Improved Medical Student Satisfaction and Test Performance With a Simulation-Based Emergency Medicine Curriculum: A Randomized Controlled Trial

Abstract

We determine the effect of a simulation-based curriculum on fourth-year medical student test performance and satisfaction during an emergency medicine clerkship. This was a randomized controlled study using a crossover design for curriculum format and an anonymous end-of-rotation satisfaction survey. Students were randomized into 2 groups. One group started the rotation with simulation and the other with group discussion. Midrotation, they each crossed over to the opposite format. All students subsequently completed the same multiple choice examination. We assessed paired samples of the number of questions missed for material taught in each format. Students rated satisfaction with a 5-point Likert scale framed as attitude toward simulation compared with group discussion. Scores ranged from 5, signifying strong agreement with a statement, to 1, signifying strong disagreement. Ninety students (99%) completed the multiple choice test. Significantly fewer questions were missed for material presented in simulation format compared with group discussion, with a mean difference per student of 0.7 (95% confidence interval [CI] 0.3 to 1.0; P=.006). This corresponds to mean scores of 89.8% for simulation and 86.4% for group discussion. Eighty-eight (97%) students completed the satisfaction survey. Students rated simulation as more stressful (mean 4.1; 95% CI 3.9 to 4.3), but also more enjoyable (mean 4.5; 95% CI 4.3 to 4.6), more stimulating (mean 4.7; 95% CI 4.5 to 4.8), and closer to the actual clinical setting (mean 4.6; 95% CI 4.4 to 4.7) compared with group discussion. A simulation-based curriculum yielded measurable benefits. Students demonstrated a small improvement in learning and were more satisfied with the simulation-based curriculum compared with group discussion.