Evaluation of Interprofessional Team Disclosure of a Medical Error to a Simulated Patient.

Objective. To evaluate the impact of an Interprofessional Communication Skills Workshop on pharmacy student confidence and proficiency in disclosing medical errors to patients. Pharmacy student behavior was also compared to that of other health professions' students on the team. Design. Students from up to four different health professions participated in a simulation as part of an interprofessional team. Teams were evaluated with a validated rubric postsimulation on how well they handled the disclosure of an error to the patient. Individually, each student provided anonymous feedback and self-reflected on their abilities via a Likert-scale evaluation tool. A comparison of pharmacy students who completed the workshop (active group) vs all others who did not (control group) was completed and analyzed. Assessment. The majority of students felt they had adequate training related to communication issues that cause medication errors. However, fewer students believed that they knew how to report such an error to a patient or within a health system. Pharmacy students who completed the workshop were significantly more comfortable explicitly stating the error disclosure to a patient and/or caregiver and were more likely to apologize and respond to questions forthrightly (p<0.05). Conclusions. This data affirms the need to devote more time to training students on communicating with patients about the occurrence of medical errors and how to report these errors. Educators should be encouraged to incorporate such training within interprofessional education curricula.

Are fourth-year medical students as prepared to manage unstable patients as they are to manage stable patients?

PURPOSE: To evaluate the fourth-year medical student's assessment and management of an unstable patient. METHOD: The authors compared the performance of fourth-year medical students in a clinical performance examination (CPX) across a spectrum of simulated stable conditions as compared with a case of ST-elevation myocardial infarction (STEMI). All fourth-year medical students at the Medical University of South Carolina participated in an eight-station CPX. Student performance was graded as the percentage of correct steps performed according to checklists developed through a modified Delphi technique. Repeated analysis of variance was performed to compare performance on different stations. Data are reported as mean (standard deviation), and P < .05 was considered significant. RESULTS: A total of 143 fourth-year medical students participated in the study. The percentage of correct actions performed in the STEMI station was 47.8 (9.5), which was significantly lower than all other stations (P < .001). There was no difference in overall performance between any of the other stable encounters. Students performed significantly worse in the physical and management/treatment components of the STEMI station, as compared with history, differential diagnosis, labs/tests, and diagnosis. CONCLUSIONS: Fourth-year medical students were less prepared to manage a simulated STEMI case compared with a range of nonacute conditions. Given the prevalence of coronary artery disease and the necessity of interns to be equipped to handle emergent situations, this deficiency should be addressed in undergraduate medical curricula.

Simulation curriculum can improve medical student assessment and management of acute coronary syndrome during a clinical practice exam.

BACKGROUND: It has been noted that increased focus on learning acute care skills is needed in undergraduate medical curricula. This study investigated whether a simulation-based curriculum improved a senior medical student's ability to manage acute coronary syndrome as measured during a clinical performance examination (CPX). The authors hypothesized that simulation training would improve overall performance when compared with targeted didactics or historical controls. METHODS: All 4th-year medical students (n = 291) over 2 years at the authors' institution were included in this study. In the 3rd year of medical school, the "control" group received no intervention, the "didactic" group received a targeted didactic curriculum, and the "simulation" group participated in small group simulation training and the didactic curriculum. For intergroup comparison on the CPX, the authors calculated the percentage of correct actions completed by the student. Data are presented as mean ± standard deviation with significance defined as P < 0.05. RESULTS: There was a significant improvement in overall performance with simulation versus both didactics and control (P < 0.001). Performance on the physical examination component was significantly better in simulation versus both didactics and control, as was for diagnosis: simulation versus both didactics and control (P < 0.02 for all comparisons). CONCLUSIONS: Simulation training had a modest impact on overall CPX performance in the management of a simulated acute coronary syndrome. Additional studies are needed to evaluate how to further improve curricula regarding unstable patients.

Simulation-based teaching to improve cardiovascular exam skills performance among third-year medical students.

BACKGROUND: Evidence supports the need for improvement in cardiac physical examination skills training. PURPOSE: This study evaluates whether the addition of simulation offers added benefit over training utilizing standardized patients only. METHODS: All 124 third-year students who completed the required clerkship in one academic year received cardiac examination skills training utilizing a standardized patient and a cardiac simulator. The control group, comprising 281 students from 2 previous academic years, received training utilizing a standardized patient only. All students' physical exam skills were assessed in an objective structured clinical examination. RESULTS: Students trained with cardiac simulation performed significantly better than the control group in all 5 cardiac skills. The number of students who correctly performed all 5 cardiac exam skills increased significantly (p=.004). Pulmonary exam skills were unchanged. CONCLUSION: The use of simulation in addition to standardized patient teaching can improve students' performance of cardiac examination skills.

Applying Theory to Assess Cultural Competency.

Using a theoretical cultural competency model, the effectiveness of a cultural competency learning assignment was examined to determine: 1) students' cultural competency levels as reflected through the assignment, and 2) the effectiveness of the assignment as a cultural competency learning activity. Third-year family medicine clerkship students completed a required project to research and reflect upon a patient's "cultural belief." Applying a model of cultural competence development, a content analysis of written project reports determined what level of cultural competence was expressed by students' reflections. Results indicated16% of students were at "no insight", 18% at "minimal emphasis" and 66% at "acceptance." While many students expressed an "acceptance" competence level, not all students expressed the desired level of acceptance about the role of cultural beliefs in medical care. Application of a cultural competency theory to assess learners permits educators to frame performance changes within the context of competency achievement and determine if desired levels of competency have been achieved.

Medical students' perceptions of rural practice following a rural clerkship.

BACKGROUND AND OBJECTIVES: Evidence suggests that rural experiences can positively influence students' preferences for rural practice. This study examined changes in students' perceptions toward rural primary care following a required rural clerkship. METHODS: Third-year students completed pre- and post-clerkship questionnaire items assessing their beliefs about primary care physicians who practice in rural communities in comparison with their urban/suburban counterparts. A factor analysis was performed, and pre- and post-clerkship scale means were calculated to determine differences. RESULTS: A total of 428 (88%) students completed these questionnaires. There was a significant increase in students' perceptions of rural primary care physicians' primary care service features and medical expertise. Students perceived the physicians' work demands more positively, and there was no change in students' perceptions of the physicians' income potential. CONCLUSIONS: Results suggest that the rural primary care clerkship positively influenced students' perceptions toward rural primary care.