Improving medical student toxicology knowledge and self-confidence using mannequin simulation

Abstract

Background: Learning medicine without placing patients at increased risk of complications is of utmost importance in the medical profession. High-fidelity patient simulators can potentially achieve this and are therefore increasingly used in the training of medical students. Preclinical medical students have minimal exposure to clinical rotations and commonly feel anxious and apprehensive when starting their clinical years.

Objectives: The objective of this pilot study was to determine if toxicology knowledge and confidence of preclinical second-year medical students could be augmented with simulation training.

Methods: We designed and implemented a simulation exercise for second-year medical students to enhance learning of Basic Life Support, toxidromes, and management of a semiconscious overdose victim. Groups of 5-6 students were tasked to identify abnormal findings, order tests, and initiate treatment on a mannequin. Faculty observers provided video-assisted feedback immediately afterwards. On-line pre- and posttests were completed in the simulation lab before and after the exercise.

Results: This simulation exercise, completed by 52 students, increased test scores on average from 60% to 71% compared to a pre-test. Among the topics tested, students scored worst in identifying normal/abnormal vital signs. Mean confidence increased from 2.0 to 2.6 using a 5-point Likert scale (1-very low to 5-very high).

Conclusion: This study suggests that simulation exercises for second-year medical students may be a valuable tool to increase knowledge and student self-confidence at a key transition period prior to beginning clerkship experiences. Further research is needed to prove long-term educational benefits of simulation interventions in the preclinical setting.

Figure 1

Mean Knowledge Questionnaire Results error bars indicate standard error; *p<0.02, **p<0.002; Q1: Normal/abnormal vital signs; Q2: Signs of crystal methamphetamine overdose; Q3: Signs of codeine overdose; Q4: Difference between a sympathomimetic and an anticholinergic overdose; Q5: Class of drugs causing dilated pupils; Q6: Role of primary survey; Q7: Interpretation of an ABG; Q8: Assessment of breathing in Basic Life Support; Q9: Complications of bag mask ventilation; Q10: Treatment of morphine overdose

Figure 2

Mean Confidence Questionnaire Results error bars indicate standard error; **p<0.001; Q1: Confidence in performing basic life support; Q2: Confidence in evaluating a drug overdose case; Q3: Confidence in managing a semi-conscious patient; Q4: Confidence in treating a patient with an acute toxic ingestion