Use of Patient Simulation in Problem-Based Learning for First-Year Medical Students

Abstract

High-fidelity patient simulation has taken hold as a teaching modality for health professional students, especially over the past two decades. The simulators are life-size manikins that mimic real patients when controlled by trained operators. Most reported uses have involved upper level students/residents during clinical skills training. Use of simulation with first-year medical students generally has been faculty-run and limited to demonstrating difficult concepts such as cardiac and respiratory physiology. Simulation has been reported coupled to problem-based learning after the PBL case has been processed to reinforce concepts learned while bringing the case to life. The authors describe the evolution, based upon 3 years of qualitative research and formative assessment, of a new student-driven approach using simulation to introduce the patient to PBL groups prior to their processing of the case. Solutions to the challenges of immersing first-year medical students and non-physician PBL facilitators into the simulation arena are conveyed. Two pilot exercises were conducted the first year: a congestive heart failure patient and a gunshot trauma/post-traumatic stress disorder victim. Formative assessments by students, facilitators, and operators lead to improvements for a new pair of exercises conducted and evaluated the following year: a deep vein thrombosis/pulmonary embolism patient and an accident trauma victim. Incorporation of “teaching moments” by the medically trained operators, such as oxygen administration or chest tube insertion, enhanced the exercises. Re-use of the first two exercises, employing lessons learned, resulted in better-received scenarios as PBL facilitators and operators became more experienced, and could better anticipate first-year medical student responses to simulations.