Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA.
Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI, USA.
Med Educ Online. 2024 Dec 31;29(1):2430576. doi: 10.1080/10872981.2024.2430576. Epub 2024 Nov 26.
New residents are often unprepared to respond to medical emergencies. To address this gap, we implemented a simulated cross-cover paging curriculum. All senior medical students enrolled in a required specialty-specific (internal medicine, procedures, emergency medicine [EM], obstetrics and gynecology [OBGYN], family medicine and pediatrics) residency preparation course (RPC) in 2020-2021 participated. Students received 3-6 specialty-specific pages that represented an urgent change in clinical status about a simulated patient. For each page, students first called a standardized registered nurse (SRN) to ask additional questions, then recommended next steps in evaluation and management. The SRNs delivered immediate verbal feedback, delayed written feedback, and graded clinical performance using a weighted rubric. Some items were categorized as 'must do,' which represented the most clinically important actions. Trends in clinical performance over time were analyzed using the Jonckheere-Terpstra test. Of the 315 eligible students, 265 (84.1%) consented for their data to be included in the analysis. Clinical performance improved from a median (interquartile range) of 59.4% (46.9%, 75.0%) on case 1 to 80.0% (68.0%, 86.7%) on case 6 ( < .001). The percentage of 'must do' items improved significantly, from 69.2% (53.8, 81.8%) to 80.0% (66.7%, 88,9%) ( < .001). Scores improved over time for all specialty courses except for EM and OB/GYN. Surveyed students largely found this to be a valuable addition to the RPC curriculum with a 4.4 overall rating (1 = poor to 5 = excellent). This novel curriculum fills important gaps in the educational transition between medical school and residency. The simulated paging platform is adaptable and generalizable to learners entering different residency specialties.
新住院医师通常对医疗紧急情况没有准备。为了解决这一差距，我们实施了模拟跨科室传呼课程。2020-2021 年，所有参加必修专科预备课程（RPC）的高年级医学生都参加了该课程，专科包括内科、程序、急诊医学（EM）、妇产科（OBGYN）、家庭医学和儿科。学生们收到了 3-6 个代表模拟患者临床状况紧急变化的专科传呼。对于每个传呼，学生首先打电话给标准化注册护士（SRN）询问其他问题，然后建议评估和管理的下一步措施。SRN 立即提供口头反馈，延迟书面反馈，并使用加权量表对临床表现进行评分。一些项目被归类为“必须做”，这代表了最重要的临床操作。使用 Jonckheere-Terpstra 检验分析随时间推移的临床表现趋势。在 315 名符合条件的学生中，有 265 名（84.1%）同意将其数据纳入分析。临床表现从第 1 例的中位数（四分位距）59.4%（46.9%，75.0%）提高到第 6 例的 80.0%（68.0%，86.7%）（<0.001）。“必须做”项目的比例从 69.2%（53.8%，81.8%）显著提高到 80.0%（66.7%，88.9%）（<0.001）。除急诊医学和妇产科外，所有专科课程的分数都随时间提高。接受调查的学生认为，这在很大程度上是 RPC 课程的一个有价值的补充，总体评分为 4.4（1=差，5=优秀）。这个新颖的课程填补了医学生和住院医师之间教育过渡的重要空白。模拟传呼平台可适应不同住院医师专业的学习者。
