July 24, 2007 When a vomiting, simulated patient mannequin was rolled into the lecture hall last fall to teach large numbers of first- and second-year Wake Forest University School of Medicine students about the brain and nervous system, Michael T. Fitch, M.D., Ph.D., wasn't sure what to expect.
In the end, he got the results he was looking for. "I really didn't know what it was going to look like when I started," said Fitch, an emergency medicine specialist who developed the teaching scenario and conducted a pilot study to determine the simulation's success in a non-traditional location with a large number of participants.
"It was hard to do and we really wanted to engage the students," said Fitch. High fidelity patient simulation of this kind has typically been done with small groups to teach clinical patient management and decision-making. What Fitch found through his student survey results is that it was well received in the large lecture setting. Students were overwhelmingly positive and the results will lead to future study of program expansion, he said. Survey results showed that 98 percent of participants rated the correlation to basic science concepts as "very good" or "outstanding," and 99 percent felt the same way about the presentation.
Fitch, whose Ph.D. is in neuroscience and who directs the Emergency Department's simulation program, was asked by James Johnson, Ph.D., who directs the neuroscience courses taught to first- and second-year students, to develop a simulation to help teach basic science principles. Many medical schools use such computerized simulated patients to teach clinical skills, but Wake Forest is one of the first schools to use this technology in live, large group lecture settings.
Fitch organized a team of resident physicians to help him implement the emergency medicine scenario. The clinical simulation containing basic science concepts was presented four times to large groups of 50 students for highly interactive 90-minute simulations. The project used SimMan™, a reproduction of an average-size adult, that makes realistic heart, lung, and bowel sounds and can be programmed to have various medical problems -- which students can work to treat. Students can also use SimMan to practice procedures such as giving injections and inserting urinary catheters or breathing tubes.
"I figured if we were going to do this, let's do it big. A lot of time and resources were involved, but we were just overwhelmed by the students' response to it," Fitch said. "I look at it like it's a live-action play. It wasn't actual real time, but I wanted them to feel like they were in the Emergency Department with me."
Through a guided group discussion to manage the case, students learned about altered levels of consciousness and potential causes of the simulated patient's symptoms, including stroke, brain injury and hypoglycemia. They learned about the sympathetic and parasympathetic nervous systems and how various mediations affect brain cell receptors. Fitch explained that using a live clinical scenario to emphasize basic science learning allows students to understand the clinical relevance of the subjects they are studying.
"What I think is really great about the concept is to create a learning environment that engages the students actively -- as opposed to passively observing a lecture," he said.
The research is published in Medical Teacher in the August print issue.
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