Assessing student usage, perception, and the utility of a Web-based simulation in a third-year medical school clerkship.

STUDY OBJECTIVE: The goals of this study were to assess students' usage data of Web-based simulation (WBS), to determine if it can fill gaps in clinical experience-based medical education, and to determine students' perceived value of this kind of simulation during a clinical clerkship. DESIGN: Observational/prospective cohort. SETTING: Medical school affiliated with a large academic hospital. SUBJECTS: A total od 138 medical students. INTERVENTIONS: Web-based simulation. MEASUREMENTS: Medical students in an anesthesiology clerkship were assigned a WBS focusing on the clinical use of pulmonary artery catheters (PACs). Usage data, including day of week and time of day that the simulation was used and total usage time, were collected for 99 students. Eighty voluntary survey responses, which gauged student perception of the simulation and clinical exposure to PACs, were also collected. MAIN RESULTS: Seventy-two percent of attempts were made during nonclinical hours of 5 pm to 7 am. Seventy-seven percent of students spent less than 30 minutes in total using the simulation. Students preferred the simulation (rated 4.1/5) over textbook (3.59) learning to a statistically significant degree (P < .001) and held favorable views toward the simulation. Sixty-seven percent of students had never encountered a patient with a PAC before performing the simulation, and 41% did not discuss this learning objective during their clerkship. Students' self-rated understanding of PACs significantly increased from a presimulation score of 1.8 of 5, to 2.56 (mean difference, 0.760; P < .001) after using the simulation. CONCLUSIONS: WBS in medical school clerkships is accepted by students and can fill gaps in clinical medical school education, without negatively affecting students' workloads or clerkship experiences.

Successful recovery after amniotic fluid embolism in a patient undergoing vacuum-assisted vaginal delivery.

Amniotic fluid embolism (AFE) is a rare, catastrophic emergency that requires prompt recognition and treatment. Despite early recognition and supportive therapy, the morbidity and mortality remain high. We report a case of AFE after vacuum-assisted vaginal delivery resulting in hemodynamic collapse and subsequent multiorgan failure. Management included mechanical ventilation, extracorporeal membrane oxygenation, and continuous veno-venous hemodialysis. The patient was able to make a full recovery with minimal sequelae. In AFE with multiorgan failure, extracorporeal membrane oxygenation and continuous veno-venous hemodialysis can be valuable therapies. Proper management requires effective communication and the combined efforts of physicians of several disciplines.