Background: Little is known about the effectiveness of simulation training for medical students entering internal medicine (IM) residency. Post clerkship students have been found to lack confidence and competence in many of the clinical situations they will face as interns. Using simulation as part of the IM Transition to Internship Course, we sought to increase learner confidence and competence when encountering common urgent and emergent IM conditions.
Methods: 4 IM faculty created 8 common, urgent and emergent IM clinical scenarios (acute GI bleed, sepsis from pneumonia, acute coronary syndrome, diabetic ketoacidosis, acute stroke, delirium, and acute respiratory failure from COPD).
20 post-clerkship 4th year IM residency bound medical students, in groups of 5, were pre-briefed on the simulation environment including the importance of verbalizing their thoughts. The simulation cases were conducted with a medium fidelity mannequin. A facilitator faculty acted as the “nurse” and an observer faculty in the control room recorded student comments. After the faculty-led debrief, students verbalized differential diagnosis, workup, and management learnings.
Identical pre and post surveys, using a 5 point Likert scale (strongly agree to strongly disagree), were administered to assess general comfort levels with the evaluation and management of the 5 topics covered in the 8 cases. Another post-simulation survey ascertained the students’ comfort level with the specific diagnoses of each case.
We used Fischer’s exact test to analyze the pre and post simulation responses, looking for differences in the proportion of students comfortable with each topic. An ⍺ level of 0.05 was considered significant. To identify areas of clinical learning, themes were extracted from the faculty’s debriefing notes.
Results: 14 of the 20 (70%) students completed both the pre and post simulation surveys. Students’ confidence improved for evaluation and management of 3 of the 5 topics – hemodynamics, respiratory failure and neurological conditions, as well as for managing chest pain. (Table) Students reported a high level (mean 92.9%) of comfort in evaluating and managing all 8 of the specific diagnoses from the cases. Clinical learning points are found in the Figure.
Conclusions: Our experience suggests that simulation can improve the confidence and competence of medical students in the evaluation and treatment of many urgent and emergent medical conditions. Simulation may be a valuable tool to improve the experience and safety of the transition from medical school to residency.
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