Prospective Randomized Crossover Study of Simulation vs. Didactics for Teaching Medical Students the Assessment and Management of Critically Ill Patients

Background: Simulation (SIM) allows medical students to manage high-risk/low-frequency cases in an environment without patient risk. However, evidence for the efficacy of SIM-based training remains limited. Objective: To compare SIM-based training to traditional didactic lecture (LEC) for teaching medical students to assess and manage critically ill patients with myocardial infarction (MI) and anaphylaxis. Methods: Prospective, randomized, non-blinded crossover study of 28 fourth-year medical students. Students were oriented to the human patient simulator, then randomized to SIM or LEC between August and December 2007. The SIM group learned to manage MI using SIM training and the LEC group learned via PowerPoint lecture. All subjects' assessment and management skills were then evaluated during a simulation session of MI. During a second instruction session, the students crossed over and were taught anaphylaxis using the opposite modality and similar assessments were conducted. Completion of critical actions for each case were scored, converted to percentages, and analyzed via signed rank test. Results: Of 28 subjects, 27 performed better when trained with SIM compared with LEC (p < 0.0001). Mean scores were 93% (95% confidence interval [CI] 91–95%) of critical actions completed for SIM and 71% (95% CI 66–76%) for LEC. Absolute increase for simulation was 22% (95% CI 18–26%). For three domains common to MI and anaphylaxis, simulation scores were higher for history (27%, 95% CI 21–38%), physical examination (26%, 95% CI 20–33%), and management (16%, 95% CI 11–21%). Conclusion: SIM training is superior to didactic lecture for teaching fourth-year medical students to assess and manage simulated critically ill MI and anaphylaxis patients.