Alphonso Aimee, Pathy Shefali, Bruno Christie, Boeras Crina, Emerson Beth, Crabtree Janice, Johnston Lindsay, Desai Vrunda, Auerbach Marc
Senior Medical Student, Yale School of Medicine.
Assistant Professor, Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale School of Medicine.
MedEdPORTAL. 2017 Jun 15;13:10594. doi: 10.15766/mep_2374-8265.10594.
The new model in medical education of longitudinal clinical clerkships can be complemented by high-technology simulation, which provides a safe space for learners to consolidate clinical knowledge and practice decision-making skills, teamwork, and communication. We developed an interdisciplinary training intervention including a simulation case and structured debriefing to link clinical content between pediatrics and obstetrics at a major academic medical center.
In this case, a 38-year-old female at 38 weeks gestation presents with onset of labor complicated by shoulder dystocia. After the appropriate maneuvers, a depressed neonate is delivered and requires resuscitation. Major equipment needed includes a high- or low-technology birthing mannequin and an infant mannequin.
Fifty-four third-year medical students participated in this simulation-based intervention at the completion of their integrated pediatrics and obstetrics clerkship. Ninety-one percent of students agreed that the shoulder dystocia simulation was designed appropriately for their learning level and enhanced their ability to handle a risky delivery. Ninety-four percent agreed that the neonatal resuscitation simulation was designed appropriately for their learning level, and 89% reported an enhanced ability to handle a similar situation in the clinic following the intervention. The average overall ratings were 4.24 ( = 0.61) and 4.06 ( = 0.89) on a 5-point scale (1 = 5 = ) for the obstetrics and pediatrics simulations, respectively.
The integrated obstetrics and pediatrics scenario is feasible to run and clinically accurate. Two distinct areas of medicine in the third-year curriculum are logically incorporated into one cohesive simulation-based training intervention that students found positive and realistic.
医学教育中的纵向临床实习新模式可以通过高科技模拟来补充，高科技模拟为学习者提供了一个安全的空间，以巩固临床知识并实践决策技能、团队合作和沟通能力。我们在一家大型学术医疗中心开发了一种跨学科培训干预措施，包括一个模拟案例和结构化的汇报环节，以将儿科和产科的临床内容联系起来。
在这个案例中，一名38岁、孕38周的女性出现临产，并发肩难产。经过适当的操作，一名新生儿娩出时情况不佳，需要进行复苏。所需的主要设备包括高科技或低科技分娩模型和婴儿模型。
54名三年级医学生在完成儿科和产科综合实习后参加了这项基于模拟的干预措施。91%的学生认为肩难产模拟针对他们的学习水平设计得当，并增强了他们处理高风险分娩的能力。94%的学生认为新生儿复苏模拟针对他们的学习水平设计得当，89%的学生报告称干预后在临床中处理类似情况的能力有所增强。在5分制量表（1 = 最差，5 = 最佳）上，产科和儿科模拟的平均总体评分分别为4.24（标准差 = 0.61）和4.06（标准差 = 0.89）。
产科和儿科综合场景实施起来可行且临床准确性高。三年级课程中的两个不同医学领域被合理地整合到一个连贯的基于模拟的培训干预措施中，学生们认为该干预措施积极且贴近现实。
