Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, 500 Hofstra Blvd., Hempstead, NY, USA.
Northwell Health Division of Allergy and Immunology, 865 Northern Blvd., Great Neck, NY, USA.
BMC Med Educ. 2019 Sep 14;19(1):352. doi: 10.1186/s12909-019-1786-5.
Immune function and dysfunction are highly complex basic science concepts introduced in the preclinical medical school curriculum. A challenge for early learners is connecting the intricate details and concepts in immunology with clinical manifestations. This impedes relevance and applicability. The impetus in medical education reform is promoting consolidation of basic science and clinical medicine during the first two years of medical school. Simulation is an innovation now widely employed in medical schools to enhance clinical learning. Its use in basic science curriculums is largely deficient. The authors piloted simulation as a novel curricular approach to enhance fundamental immunology knowledge and clinical integration.
The authors introduced a Primary Immunodeficiency Disease (PIDD) simulation during a basic science immunology course for second-year medical students at the Zucker School of Medicine at Hofstra/Northwell. The simulation tasked small groups of students with evaluating, diagnosing and managing an infant with previously undiagnosed immunodeficiency. Joint facilitation by clinical and science faculty during terminal debriefings engaged students in Socratic discussion. Debriefing aimed to immerse basic science content in the context of the clinical case. Students completed a post-simulation Likert survey, assessing utility in reinforcing clinical reasoning, integration of basic science and clinical immunology, enhanced knowledge and understanding of immunodeficiency, and enhanced learning. A summative Immunodeficiency Objective Structured Clinical Examination (OSCE) question was created by faculty to assess students' recognition of a PIDD and clinical reasoning.
The simulation was well received by students with > 90% endorsing each of the objectives on the post-simulation survey. The authors also determined a statistically significant score variance on the summative OSCE question. Higher scores were achieved by the cohort of students completing the OSCE post-simulation versus the cohort completing the OSCE pre-simulation.
The innovative use of simulation in a highly complex basic science immunology course provides relevance and consolidation for preclinical learners. Additional data will be collected to continuously assess application of concepts and proficiency stemming from this novel curricular intervention. The authors advocate the initiation and/or expansion of simulation in non-clinical basic science courses such as immunology to bridge the gap between theory and practice.
免疫功能和功能障碍是在临床医学预科课程中引入的高度复杂的基础科学概念。对于早期学习者来说，将免疫学中的复杂细节和概念与临床表现联系起来是一个挑战。这阻碍了相关性和适用性。医学教育改革的动力是在医学院的头两年促进基础科学和临床医学的整合。模拟是一种创新，现在广泛应用于医学院，以增强临床学习。它在基础科学课程中的应用还远远不够。作者尝试了模拟作为一种新颖的课程方法，以增强基础免疫学知识和临床整合。
作者在霍夫斯特拉/诺斯韦尔的祖克医学院为二年级医学生的基础科学免疫学课程中引入了原发性免疫缺陷病（PIDD）模拟。该模拟任务是让学生小组评估、诊断和管理一名以前未被诊断出免疫缺陷的婴儿。临床和科学教师的联合辅导在终端讨论中使学生参与苏格拉底式讨论。讨论的目的是将基础科学内容沉浸在临床病例中。学生完成模拟后，用李克特量表进行调查，评估其在强化临床推理、基础科学与临床免疫学的整合、增强对免疫缺陷的知识和理解以及增强学习方面的作用。教师创建了一个总结性的免疫缺陷客观结构化临床考试（OSCE）问题，以评估学生对 PIDD 的识别和临床推理能力。
模拟受到学生的好评，超过 90%的学生对调查中的每个目标都表示认可。作者还确定了 OSCE 总结性问题上的分数差异具有统计学意义。完成 OSCE 模拟后得分高于完成 OSCE 模拟前的学生。
在高度复杂的基础科学免疫学课程中创新性地使用模拟为预科学习者提供了相关性和巩固。将收集更多数据，以不断评估这一新颖课程干预措施所产生的概念应用和熟练程度。作者主张在非临床基础科学课程（如免疫学）中开展和/或扩展模拟，以弥合理论与实践之间的差距。
