Emergency Medicine Interest Group Procedural Simulation Conference: An Experience for Multiple Learner Levels

Abstract

Prior research has identified knowledge gaps between the verbalization of procedures and performance in simulations. Against this background, we designed a procedural simulation conference to enhance our students’ procedural skills development using instruction and deliberate practice. The conference had six procedure stations, each focusing on specific learning objectives. Sixty medical students and 20 instructors from University of Missouri-Kansas City’s Emergency Medicine Interest Group participated. A majority rated the conference as helpful in enhancing students’ procedural skills.

Background and Purpose

Emergency Medicine (EM) requires the ability to perform a range of procedures in a stressful environment.¹ With the demands of performing procedures with accuracy under challenging conditions, it is important to hone skills and practice them on a regular basis.² Additionally, public demand for improved patient safety means that providers must be competent in procedures prior to performing them on actual patients.³ The use of simulation in the training of medical students, EM residents, and faculty has shown to be a useful educational tool. Prior research has, however, identified a knowledge gap between the ability to verbalize steps in procedures and actual performance in simulations.⁴ As other researchers have previously attested, interactive simulation workshops alone or with other interventions are likely to improve performance on procedures as compared to didactic lectures alone.⁵ It is against this background that we designed a one-day procedural simulation conference to enhance our medical students’ procedural skills using simulation-based, deliberate hands-on practice, and structured feedback. The ultimate goal was to provide a model on which students could develop real-life skills before entering residency.

The procedural simulation conference was hosted at the University of Missouri-Kansas City (UMKC) medical school’s simulation center. UMKC is one of the few medical schools in the United States that offers a six-year combined baccalaureate/medical degree (BA/MD) program. Sixty medical students from our Emergency Medicine Interest Group (EMIG) participated in the conference. The students were divided into six groups based on their curriculum year, ranging from first-year students who were still taking undergraduate coursework to fifth-year students who were in the process of completing their core clinical medical rotations.

Curricular Design

The conference had six procedure stations: Airway Management, Lumbar Puncture, Ultrasound, Emergency Medical Services (EMS), Suturing/Peripheral Access, and Trauma Surveys. The stations were selected to be representative of the range of common procedural skills utilized in EM. Each of the six stations had specific learning objectives tailored to the level of the learners. Students were provided with binders with station reference information and areas for note-taking. Each station had three instructors with varying levels of training; an EM faculty member, EM resident, as well as a senior year 6 medical student entering into EM residency. In addition, an advanced practice nurse (NP) and paramedics served as instructors for the Suturing/Peripheral Access and EMS stations respectively; this provided students the opportunity to experience an interprofessional team-based approach mirroring care provided in the emergency department.

All instructors were provided with skills binders at their stations with specific learning objectives and checklists specific to each group of students. Given that students of the same education level were grouped together, the binders assisted faculty in curtailing their instruction to the level of the learners. Additional tasks for the instructors included introducing students to the interprofessional approach of EM care and providing an opportunity for medical students to explore EM as a possible career choice. Students spent 60 minutes at each station and, overall, the conference was seven hours long. Given that this was our first procedural conference, we found it crucial to solicit participants’ perceptions of the effectiveness of the conference particularly on enhancing the procedural skills development in order to improve our future implementation processes.

Dr. Ellison instructing the lumbar puncture station.

Photo credit, Bob Steckmest, UMKC School of Medicine Photographer

At the conclusion of the conference and following approval by the UMKC Institutional Review Board, we surveyed both student and instructor participants on their conference experiences. Using a five point Likert-scaled response format (Strongly Disagree to Strongly Agree), the student survey solicited their ratings of the extent to which each of the six stations had equipped them with the necessary procedural skills appropriate to their level of medical education. Other items in the survey asked students’ overall feelings about the helpfulness of the conference in relation to other competencies, for example, interprofessional participation. The instructors’ survey asked the extent to which they felt they had provided sufficient group and individual feedback to students at their respective stations as well as their overall feeling about the effectiveness of the conference as a whole. We also collected qualitative data through open-ended items where participants were asked in the survey to share experiences about and perceptions of the conference. A paper version of the survey was distributed at the conclusion of the conference and participation in the survey was voluntary for both students and instructors. Fifty-two students out of 60 completed the survey for a response rate of 87%. The distribution of the students was as follows: Year 1=13; Year 2=11; Year 3=13; Year 4=8; and Year 5=7. Fifteen out of 20 instructors (1 paramedic, 1 NP, 3 attending, 6 resident, 3 senior students) completed the survey for a response rate of 75%. The two faculty and the student responsible for developing the curriculum and assessments did not complete the survey to avoid bias. Data were analyzed using Statistical Package for Social Scientists (SPSS) version 22. We first calculated frequency distributions and obtained data are presented as means and percentages. We then used Analyses of Variance (ANOVA) to determine if students’ ratings of the various aspects of the conference would differ as a function of year of study as well as if instructor’s responses would differ as a function of type of instructor.

Effectiveness Of Conference

The main goal of our survey was to solicit students’ evaluations of the usefulness of the conference on enhancing their procedural skills development for their level of medical education. To that effect, a majority of students strongly agreed that all the five stations had equipped them with the necessary procedural skills appropriate for their level of medical education. Specifically, 73% and 75% of the student participants strongly agreed that the Ultrasound and the Emergency Medical Services stations effectively equipped them with the necessary procedural skills for their level of medical education. On that same note, 81% of the student participants strongly agreed that both the Airway and the Suturing/Peripheral Access stations effectively equipped them with the necessary procedural skills. The Trauma Survey and Lumbar Puncture were most positively rated with 85% and 92% of the student participants respectively strongly agreeing that the stations effectively equipped them with the necessary procedural skills for their level of medical education (See Table 1). Students’ positive ratings of the effectiveness of the stations in equipping them with the necessary procedural skills was not surprising given that all the instructor participants either agreed or strongly agreed that they were able to follow the set learning objectives and adjust the material to the educational level of the learners. Additionally, 93% of the instructors either agreed or strongly agreed that they were able to provide sufficient individualized or group feedback to the students (See Table 2). Both student and instructors’ responses, therefore, confirm the intended benefits of the procedural conference in relation to enhancing students’ procedural skills development.

Table 1.

Students Ratings of the Stations and Other Experiences about the Conference (N=52)

	Strongly Disagree (%)	Disagree (%)	Neural (%)	Agree (%)	Strongly Agree (%)
Station equipped me with procedural skills appropriate for my level of medical education
Ultrasound	0	0	0	27	73
Trauma Survey	0	0	2	13	85
IV/IO/Suturing	0	0	2	17	81
Lumbar Puncture	0	0	0	8	92
Airway Management	0	0	0	19	81
EMS Station	0	0	0	25	75
Other Experiences about the Conference
Group sizes were appropriate	0	0	0	17	83
Conference fostered interprofessionalism	0	0	0	15	85
Conference fostered EMS collaboration	0	0	2	23	75
Conference fostered advisor opportunity	0	0	0	21	79
Conference was a good experience	0	0	0	12	88
Conference should be repeated	0	0	0	10	90

Notes: IV/IO/Suturing=Suturing/Peripheral Access; EMS =Emergency Medical Services

Table 2.

Faculty Ratings of their Experience about the Conference

	Strongly Disagree (%)	Disagree (%)	Neural (%)	Agree (%)	Strongly Agree (%)
Appropriateness of group sizes	0	0	7	33	60
Provided sufficient and indi. feedback	0	0	0	40	60
Adjusted material to learner’s level	0	0	0	20	80
Conference reinforce own skills	0	0	0	20	80
Recognition of mentoring role	0	0	0	7	93
Conference was a good experience	0	0	0	0	100
Conference should be repeated	0	0	0	0	100

Student and instructors’ responses also confirmed other intended additional benefits of the conference. For example, 85% of the student participants strongly agreed that the procedural conference reinforced the interprofessional and team-based approach to EM. Additionally, 80% of instructors strongly agreed that, by serving as an instructor, the procedural conference had reinforced their own procedural skills. Given the positive ratings of various sub-components of the conference, it was not surprising that, 85% of students and 93% of the instructors strongly agreed the conference was a good experience whereas almost all participants were of the view that the conference should be repeated. On a different note, 79% of the student participants strongly agreed that the conference was a platform to get connected with potential advisors. In concurrence with student views, 80% of instructors also strongly recognized their role as potential advisors and role models to medical students interested in EM as a career choice (See Tables 1 and 2).

The general positive ratings of the overall effectiveness of the procedural conference were well corroborated by open-ended qualitative responses. For example, one student participant remarked that the conference “covered material that was not covered elsewhere in the curriculum.”

Both student and instructor participants, through open-ended qualitative responses, also provided valuable information on aspects that they perceived as having worked very well at the stations. For example, one participant noted that the use of the GlideScope allowed instructors to demonstrate airway views and techniques to the large group of students prior to having the students attempt airway management on their own. At the same time, participants also provided valuable suggestions that may help improve our next implementation of a conference of this nature. For example, both students and instructors noted that the Suturing/Peripheral Access station needed more time to complete the planned learning objectives as compared to other stations. While a majority of students (83%) strongly agreed that the conference configurations were appropriate (i.e. group size and arrangement, station organization, and timing), only 67% percent of instructors shared the same view. Through open-ended responses, some instructors provided valuable qualitative feedback especially pertaining to group sizes, which is quite helpful in guiding our implementation of our next procedural conference.

Although our sample sizes for both student and instructor participants were small for any meaningful inferential statistics, we wanted to determine if students’ ratings of each station would be significantly different as a function of their year of study. Results showed that Year 4s (X̄=4.38) rated Suturing/Peripheral Access significantly lower (p<0.05) as compared to other groups of student participants (X̄ ranging from 4.73–5.00). We could not propose a plausible explanation to account for this difference in ratings of this station. No further significant differences were noted on other various aspects of the survey items. We also wanted to determine if faculty ratings/evaluations of the various aspects of the conference would be significantly different as a function of the position of the instructor (EM faculty, EM resident, EMS instructor, NP, and senior medical student) and our results did not show any significant differences (p>0.05).

Conclusions

Procedural competence is necessary to ensure safe patient care. This is especially important for emergency department and critical care procedures, which are frequently performed under challenging conditions. This procedural conference provided students an opportunity to practice skills in a safe environment that promoted learner-specific objectives, active learning and constructive feedback. Instructors reinforced their own skills through teaching and also recognized their roles as potential mentors. Such a conference can be replicated in other medical schools as a way to advance the procedural skills of students, expose students to the interprofessional nature of EM, and facilitate EM faculty and resident involvement in the medical school. As a result of the success of this conference and the constructive feedback we have received, our institution is planning to continue this experience for students. Considerations for future conferences will include expansion of the interprofessional component, learning objective refinement, and revisions of station configuration to ensure adequate time to complete the learning objectives.

Biography

Megan Litzau, MD, (above) University of Missouri-Kansas City School of Medicine Class of 2015, now a Resident at Indiana University Department of Emergency Medicine. Emily Hillman, MD, MSMA member since 2014, Assistant Professor Emergency Medicine, Assistant Program Director & Clerkship Director Emergency Medicine, Medical Director Clinical Training Facility, University of Missouri-Kansas City School of Medicine. Stefanie Ellison, MD, Associate Professor Emergency Medicine, and Associate Dean of Curriculum, University of Missouri-Kansas City School of Medicine. Angellar Manguvo, PhD, Instructional Design Specialists Assistant Professor, Department of Medical Education Support Services, University of Missouri-Kansas City School of Medicine.

Contact: MLL7c9@mail.umkc.edu