Wayne Diane B, Cohen Elaine R, Singer Benjamin D, Moazed Farzad, Barsuk Jeffrey H, Lyons Elizabeth Allison, Butter John, McGaghie William C
From the Department of Medicine (D.B.W., E.R.C., B.D.S., F.M., J.H.B., E.A.L. J.B.), and Augusta Webster MD Department of Medical Education and Faculty Development (W.C.M.), Northwestern University Feinberg School of Medicine, Chicago, IL.
Simul Healthc. 2014 Feb;9(1):33-9. doi: 10.1097/SIH.0000000000000001.
Medical school graduates are expected to possess a broad array of clinical skills. However, concerns have been raised regarding the preparation of medical students to enter graduate medical education. We designed a simulation-based "boot camp" experience for students entering internal medicine residency and compared medical student performance with the performance of historical controls who did not complete boot camp.
This was a cohort study of a simulation-based boot camp educational intervention. Twenty medical students completed 2 days (16 hours) of small group simulation-based education and individualized feedback and skills assessment. Skills included (a) physical examination techniques (cardiac auscultation); technical procedures including (b) paracentesis and (c) lumbar puncture; (d) recognition and management of patients with life-threatening conditions (intensive care unit clinical skills/mechanical ventilation); and (e) communication with patients and families (code status discussion). Student posttest scores were compared with baseline scores of postgraduate year 1 (PGY-1) historical controls to assess the effectiveness of the intervention.
Boot camp-trained medical students performed significantly better than PGY-1 historical controls on each simulated skill (P<0.01). Results remained significant after controlling for age, sex, and US Medical Licensing Examination step 1 and 2 scores (P<0.001).
A 2-day simulation-based boot camp for graduating medical students boosted a variety of clinical skills to levels significantly higher than PGY-1 historical controls. Simulation-based education shows promise to help ensure that medical school graduates are prepared to begin postgraduate training.
医学院毕业生应具备广泛的临床技能。然而，对于医学生为进入毕业后医学教育所做的准备，人们已提出担忧。我们为即将进入内科住院医师培训的学生设计了一种基于模拟的“新兵训练营”体验，并将医学生的表现与未参加新兵训练营的历史对照组的表现进行了比较。
这是一项基于模拟的新兵训练营教育干预的队列研究。20名医学生完成了为期2天（16小时）的小组模拟教育、个性化反馈和技能评估。技能包括：（a）体格检查技术（心脏听诊）；技术操作，包括（b）腹腔穿刺术和（c）腰椎穿刺术；（d）对危及生命状况患者的识别和管理（重症监护病房临床技能/机械通气）；以及（e）与患者及其家属的沟通（代码状态讨论）。将学生的后测分数与一年级住院医师（PGY - 1）历史对照组的基线分数进行比较，以评估干预的有效性。
接受新兵训练营培训的医学生在每项模拟技能上的表现均显著优于PGY - 1历史对照组（P<0.01）。在控制了年龄、性别以及美国医师执照考试第1步和第2步的分数后，结果仍然显著（P<0.001）。
为期2天的基于模拟的医学院毕业生新兵训练营将多种临床技能提升到了显著高于PGY - 1历史对照组的水平。基于模拟的教育有望帮助确保医学院毕业生为开始研究生培训做好准备。
