Integration of Echocardiography, Simulation and Traditional Teaching of Cardiovascular Physiology to First Year Medical Students

Abstract

We have combined the use of echocardiography, high fidelity simulation, and team‐based learning into a traditional course in which traditional didactic processes formerly predominated, in order to advance the teaching of the cardiovascular system to first year medical students. In previous years, clicker technology was used to determine not only the ability of the students to demonstrate knowledge of physiology but also as a tool to determine gaps or deficiencies in understanding. Upon reorganization of the medical curriculum to present “thinking like a doctor” courses in the first year curriculum, we added more clinical components to the Medical Physiology course. During the cardiovascular section, echocardiography was incorporated into the Cardiac Cycle and the Heart Sounds and Murmurs lectures. In addition, high fidelity simulation was included in two of the cardiovascular laboratory sessions. The ECG laboratory included small groups of students obtaining ECGs on each other and an interactive session with larger groups of students discussing arrhythmias. Similar arrhythmias were then produced on a simulation manikin (CAE Healthcare) so that students could feel pulses and note hemodynamic changes resulting from the arrhythmias on a clinical monitor. In addition, the simulation manikin was used to present real time changes in cardiovascular parameters induced by drug administration, vagal stimulation, and occlusion of the inferior vena cava. This was followed by a computerized small group exercise in which medical students and CRNA students worked together to interpret the cardiovascular changes due to similar types of manipulations in an instrumented conscious dog (Comish K, Zucker I, MedEd PORTAL Publications; 2009). Group learning and interprofessional education was incorporated into the interpretation of mechanisms of responses to the cardiovascular manipulations. Thus we were able to successfully integrate several clinically relevant concepts to the understanding cardiovascular function by first year medical and CRNA students.