Development of a simulation-based sub-module in undergraduate medical education.

BACKGROUND: It is well documented that medical students struggle to bridge the theory-practice gap. Competently integrating classroom-taught skills into the clinical setting is a challenge. METHODS: A survey of final year medical students identified a lack of confidence in managing common clinical emergencies that are experienced in the Intern role. The researchers devised a new sub-module to include high-fidelity simulation in the undergraduate medical curriculum. This development was underpinned by an educational curriculum model. Students attended small group teaching using high-fidelity simulation training (Sim-Man 3G ™) and practiced managing common emergencies. Training sessions were facilitated by clinical tutors and anaesthetic lecturers. Cases were supplied by clinical staff. An evidence-based format was utilised as an integrative teaching method. RESULTS: A simulation-based sub-module based on Finks Taxonomy was planned, introduced and evaluated. Utilisation of a high-fidelity simulation-based approach to teaching had a marked effect on student's confidence in their ability to manage clinical emergencies. Students reported very positive attitudes to this new method of teaching, specifically related to the integration of previously acquired knowledge and skills. A hands-on practical approach in a safe learning environment was valued by students. CONCLUSIONS: The module descriptor devised can be used as a template for further curricular reform. Simulation-based teaching is feasible in the undergraduate setting and may ease the transition to postgraduate teaching modalities.

Evaluation of a "Subintern" Role: Action Over Observation For Final-Year Medical Students in Surgery.

BACKGROUND: This study sought to investigate the potential of a subinternship apprentice role as a structured experiential learning opportunity by enabling final-year medical students to learn through action rather than observation. METHODS: A convenience sample of 65 final-year medical students was allocated to "intern shadow" (control group) or "subintern" (research group) for 2 weeks during the first clinical attachment of their final year. "Intern shadow" involved direct observation of the intern role, whereas "subintern" involved a fully immersive performance of the intern role under direct supervision by the surgical team. All students completed an evaluation form that was devised in-house and based on course learning objectives. This consisted of Likert scales and free text. RESULTS: Wilcoxon rank sum test results showed that students participating in the "subintern" group had a statistically significantly better clinical experience than the "intern-shadow" group regarding role modeling (p = 0.0002), learning and teaching (p = 0.0021), organization and support (p = 0.0219), and patient interaction (p = 0.0063). CONCLUSION: The "subintern" apprentice role shows strong potential for enabling final-year students to learn on the job by actually performing the intern role rather than merely observing an intern at work. Subinterns reported feeling valued within the team structure and expressed a desire to emulate expert practice directly experienced through close collaboration with consultant surgeons.

An alternative certification examination ("ACE") in surgery.

BACKGROUND: Medical graduates are required to be competent in many domains of professional practice when joining the health care workforce. Current undergraduate examination methods robustly assess up to 5 of these 8 required skills. This study sought to evaluate an alternative certification examination ("ACE") in assessing all of the 8 required domains in surgical cases. METHODS: A total of 143 final-year medical students were invited to participate in an "ACE" in February 2013. In total, 137 students, 95.8% of the class, agreed to participate. The "ACE" format consisted of 4 sequential patient encounters observed by 2 independent examiners. It assessed all the 8 required domains of professional practice. The examiners and the students evaluated this examination format using a Likert scale and free-text comments. RESULTS: The "ACE" assessed all the 8 domains. The inclusion of a patient safety measure to avoid an egregious error in the pass criteria resulted in 27 (18.9%) students failing to meet them. The correlation of grades between the independent examiners in the "ACE" was strong at a Cronbach α of 0.907 (CI: 0.766-1). The "ACE" format was reported as an acceptable examination methodology by the examiners for formative or summative assessment of surgical cases at the end of a primary medical degree. CONCLUSION: The "ACE" format is standardized, is integrative, and has excellent interrater reliability. Inclusion of a patient safety measure as pass criteria appears to increase specificity. The "ACE" shows potential as an alternative examination to the traditional long case examination and objective structured clinical examination in assessing all the 8 domains of professional practice.