Learning to practice medicine: developing medical students' acute patient management skills using a longitudinal program of mannequin-based simulation

Abstract

This qualitative study examines the development of medical students’ acute patient management skills during participation in a longitudinal patient management simulation program. Current research shows that junior doctors feel ill-equipped to manage clinical deterioration in the acute healthcare setting due to a lack of skill and experience. It is also evident that conventional simulation facilitation practices are not meeting the learning needs of novice medical students. The focus of this study was to analyse the impact that a specifically designed simulation program had on the development, retention, and transfer of acute patient management skills for three groups of medical students during their medical school training.

Educational design research was used to develop and introduce two curriculum interventions to support learning. The two interventions were based on issues relating to the content and the delivery of the simulation program. Intervention 1 was the introduction of a clinical deterioration component to every case-based core presentation simulation in an established program. Intervention 2 was the introduction of a newly developed role of in-game coach, which replaced the original role of simulation facilitator.

In order to assess learning, retention, and transfer of acute patient management skills, video-recorded simulations were generated and analysed for learning progression. The coaching that supported student learning was analysed in order to conceptualise the new role more definitively and to create guidelines for supporting student learning. Focus group interviews complemented the data set and provided insights into the students’ experiences and reflections as a result of taking part in the simulations. Learning frameworks were developed to show typical learning progression and can be further applied to support student learning through the provision of feedback, as an assessment tool, and to provide support to coaches.

The study found that repeated practice using standardised approaches to acute patient management enabled rapid retrieval of knowledge from long-term memory into working memory after an extended retention interval. A learning progression model identified a shift from novice to either competent or proficient practice in acute patient management skills at the completion of the program. Common misconceptions and difficulties for students at various stages of the progression were identified so that coaching can be targeted more effectively to support students. Local instruction guidelines based on the interventions and the data analysis have been developed as an output of this research.