1. Acute Presentation Workshop Using Simulation to Teach “High Stakes” Clinical Situations in a Safe Environment Miriam Hoffman, MD; Molly Cohen-Osher, MD; Lauren Scott, PhD Deborah Dreyfus, MD, MSc; John Wiecha, MD, MPH Department of Family Medicine Boston University School of Medicine

2. Learning Objectives  Describe the FM Clerkship Acute Presentation Workshop  Understand the importance of high fidelity simulation in medical education  Understand the importance of Family Medicine in role modeling care of acutely ill patients  Discuss approaches to implementation of simulation exercises at your home institutions

3. Simulation in Medical Education  The continuum of simulation in medical education  Paper cases  Standardized patients  Task simulators  Computer based simulation  High fidelity simulator  Virtual world  Learning environment  High stakes  Safe

4. Overview of APW  High Fidelity Simulator  Can talk!  Very realistic physical findings  Vital signs  Instructions to the students

6. Anxiety and Learning/Memory/Performance Yerkes-Dodson Law Yerkes, R. M., and Dodson, J. D. (1908). The relation of strength of stimulus to rapidity of habit-formation. Journal of Comparative Neurology and Psychology, 18, 459-48.

7. Video #1

8. Discussion  Generate a list on the board:  Differential diagnosis  Testing  Treatment

9. Video #2

10. Case Debrief  How would you facilitate the feedback conversation?  What are some of the main feedback points?  What questions would you ask the students to get them thinking/reflecting on the experience?

11. Students’ Perspectives on the Experience  Medical student perspective  Student evaluations

12. Post-session This session was a useful educational experience. 1 2 3 4 5 6 7 8 9 10 Strongly Neutral Strongly Disagree Agree The experience felt realistic. 1 2 3 4 5 6 7 8 9 10 Strongly Neutral Strongly Disagree Agree I found the session stressful. 1 2 3 4 5 6 7 8 9 10 Strongly Neutral Strongly Disagree Agree

13. Realistic The experience felt realistic. 1 2 3 4 5 6 7 8 9 10 Strongly Neutral Strongly Disagree Agree

14. Realistic The experience felt realistic. 1 2 3 4 5 6 7 8 9 10 Strongly Neutral Strongly Disagree Agree Great exercise to elicit … symptoms & recognize an emergency- good reminder to check vitals & make sure patient is stable first 70 %

15. Stressful I found the session stressful. 1 2 3 4 5 6 7 8 9 10 Strongly Neutral Strongly Disagree Agree

16. Stressful  Excellent!! Caught us off guard, forced us to act on our own without instruction  Great shock value, did not expect the patient to crash in front of us  Great simulation, wake-up call that we need to review standards for resuscitation I found the session stressful. 1 2 3 4 5 6 7 8 9 10 Strongly Neutral Strongly Disagree Agree 53 %

17. Useful This session was a useful educational experience. 1 2 3 4 5 6 7 8 9 10 Strongly Neutral Strongly Disagree Agree

18. Useful This session was a useful educational experience. 1 2 3 4 5 6 7 8 9 10 Strongly Neutral Strongly Disagree Agree The best part was the suspense- not knowing what was going to happen is good practice Has helped me to define an acute situation & what instant steps I need to take Take-home points: important to think about ddx & not focus on one clinical finding/dx 95 %

19. Other Comments  We should be in here at least every week  More of these sessions!

20. Another kind of simulation

21. Discussion  Similar experiences using High Fidelity Simulators in Family Medicine Education  How can you implement something like this at your own institution?  Thoughts/Comments