. The students then participate in a simulation debrief where important aspects of clinical decision making are addressed.CONCLUSIONSWe have found that integrating patient history and physical examination with imaging and laboratory test results into clinical simulation scenarios to be a useful adjunct to traditional methods of teaching physiology to pre‐clinical medical students. A distinct advantage of this innovative experiential approach to teaching is simulation serves as an alternative to learning on real patients. Thus, a trainee can make mistakes and learn from them without the possibility of harming the patient. This approach encourages students to become facile at integrating diagnostic imaging and clinical pathology as part of their assessment in order to reach a definitive diagnosis. Moreover, it contributes to providing our students with a solid foundation in clinical reasoning.