Maria N. Kelly, MD, Nicole Paradise Black, MD, University of Florida, College of Medicine, Gainesville, Florida, Meredith K. DiPietro, PhD, University of North Carolina at Charlotte, Charlotte, North Carolina, Erik W. Black, MA, School Teaching and Learning, University of Florida, Maureen A. Novak, MD, University of Florida, College of Medicine, Gainesville, Florida
OBJECTIVE: Medical simulators teach technical skills without the logistical, legal and emotional concerns associated with real patients. Additionally, utilizing reflective practice to critically analyze one’s practice promotes the development of expertise. Together these educational modalities have minimal exposure in pediatric research. We aim to evaluate the impact of simulators, specifically the pediatric hip and lumbar puncture (LP) simulators, on key areas of medical student education: 1) procedural knowledge 2) technical skill and 3) reflective assessments. METHODS: Cohort design at a large academic medical center using 3rd-year medical students (n=147). They participated in a 5-phase design: 1) pre-test knowledge assessment 2) technical skill instruction: handout with video demonstration (intervention group also received simulator instruction and practice) 3) post-test knowledge assessment 4) technical skills assessment and 5) reflective assessment. Data analyses included comparison of pre/post-test scores, technical skills assessment (ANOVA, within-subjects t-test, Cohen’s-d) and qualitative reflective assessments (triangulation of analysis). RESULTS: Simulator instruction and practice improved students’ pre-test (6.3, possible 10) to post-test (8.0) scores (p<0.01, Cohen’s effect: large, d=1.03) and acquisition of technical skills (LP 18.2 p=0.01, Hip 18.9 p<0.01). Reflective responses demonstrated 100% positive comments with ‘confidence’ as the major self-reported outcome in two categories: lowering anxiety/apprehension and positive self-assurance for perceived technical ability. Participants reflected more robustly on the LP simulator experience due to perceived complexity, technicality and invasiveness of the procedure as compared to the hip simulator. CONCLUSIONS: Instruction and practice on pediatric LP and hip simulators improved students’ procedural knowledge, self-perceptions of technical ability, competence, and confidence in conjunction with actual improved technical abilities. Simulators and reflective practice should be considered as supplemental learning tools in pediatric medical education.