Background: At many academic institutions, medical students in their last year of training participate in transition-to-residency (TTR) courses. At our institution, our TTR course includes residency-specific tracks including one for students transitioning into Internal Medicine.
Purpose: Despite the frequency of cross-cover care, studies note that this skill is not often formally taught, and most incoming interns are not specifically trained in cross-cover strategies in medical school. To our knowledge, there are no published simulation based cross-cover curricula. Additionally, many hospitals are moving away from the use of pagers to relay patient care related messages with the implementation of secure text messaging systems. Within the Internal Medicine track of our TTR course, we developed a 1.5-hour simulation session for commonly encountered cross-cover scenarios in the hospital setting using secure text messaging technology.
Description: Students are assigned to small groups of ten to participate in a 1.5-hour simulation session facilitated by hospital medicine faculty. All facilitators receive a one-hour training session on Zoom. We created ten clinical case scenarios based on feedback from practicing hospitalists about clinical issues that commonly arise during cross-cover care. Scenarios range from inpatient emergencies to non-urgent requests, with a goal to learn to prioritize scenarios based on clinical acuity. Prior to the session, we created messaging groups on our secure messaging application that include all participants, both students and faculty. Students are given a standardized mock handoff including simulated patient information. Throughout the session, one remote faculty member sends out mock page texts every 5-7 minutes on the secure messaging application to all participants. With guidance from their group facilitator, students work together to triage and respond to these messages appropriately. At the end of the session, the faculty facilitator debriefs the session, and reviews the cases with standardized teaching points.On our post-session surveys, students responded that this session increased their confidence in approaching cross-cover scenarios in the hospital. Students rated the relevance of the session on a 5-point Likert scale (5 being highly relevant), with 64 out of 68 (94%) of respondents rating it as “highly relevant” to their future practice. 63% of students rated that they were “much more comfortable” responding to cross-cover scenarios and 37% rated they were “somewhat more comfortable”. Factors that impacted student ratings as determined by written comments were the opportunity to practice triaging simultaneous clinical demands, a structured post-session debriefing and facilitation by experienced hospitalists who shared their own experiences responding to cross cover scenarios.
Conclusions: We developed a scalable model to provide clinical simulation to graduating medical students using secure text messaging technology. These scenarios can be implemented in teaching environments without a dedicated simulation center, offering a cost-effective example of a simulation exercise. Simulation based education in combination with peer-assisted learning improves learner knowledge, satisfaction and performance.