Blog #3 – March 10, 2017

Today, I reflect on a ward emergency simulation that took place during noon rounds. I thought the session was innovative and relevant for learners at all levels of training. The scenario was realistic and included roles for a junior resident, senior resident, and nurse on the ward. During the debrief session, I liked how the participant was initially asked to self-assess his own performance. Feedback was also delivered constructively by multiple people in a way that I felt was clear and helpful for the learner. From this debrief session, I learned the importance of knowing how to separate acutely, unstable patients from those who are stable. I also found it useful to learn when to call for extra help and when to call a code blue. Following the simulation, the senior resident summarized the underlying topic of sepsis in a PowerPoint presentation, highlighting key concepts while citing current literature. Overall, I was impressed with how the simulation and debrief session was organized and delivered. It is the perfect topic to cover for trainees before they enter residency!

I think simulations are very effective teaching tools especially for the participants involved. They can help learners improve in their clinical judgement, decision-making, and communication skills. I do wonder how effective and efficient simulations are at teaching large groups of students, however. At what point are there too many learners involved? How effective are simulations for observers compared to participants? How long do learners retain the information learned compared to traditional methods of teaching (e.g. didactic lectures or seminars)? Having been a participant in a few large group simulation that involved over ten students, I remember how chaotic and disorganized the scenario was. I found myself reflecting more on how to use closed-loop communication effectively rather than remembering the actual content of the scenario itself. Perhaps the most crucial part of the simulation session is the debrief portion. I think it would be effective to not only provide the participants with feedback, but perhaps allowing participants to dissect the scenario in a stepwise manner (cognitive task analysis), discussing decision points, or providing learners with an “ideal” or “expert” approach may enhance simulation sessions.

With all that said, I think that this ward emergency simulations should be a mandatory component in our transition to residency curriculum. As a soon-to-be resident, I think having these scenarios may be a more effective way of preparing us for our first year of residency than the current curriculum format where some learners may be completing rotations only to fulfill a course requirement. These simulations would be relevant for all medical students transitioning into residency, regardless of the specialty they are entering, and would raise important issues that are often learned while trainees are experiencing them on the wards.

- CY