Proceedings of The Physiological Society

Physiology 2016 (Dublin, Ireland) (2016) Proc Physiol Soc 37, PCA093

Poster Communications

Applying knowledge to practice: Use of clinical simulation during first-year medical physiology

T. A. Pressley1, G. L. Brower1, V. H. Lee1, J. C. Fowler1

1. Dept. of Medical Education, Texas Tech University Health Sciences Center, Lubbock, Texas, United States.

Many first-year medical students struggle to connect the fundamental knowledge of didactic coursework in physiology with the clinical relevance of patient care. Accordingly, we have introduced multiple simulation activities within our first-year course in medical physiology with the goal of easing the development of diagnostic reasoning skills by providing straightforward illustrations of the underlying basic science. We take advantage of four interactive learning strategies with a progressive increase in realism and clinical exposure. All of these could be considered extensions of the flipped-classroom model because they require the independent study of material by the students before participating in the activity. The most straightforward and simplest activity is a team-based problem-solving session focused on a clinical scenario. Based on the initial description of the case, students must determine what additional information is needed to arrive at a diagnosis. We have used basic hematology and capillary exchange as the foundations for these activities. A slightly more realistic approach makes use of cardiopulmonary manikins to explore the temporal relationships between auscultation of heart sounds and the associated cardiac and pulmonary functional events. Closer still to a real-life experience is an interactive model in which small groups of students use ultrasonography in standardized patients to reinforce structure-function relationships. We have used ultrasound visualization to correlate the cardiac cycle with the generation of heart sounds and to reinforce renal function by measuring urine production based on periodic estimates of urinary bladder volume. Our most complex and life-like interactive model is a clinical simulation using high-fidelity manikins. We currently use clinical scenarios that demonstrate the compensatory mechanisms evoked by acute hemorrhagic shock, the changes in ventilation and circulation accompanying a tension pneumothorax, and the systemic responses to acute diabetic ketoacidosis. The manikin's physiological parameters are adjusted in real-time during each scenario based on students' interventions. The use of clinical simulations of varying complexity has allowed us to reduce the number of formal lecture hours from 20 to 12 over the last 5 years without compromising students' performances on either in-house or standardized examinations. We anticipate that the increasing use of clinical scenarios and simulation will facilitate a smooth transition to patient care for our students and improve their long-term retention of fundamental physiological principles.

Where applicable, experiments conform with Society ethical requirements