1. Simulated Procedures in Family Medicine
in a Pre-clinical Medical Student Curriculum
Scott A. Kelley, MD and James M. Cooke, MD
University of Michigan Department of Family Medicine, University of Michigan Clinical Simulation Center
ABSTRACT
METHODS
Medical simulation can be an effective tool for procedural training of medical students due to the low cost, safety, and ability for repetition. In 2012, the Society of Teachers of Family Medicine formed the Group on Simulation in Medical Education to promote the appropriate use of simulation in medical education for instruction and evaluation.1 Due to the wide variety of inpatient and outpatient procedures within the specialty, family physicians are uniquely positioned to provide targeted instruction for preclinical students on diagnostic and therapeutic procedures commonly encountered during both medical and surgical clerkships. Beginning in 2012, faculty in the UM Medical School Department of Family Medicine (DFM) offered second-year medical students an elective course focusing on procedural training utilizing task simulators. The goals of the course were to increase students’ knowledge of procedures employed by Family Medicine physicians, improve students’ confidence and skill, and to pique students’ interest in the field.
In 2012, a UM Medical School RFP solicited faculty proposals for elective courses targeting second-year medical students. These courses were envisioned to be both targeted and brief, totaling three two-hour blocks during the Fall semester. The proposed course, Simulated Procedures in Family Medicine, was designed to provide M2s with hands-on experiences including: cardiac exam,5 thoracentesis,6 lumbar puncture,7 and central line placement.8 The proposal was accepted, and, in October 2012, a total of 18 M2s enrolled in the course.
Students were evenly divided into two groups: group one received
training and practice in central line placement, thoracentesis, and lumbar puncture, and group two received training and practice in cardiac exam, central line placement, and lumbar puncture. These procedures were selected for their general relevance and to demonstrate a sample of procedures within the scope of family medicine.
Each two hour session consisted of a brief presentation (e.g., anatomic landmarks, indications, contraindications, potential complications, etc.), followed by a demonstration by the instructor, hands-on practice with one-on-one coaching, and in-depth discussion of the finer details associated with each procedure. The students were provided with formative feedback during the practice sessions focusing on technique.
After each session, students were asked to complete a short questionnaire to rate their experience with the UM Clinical Simulation Center (note: all participants using the simulation center are asked to complete this same questionnaire). Summary scores and qualitative responses are presented.
Cardiac Exam Mannequin Thoracentesis Training Model6
Lumbar Puncture Simulator Central Venous Access Model8
CONCLUSIONS
PURPOSE
This hands-on course using clinical simulation mannequins proved to be well-received by preclinical students at the UM Medical School. Prior to the course, all students had been exposed to cardiac exam, but few had practiced central line placement, thoracentesis, or lumbar puncture. At the end of the course all students demonstrated proficiency and understanding of each procedure, and nearly all rated the course as having significantly improved their knowledge and skill.
Future directions for the course could include summative assessment of knowledge acquisition and retention (e.g., short exam immediately following the course and 6 months later to measure students mastery of key concepts), and an investigation as to whether the course prompted students to pursue a career in Family Medicine. We hope that a positive experience with Family Medicine early in medical training will translate into more interest in the specialty, thus creating a new opportunity to recruit the brightest and best students to the field.
Pre-clinical medical school students (M1s and M2s) are eager for hands-on experiences, but have very few opportunities to actively participate in medical procedures during their first two years of training. They also have limited contact with family physicians during the preclinical years at many medical schools and may have an incomplete understanding of the breadth of procedures within the scope of family medicine, which can contribute to the less favorable perception of family medicine when compared to other medical specialties.2-3
To promote hands-on experience with medical procedures and to increase both medical students’ confidence4 and exposure to the breadth of services provided by family physicians, a DFM faculty member developed an elective course that provided M2 students with the opportunity to learn and practice procedures using the medical school’s clinical simulation mannequins.
The goals of this course were: (1) to improve students’ confidence and procedural skills, (2) to expose students to a broad range of procedures common in family medicine, and (3) to pique students’ interest in Family Medicine.
RESULTS
By the end of each session all students demonstrated competence with the session’s target procedure.
Overall, results from the simulation center’s questionnaire show the elective was received positively by students. When asked to “Rate the degree to which you believe you acquired knowledge and skills in this session”—where 1 was the least positive response and 6 the most positive—students’ mean rating for the course was Highest ratings were seen for “Opportunity to do hands-on learning,” and “Opportunity to have hands-on practice,” where mean scores were 5.53 and 5.51, respectively.
The questionnaire also provided space for students to offer qualitative feedback (“What else would you like to tell us about this session in the Clinical Simulation Center?”). Of the 11 responses given, 9 described the course positively and 2 negatively. Among the positive responses, students stated the following: “We love to come into the Sim Center[,] it[‘]s a great way to learn outside of class,” “Hands-on experience very helpful,” “The instruction was fantastic,” and “I had no idea what a central line was before starting and now feel comfortable practicing further”. The two negative comments related to the course’s pace: “Presentation was a bit slow” and “Maybe we could do two different procedures in 2 hours instead of spending so much time on LPs.”
REFERENCES
1 Society of Teacher s of Family Medicine, Group on Simulation in Medical Education. (2013, March 28). Simulation in Medical Education. Retrieved from
2 Musham, C., & Chessman, A. (1994). Changes in medical students' perceptions of family practice resulting from a required clerkship. Family Medicine, 26(8),
3 Phillips, J., Weismantel, D., Gold, K., & Schwenk, T. (2012). How do medical students view the work life of primary care and specialty physicians? Family Medicine, 44(1), 7-13.
4 Cooke, J. M., Larsen, J., Hamstra, S. J., & Andreatta, P. B. (2008). Simulation enhances resident confidence in critical care and procedural skills. Family Medicine, 40(3), 5 6 7 8