Active learning strategies to teach renal-cardiovascular integration with high student-to-teacher ratios.

To address the challenge of increasing opportunities for active learning into a medical physiology course with approximately 190 students enrolled, we chose an integrated approach. This was facilitated by the availability of a patient simulator facility at the School of Nursing at the Medical College of Georgia, and an approximately 20-min simulation of acute hemorrhage on the simulators comprised the first of three components in our approach. The second component was a small-group problem-solving session that each group conducted immediately after their patient simulator session. It brought in the more complex physiological responses to acute hemorrhage using an exercise we designed using free downloadable simulation software from the Department of Physiology and Biophysics at the University of Mississippi Medical Center. The third component was a student worksheet exercise that was built around data collected from 12 students who volunteered to collect a 24-h urine sample and have blood pressure measured after 3 days on either high or low salt intake. The worksheet was completed independently, and the answers and student data formed the basis for a classroom lecture. The approach has met with increasingly positive reviews due to testing the first two components on second-year medical student volunteers before its implementation, keeping the first component as simple as possible, keeping the second component to <30 min, and continued revision of the third component to increase clinical context of the study questions. An integrated active learning approach can enhance student interest in integrating cardiovascular-renal physiology, particularly if faculty members are willing to revise the approach in response to student feedback.

Simulation-based crisis team training for multidisciplinary obstetric providers.

BACKGROUND: The use of team training programs is promising with regards to their ability to impact knowledge, attitudes, and behavior about team skills. The purpose of this study was to evaluate a simulation-based team training program called Obstetric Crisis Team Training Program (OBCTT) (based on the original training program of Crisis Team Training) framed within a multilevel team theoretical model. We hypothesized that participation in OBCTT would positively impact 10 variables: individual's knowledge (about team process and obstetric emergency care); confidence and competence in handling obstetric emergencies; and participant attitudes (toward the utility of a rapid response team, simulation technology as a teaching methodology, the utility of team skills in the workplace, comfort in assuming team roles; and individual and team performance). Improvement of objectively measured team performance in a simulated environment was also assessed. METHODS: Twenty-two perinatal health care professionals (attending physicians, nurses, resident, and nurse midwives) volunteered to participate in this pretest-posttest study design. All participants were given an online module to study before attending a 4-hour training session. Training consisted of participation in four standardized, simulated crisis scenarios with a female birthing simulator mannequin. Team simulations were video recorded. Debriefings were conducted after each simulation by having team members review the video and discuss team behaviors and member skills. Self-report measures of perinatal and team knowledge as well as several attitude surveys were given at the beginning and again at the end of the training session. A postsimulation attitude survey was administered immediately after the first and last simulation, and a course reaction survey was administered at the end of the training program. Objective task completion scores were computed after each simulation to assess performance. RESULTS: There were significant (P<0.004) improvements in three of the outcome variables, after controlling for type I error with Bonferroni's correction; attitudes toward competence in handling obstetric emergencies (t=1.6), as well as individual (t=4.2), and team performance (t=4.1). The remaining 6 variables, attitude toward simulation technology, attitude toward the rapid response team; confidence in handling obstetric emergencies; utility of team skills in the workplace; comfort in assuming various team roles; and knowledge, were not statistically significant. Overall task completion from the first to the last simulation (XF, df=3, n=3, 8.2, P=0.042) substantially improved (P<0.05). CONCLUSION: The crisis team training model is applicable to obstetric emergencies. Trainees exhibit a positive change in attitude; perception of individual and team performance, and overall team performance in a simulated environment. The ability of individuals to accurately assess their performance improved as a result of training.

Do medical students respond empathetically to a virtual patient?

BACKGROUND: Significant information exchange occurs between a doctor and patient through nonverbal communication such as gestures, body position, and eye gaze. In addition, empathy is an important trust-building element in a physician: patient relationship. Previous work validates the use of virtual patients (VP) to teach and assess content items related to history-taking and basic communication skills. The purpose of this study was to determine whether more complex communication skills, such as nonverbal behaviors and empathy, were similar when students interacted with a VP or standardized patient (SP). METHODS: Medical students (n = 84) at the University of Florida (UF) and the Medical College of Georgia (MCG) underwent a videotaped interview with either a SP or a highly interactive VP with abdominal pain. In the scenario, a life-sized VP was projected on the wall of an exam room in SP teaching and testing centers at both institutions. VP and SP scripted responses to student questions were identical. To prompt an empathetic response (ie, acknowledging the patients' feelings), during the interview the VP or SP stated "I am scared; can you help me?" Clinicians (n = 4) rated student videotapes with respect to nonverbal communication skills and empathetic behaviors using a Likert-type scale with anchored descriptors. RESULTS: Clinicians rated students interacting with SPs higher with respect to the nonverbal communication skills such as head nod (2.78 +/- .79 vs 1.94 +/- .44, P < .05), and body lean (2.97 +/- .94 vs 1.93 +/- .58, P < .05), level of immersion in the scenario (3.31 +/- .49 vs 2.26 +/- .52, P < .05), anxiety (1.16 +/- .31 vs 1.45 +/- .33, P < .05), attitude toward the patient (3.24 +/- .43 vs 2.89 +/- .36, P < .05), and asking clearer questions (3.06 +/- .32 vs 2.51 +/- .32, P < .05) compared to the VP group. The students in the SP group also had a higher empathy rating (2.75 +/- .86 vs 2.16 +/- .83, P < .05) and better overall rating (4.29 +/- 1.32 vs 3.24 +/- 1.06, P < .05) than the VP group. Empathy was positively correlated with the observed nonverbal communication behaviors. Eye contact was the most strongly correlated with empathy (r = .57, P < .001), followed by head nod (r = .55, P < .001) and body lean (r = .49, P < .001). CONCLUSIONS: Medical students demonstrate nonverbal communication behaviors and respond empathetically to a VP, although the quantity and quality of these behaviors were less than those exhibited in a similar SP scenario. Student empathy in response to the VP was less genuine and not as sincere as compared to the SP scenario. While we will never duplicate a real physician/patient interaction, virtual clinical scenarios could augment existing SP programs by providing a controllable, secure, and safe learning environment with the opportunity for repetitive practice.