Simulation Teaching Associates: a Model Utilizing Senior Medical Students as Simulation Educators

Abstract

Student-as-teacher programs have become commonplace in undergraduate medical education over the past 15 years. Recognizing the important role of medical students as teachers, we created an innovative Simulation Teaching Associate elective to improve the quality and consistency of simulation education and to encourage and support medical students as future educators.

The current literature continues to highlight the importance of student-as-teacher curricula in undergraduate medical education [1–4]. In 2015, we created a Simulation Teaching Associate (STA) program that utilizes senior-level medical students to assist in facilitating and debriefing simulation cases as opposed to relying exclusively on volunteer faculty members. The STA program has continued to grow and develop over the past eight years. We believe our program is unique in that we have provided mentorship and role modeling of best practices in simulation-based education for over 100 students. The STA program serves as one of the 4^th year electives for medical students. This program was originally designed to fulfill three specific goals: (1) to improve quality and reliability of simulation education within the pre-clinical curriculum, (2) to train a new generation of simulation educators, and (3) to develop an opportunity for senior medical students to develop and practice their skills as educators. A sampling of one of our original cohorts yielded encouraging results. STA participants were able to demonstrate significant improvement in their comfort as an educator, simulation teaching ability, and likelihood to pursue a career in academics (Table 1).

Table 1.

Survey results from original STA cohort

Question 1–5 Scale	Pre-course	Post-course	Difference of means	P-value
	Mean	Mean
Please rate your simulation teaching ability	2.57	4.43	+ 1.86	< 0.05
Please rate your comfort level as a learner in simulation	3	4.86	+ 1.86	< 0.05
Please rate your comfort level as an educator	3.14	4.42	+ 1.29	< 0.05
I am likely to pursue a career in academics	3.42	4.42	+ 1	< 0.05
This course helped to improve my clinical skills	N/A	4.42
This course has helped me make progress towards achieving my career goals	N/A	4.28

Although simulation has been proven to be an essential part of medical curricula, training faculty to facilitate and debrief simulation sessions requires significant faculty time as well as administrative support [5]. As a result, many simulation centers rely on volunteer faculty members to facilitate and debrief which is an unpredictable and unsustainable staffing model. The simulation center at our institution provides simulation experiences for 190 medical students each month in the preclinical curriculum alone. The STA program has provided a consistent cohort of approximately 20 medical students each year to help facilitate these events.

A foundational component of the STA program is two four-hour orientation workshops where each student receives training in simulation theory, manikin operations, and effective utilization and implementation of debriefing techniques. In order to receive credit for completion of the elective course, each STA must participate in at least 32 simulation sessions throughout the year in exchange for one month of elective credit. The simulation sessions last one hour each and include cases related to pre-clinical modules in the first and second year medical school curriculum.

STAs are also required to attend monthly, two-hour prebriefing sessions throughout the year to learn more about the specific cases being offered each month. These prebriefing sessions provide an opportunity for faculty to run the case and review the debriefing guides with the STAs. During these sessions, STAs participate as learners in the simulation and in the debriefing in order to experience the case and to see an example of the debriefing structure for that case. This hands-on experience allows STAs to gain a better understanding of best practices related to simulation and instills confidence as they prepare to serve in a teaching role the following week. The roles of the STA vary during each simulation event. Typical STA roles include functioning as a technician to manipulate the manikin, serving as the voice of the patient, serving as an embedded simulation participant alongside the learners during the case, and helping to co-debrief with a faculty member immediately following the case. Details of the STA curriculum are presented in Table 2.

Table 2.

Outline of STA curricular components

Curricular component	Description
Orientation Workshop Part 1 (4 h)	Simulation theory, debriefing framework
Orientation Workshop Part 2 (4 h)	Operational troubleshooting, facilitation practice, debriefing practice
Prebriefing Sessions (2 h monthly/8 monthly sessions)	Walking through the specific simulation cases for that month, experiencing the cases from the perspective of the learner, observation of faculty facilitation and expert debriefing
Simulation Sessions (2 cases per hour/32 h required over the course of the MS4 year)	Hands-on facilitation of the cases and debriefing of each case

In addition to improving the quality and reliability of simulation education within the pre-clinical curriculum, our hope is that the STA program will motivate a new generation of students to pursue careers in simulation and medical education. Data from one of our STA cohorts suggests that students who participated in the program were more likely to pursue a career in academics (Table 1). Similar student-as-teacher electives, which also emphasize small group workshops and teaching opportunities, have reported that students pay close attention to the language used by faculty and are attuned to the details involved in effective teaching [1]. The required monthly sessions give STAs an opportunity to see expert facilitators and debriefers role model appropriate behaviors. Anecdotal observations by faculty who regularly attend these sessions indicate that STAs commonly use specific language and questioning techniques they have witnessed during the prebriefing sessions when they co-debrief cases with the junior medical students.

Recent literature-based recommendations for student-as-teacher curricula emphasize the importance of providing students with an authentic opportunity to engage in an educational or teaching role [2]. By the time STAs complete their elective at the end of their senior year, they will have debriefed 64 simulation cases where they are directly involved in the facilitation and debriefing of the simulation event. STA evaluations from these sessions include an open-ended question asking students what they learned from this experience. Student comments reflect an improved understanding of how to facilitate discussion, how to provide feedback, and how to teach in a way that is conducive to learning.

A narrative review by Cohen et al. concludes that faculty in undergraduate medical education should no longer question whether medical students benefit from student-as-teacher programs; instead, our focus should be on finding ways to successfully engage students in teaching roles [2]. We believe the STA program provides medical students with the teaching and leadership skills necessary to support and encourage them to pursue educational roles in the future. We are currently exploring how we might collect data related to which students pursue roles in education following residency and whether the STA program had an impact on their decision. As the STA program continues to grow and evolve, we look forward to involving our STAs more directly in content creation, and guided reflection on their experiences with the program.

Author Contribution

Both authors contributed to the preparation of the manuscript. Both authors reviewed and edited versions of the manuscript and approved the final manuscript. Dr. Todd Peterson was responsible for the development of the STA elective. Dr. Dawn Taylor Peterson was responsible for the development of the workshops for the elective. Dr. Todd Peterson was responsible for data collection and analysis of student feedback related to the workshops and the actual simulation events that were part of the elective.

Declarations

Conflict of Interest

The authors declare no competing interests.