A multi-institutional study using simulation to teach cardiopulmonary physical examination and diagnosis skills to physician assistant students.

PURPOSE: Research demonstrates limitations in the ability of health care trainees/practitioners, including physician assistants (PAs), to identify important cardiopulmonary examination findings and diagnose corresponding conditions. Studies also show that simulation-based training leads to improved performance and that these skills can transfer to real patients. This study evaluated the effectiveness of a newly developed curriculum incorporating simulation with deliberate practice for teaching cardiopulmonary physical examination/bedside diagnosis skills in the PA population. METHODS: This multi-institutional study used a pretest/posttest design. Participants, PA students from 4 different programs, received a standardized curriculum including instructor-led activities interspersed among small-group/independent self-study time. Didactic sessions and independent study featured practice with the "Harvey" simulator and use of specially developed computer-based multimedia tutorials. Preintervention: participants completed demographic questionnaires, rated self-confidence, and underwent baseline evaluation of knowledge and cardiopulmonary physical examination skills. Students logged self-study time using various learning resources. Postintervention: students again rated self-confidence and underwent repeat cognitive/performance testing using equivalent written/simulator-based assessments. RESULTS: Physician assistant students (N = 56) demonstrated significant gains in knowledge, cardiac examination technique, recognition of total cardiac findings, identification of key auscultatory findings (extra heart sounds, systolic/diastolic murmurs), and the ability to make correct diagnoses. Learner self-confidence also improved significantly. CONCLUSIONS: This study demonstrated the effectiveness of a simulation-based curriculum for teaching essential physical examination/bedside diagnosis skills to PA students. Its results reinforce those of similar/previous research, which suggest that simulation-based training is most effective under certain educational conditions. Future research will include subgroup analyses/correlation of other variables to explore best features/uses of simulation technology for training PAs.

Reinventing the Wheel: One Program's Approach to Redesign of Didactic Courses.

Curriculum and course redesign are expected and intentional efforts in health professions education. For physician assistant (PA) education, ongoing program self-assessment is a required accreditation standard and may guide deliberate changes within curriculum. The purpose of this article is to describe one PA program's approach to the redesign of 4 courses into 3 courses that span the entire didactic phase. Significant lessons learned include the importance of planning ahead, identifying key players, documenting the process as part of ongoing self-assessment, competency mapping, and being prepared to make real-time modifications and changes based on course evaluations and faculty feedback. Our approach and guiding principles to the successful redesign of the didactic courses may provide both established and new PA educational programs with useful methods to apply in their own unique curricula.