内科实习中模拟器课程对医学生教育的长期影响。

Department of Medicine, Brigham and Women's Hospital, G.S. Beckwith Gilbert and Katharine S. Gilbert Medical Education Program in Medical Simulation, Harvard Medical School, Boston, MA 02115, USA.

Simul Healthc. 2010 Apr;5(2):75-81. doi: 10.1097/SIH.0b013e3181ca8edc.

BACKGROUND

Medical simulation is frequently used in postgraduate medical training, but its value and sustainability in medical student education are less clear. We report the first long-term experience of mannequin simulation in an internal medicine clerkship.

METHODS

During a 6-year period (2002-2009), 327 Harvard medical students participated in a simulator-based teaching experience designed to expose students to the principles of myocardial infarction (MI). This experience was additive to a 12-week clerkship curriculum. Through blinded survey instruments, we sought to determine how the simulator exercise modified student exposure to a core curricular objective in the traditional clerkship. We also sought student and faculty perception of this educational tool and factors important to sustainability.

RESULTS

Three hundred twenty-seven consecutive students were exposed to the simulation exercise and their experiences evaluated. Three hundred twenty-six students (99%) described the simulation experience as valuable, with >69% requesting multiple sessions be provided during each clerkship. Although a core objective, only 78% of students reported having a didactic teaching session on MI during the clerkship, and only 47% of students reported exposure to a live patient with MI. Furthermore, only 15% of students reported exposure to at least two different clinical presentations of MI, allowing comparison and reflection. Thus, the simulation exercise provided the only exposure to this topic for 22% of students and facilitated comparisons of different clinical presentations for 85% of students. When students participated in both the simulator and the didactic sessions, 74% favored the simulation exercise. Faculty cited small group size, once monthly delivery and focused curricula as key points for sustainability of this effort.

CONCLUSION

Mannequin simulation is a valuable and sustainable addition to a third-year internal medicine clerkship. For some students, simulation provides otherwise unavailable exposure to core content material. For the majority of students, simulation also provides the only means of exposure to multiple presentations of a single illness. Together, these data strongly suggest that simulation promotes both experiential learning and comparative analysis in a clerkship setting.

背景

医学模拟在研究生医学培训中经常使用，但在医学生教育中的价值和可持续性尚不清楚。我们报告了内科实习中首次使用人体模型模拟的长期经验。

方法

在 6 年期间（2002-2009 年），327 名哈佛医学生参加了一项基于模拟器的教学经验，旨在使学生接触心肌梗死（MI）的原理。这项经验是在为期 12 周的实习课程之外进行的。通过盲法调查工具，我们试图确定模拟器练习如何改变学生对传统实习课程核心课程目标的接触。我们还寻求学生和教师对这种教育工具的看法以及对可持续性重要的因素。

结果

327 名连续学生接受了模拟练习并对其经验进行了评估。326 名学生（99%）认为模拟经验有价值，超过 69%的学生要求在每次实习中提供多个课程。尽管是一个核心目标，但只有 78%的学生报告在实习期间有关于 MI 的教学课程，只有 47%的学生报告接触过 MI 的活患者。此外，只有 15%的学生报告至少接触过两种不同的 MI 临床表现，以便进行比较和反思。因此，模拟练习为 22%的学生提供了唯一的接触机会，并为 85%的学生提供了比较不同临床表现的机会。当学生同时参加模拟练习和教学课程时，74%的学生更喜欢模拟练习。教师认为小组规模小、每月一次的授课和重点课程是维持这项工作的关键。