COMSEP 2008 Atlanta Meeting
Reflective Education and Simulation in Pediatric Medical Education
Maria N Kelly, , Nicole M Paradise Black, , Meredith K DiPietro, Erik W Black, and Maureen A Novak,
University of Florida College of Medicine & Educational Technology, University of Florida College of Education
OBJECTIVE: Medical students acquire skills through “hands-on” training under the supervision of experienced physicians. However, since the 1999 IOM report to Err is Human, the concept of learning by doing has become less acceptable especially when invasive procedures and high-risk care is required. Medical simulators can teach and improve medical skills without the logistical, legal and emotional concerns associated with “real” patients. In addition, the ability to reflect actively upon one s practice promotes the development of medical expertise. Studies suggest successful physicians engage in reflective practice on a regular basis and the ACGME has incorporated this practice within its core competencies. Both of these individual educational modalities are limited in pediatric research and to our knowledge never in combination. Our objective is to evaluate the impact of medical simulators, specifically simulations of the neonatal hip examination and lumbar puncture procedure, on two key areas of medical education: 1) individual core procedural knowledge and 2) reflective assessments. We hypothesize that medical students participating in these pediatric simulation experiences will demonstrate improved procedural knowledge, skill, competence, and confidence.
METHODS: Third year medical students (n=59) participated in a 4-phase research program: pre and post-test knowledge assessment, simulator introduction and instruction, and reflective assessment of simulator impact on performance of these procedures on future “real” patients.
RESULTS: Results of procedural knowledge pre- and post-tests provided to medical students at the beginning and end of their pediatric clerkship indicate a significant increase in knowledge (p=.001, Cohen’s effect size: moderate at d=.58). Qualitative analyses on reflective question responses demonstrate 100% positive comments with confidence as a major outcome. Confidence is demonstrated in two main categories: lowering anxiety and apprehension regarding procedural performance and positive self-assurance regarding performance ability. Participants provided more robust and articulate responses on the lumbar puncture simulators due to their perception of complexity, technicality and invasiveness of the procedure.
CONCLUSIONS: The utilization of medical simulators improved the procedural knowledge, skill, competence, and confidence of medical students and should be considered as learning tools in pediatric medical education.