Medical Students as Simulation Educators.

INTRODUCTION: Physicians are expected to educate patients, students, colleagues, as well as members of the interdisciplinary team. However, unlike in the United Kingdom and Canada, US medical schools do not require teaching as a competency for graduation. High-quality teaching and communication skills are necessary to ensure patient safety and trust. As the field of medicine becomes increasingly expansive and complex, it can no longer rely on empiric forms of knowledge exchange. Physician training must include pedagogy to create competent educators. In this project, the educational efforts of senior medical students providing simulation-based education to junior students were compared with that provided by faculty-led education. METHODS: The "Medical Students as Simulation Educators" (MSASE) course consists of a didactic and a teaching application component. The didactic component delivers learning modules on topics such as simulation education history, learning theories, debriefing and feedback, curriculum development, teaching methods, assessment, evaluation, and essentials of running the Laerdal SimMan 3G simulation system. After completing didactic courses, student educators apply their pedagogic skills in facilitator-guided, high-fidelity clinical simulations in areas such as anaphylaxis, heart failure, and atrial fibrillation. The evaluation of MSASE compared the knowledge gain of learners led by clinical faculty to those led by student-educators. Learners completed the same multiple-choice quiz (MCQ) before and after the simulation training. In addition, student satisfaction surveys were used to assess their attitudes to being taught by their peers. RESULTS: Scores from the pre- and post-tests were nearly identical in the faculty and student-led groups. The faculty-led group's average pre- and post-activity scores were 41.67% and 72.81%, respectively. The average increase in scores was 31.14%. The student-led group's average pre- and post-activity scores were 44.43% and 75.71%, respectively. The average increase in scores was 31.28%. The results of the student satisfaction survey were supportive of peers as educators. The survey used a 5-point scale with 1 representing "strongly disagree" and 5 representing "strongly agree". Aspects surveyed include learning objective identification and achievement, educator preparedness, organization and structure, simulation realism, complexity appropriateness, engagement level, quality of debriefing, and more. The average student satisfaction score for each aspect of the survey was greater than 4.5. The average of all elements surveyed was 4.75/5. CONCLUSIONS: Data support the contention that medical students are equally effective in simulation-based teaching as clinical faculty. Participating student educators and student learners reported satisfaction with the MSASE experience.

Mature Cystic Teratoma Mimics Heterotopic Pregnancy on Sonograph.

INTRODUCTION: Mature cystic teratomas (MCTs) present clinically with a wide host of different symptomatic manifestations. Because they are often comprised of multiple tissue types, imaging can also take on many different forms making the diagnosis of MCT difficult in certain situations. In this case, we present a patient who had a MCT that mimicked a heterotopic pregnancy on sonograph. CASE PRESENTATION: A 21-year-old female G1P0 at approximately six weeks gestation by last menstrual period presented to the emergency department with a chief complaint of vaginal bleeding that began the previous day. A transvaginal ultrasound demonstrated a viable intrauterine pregnancy with fetal cardiac activity and an additional structure in the left adnexa resembling a gestational sac and fetal pole absent of cardiac activity. Obstetrics was consulted, and a preliminary diagnosis of heterotopic pregnancy was made. Diagnostic laparoscopy with intraoperative ultrasound revealed a 3 cm cyst in the left ovary that appeared to contain serous fluid. Aspiration and subsequent dissection of the cyst revealed material consistent with a mature cystic teratoma confirmed by pathologic analysis. DISCUSSION: This case highlights the importance of ultrasound in detecting adnexal masses while also exposing some of its limitations. Due to their variable presentation and potential to mimic other insidious pathologies, MCTs must always be considered when identifying adnexal structures on ultrasound.