Impact of a Multiday, High-fidelity, Immersive Simulation on Military Medical Students' Self-confidence.

Abstract

Decision-making is a critical competence that all medical students must develop before becoming independently licensed physicians. One aspect of the decision-making process is confidence, which has not been extensively studied in undergraduate medical education. Intermittent simulation has been found to improve medical students' self-confidence across a wide range of clinical scenarios; however, no research to date has examined how a more extensive medical and operational simulation impacts miltary medical students' confidence in their decision-making abilities. This study was conducted online through the Uniformed Services University and in person at Operation Bushmaster, a multiday, out-of-hospital, high-fidelity, immersive simulation held at Fort Indiantown Gap, PA. This investigation focused on examining the impacts of asynchronous coursework and simulation-based learning on improving decision-making confidence for senior medical students 7 months before graduation. Thirty senior medical students volunteered. Each completed a 10-point confidence scale before and after either accomplishing asynchronous online coursework (control group) or attending a medical field practicum (experimental group). We conducted a repeated-measures analysis of variance to examine any change in students' confidence scores before and after completing each educational modality. The results of the analysis of variance indicated a significant time effect for our students' confidence in both the experimental and control groups as measured on our confidence scale, suggesting that Operation Bushmaster and asynchronous coursework both possessed the potential to increase students' confidence in their decision-making. Both simulation-based learning and asynchronous online learning can increase students' decision-making confidence. Future larger-scale research is needed to calculate the impact of each modality on military medical students' confidence.