First- and second-year students at Wake Forest University School of Medicine were expecting a standard lecture on the brain and nervous system. Instead, a semi-conscious, vomiting "patient" was rolled into the lecture hall and the doctors-to-be were asked to help manage the case.
"SimMan™," a reproduction of an average-size adult, is more than a typical mannequin. The simulated patient makes realistic heart, lung, and bowel sounds and can be programmed to have various medical problems - which students can work to treat. Students can also use SimMan to practice procedures such as giving injections and inserting urinary catheters or breathing tubes.
Many medical schools use such computerized simulated patients to teach clinical skills. Wake Forest is one of the first schools to use this technology in live large group lecture settings to teach basic science principles.
"Using a 'live' clinical scenario to emphasize basic science learning allows students to understand the clinical relevance of the subjects they are studying," said Michael Fitch, M.D., Ph.D., an emergency medicine specialist, who developed the teaching scenario. "What I think is really great about the concept is to create a learning environment that engages the students actively - as opposed to passively observing a lecture."
Fitch, whose Ph.D. is in neuroscience and who directs the emergency department's simulation program, was asked by James Johnson, Ph.D., who directs the neuroscience courses taught to first- and second-year students, to develop a simulation to help teach basic science principles.
Fitch organized a team of resident physicians to help him implement the emergency medicine scenario. He has received a Brooks Scholarship in Academic Medicine, made possible by two former faculty members, to pursue the idea and to develop other scenarios. He was invited to present the project at a recent meeting of the Society for Academic Emergency Medicine.
"Our curriculum challenges students to apply knowledge and skills to the clinical workplace during rather than after the initial learning process," said Johnson. "The opportunity for students to learn and apply principals of neuroscience through a medical emergency was only possible through this creative use of a simulated patient."
Through a guided group discussion to manage the case, students learned about altered levels of consciousness and potential causes of the simulated patient's symptoms, including stroke, brain injury and hypoglycemia. They learned about the sympathetic and parasympathetic nervous systems and how various mediations affect brain cell receptors.
"Dr. Fitch's innovative exercise is a real attention-grabber for our students," said K. Patrick Ober, M.D., associate dean for education. "It emphasizes the linkage between basic science knowledge and excellence in patient care."
Fitch plans to expand the program to include additional concepts in science and is working on a case involving traumatic injury to the lung to teach some fundamentals of respiratory physiology.
"This type of innovation is directly aligned with a relatively recent emphasis on active learning strategies in the medical student curriculum," said M. Ann Lambros, Ph.D., assistant dean for education. "Dr. Fitch's use of simulation in the lecture setting provides an outstanding model for other faculty to consider."