Improved Medical Student Satisfaction and Test Performance With a Simulation-Based Emergency Medicine Curriculum: A Randomized Controlled Trial
Presented as an abstract at the ACEP 2008 Research Forum, October 2008, Chicago, IL.
Received 15 November 2008; received in revised form 8 February 2009 and 27 February 2009; accepted 24 March 2009. published online 27 April 2009.
Study objective
We determine the effect of a simulation-based curriculum on fourth-year medical student test performance and satisfaction during an emergency medicine clerkship.
Methods
This was a randomized controlled study using a crossover design for curriculum format and an anonymous end-of-rotation satisfaction survey. Students were randomized into 2 groups. One group started the rotation with simulation and the other with group discussion. Midrotation, they each crossed over to the opposite format. All students subsequently completed the same multiple choice examination. We assessed paired samples of the number of questions missed for material taught in each format. Students rated satisfaction with a 5-point Likert scale framed as attitude toward simulation compared with group discussion. Scores ranged from 5, signifying strong agreement with a statement, to 1, signifying strong disagreement.
Results
Ninety students (99%) completed the multiple choice test. Significantly fewer questions were missed for material presented in simulation format compared with group discussion, with a mean difference per student of 0.7 (95% confidence interval [CI] 0.3 to 1.0; P=.006). This corresponds to mean scores of 89.8% for simulation and 86.4% for group discussion. Eighty-eight (97%) students completed the satisfaction survey. Students rated simulation as more stressful (mean 4.1; 95% CI 3.9 to 4.3), but also more enjoyable (mean 4.5; 95% CI 4.3 to 4.6), more stimulating (mean 4.7; 95% CI 4.5 to 4.8), and closer to the actual clinical setting (mean 4.6; 95% CI 4.4 to 4.7) compared with group discussion.
Conclusion
A simulation-based curriculum yielded measurable benefits. Students demonstrated a small improvement in learning and were more satisfied with the simulation-based curriculum compared with group discussion.
aWright State University, Boonshoft School of Medicine, Department of Emergency Medicine, Kettering, OH
bMedical College of Wisconsin, Department of Emergency Medicine, Milwaukee, WI
Address for reprints: Raymond P. Ten Eyck, MD, MPH, Department of Emergency Medicine, 3525 Southern Blvd, Kettering, OH 45429
Author contributions: RPTE conceived the study, designed the trial, and obtained institutional review board approval. RPTE, MT, and JMB designed the curriculum, determined the learning objectives, and created the individual session debriefing slides. RPTE wrote the simulation programs and MT conducted a pilot session. RPTE and JMB conducted subject recruitment, simulations, and some of the group discussion sessions. RPTE managed the data, including quality control, and worked with the university's statistical consulting center for analysis of the data. RPTE drafted the article, and all authors contributed significantly to revisions. RPTE takes responsibility for the paper as a whole.
Funding and support: By Annals policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article that might create any potential conflict of interest. See the Manuscript Submission Agreement in this issue for examples of specific conflicts covered by this statement. No external funding was involved in completion of this study, and none of the authors have any financial interest in the product studied or the company that produced it.
Publication date: Available online April 25, 2009.
ABSTRACT