Enhancing a SimMan Experience through Team-Based Learning

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Enhancing a SimMan Experience through Team-Based
Learning

• J. Pasley, M. Petty, M. Jennings, M. Soulsby,
• J. Firnhaber, M. Palacios, J.White
• UAMS, Little Rock, AR, USA

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Introduction

• Physiology educators formerly used animal-based
  laboratory exercises to reinforce basic
  physiological concepts.
• Medical simulation is now used to provide a link
  between basic science education and clinical
  bedside teaching.

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Introduction

• Patient simulation brings learning concepts to
  life in a clinical setting.

4
Overview

• Implementation of Simulation in Physiology
• Cardiovascular
• Pulmonary

• Implementation of TBL to encourage Preparation
  for SimMan Experience

5
The Process
Spring 2000 - 2002
Modification of Courses
Spring 2003 - 2005
Included TBL
Spring 2005
2007
Modified TBL Added 3 mannequins
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Spring 2000-2002

• Standard use of ECG and Spirometer
• Cardiovascular Physiology
• ECG interpretation
• Myocardial blood flow
• Heart failure
• Respiratory Physiology
• Airway resistance
• Restrictive lung disease
• Obstructive lung disease
• Mediocre Examination Performance by Students in
  both areas of Physiology

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Spring 2003-2005

• Modified courses to include SimMan
• computer-driven patient simulator
• Groups of 10 students
• 20 minute experience
• Observations
• Students not well prepared prior to simulator
• Hands-on activity by 3-5 students
• Interested students, but still passive

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Spring 2005

• Added TBL to encourage preparation
• First implementation in medical curriculum at
  UAMS
• Group size 10
• IRAT given as members arrive for Simulator in
  waiting area
• GRAT given just outside of Simulator
• Lively questioning by most students
• Faculty learned how lecture/questions needed
  clarification
• Application
• Next classroom session
• In conjunction with review session for test
• Problematic

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Results

• Scores on the cardiovascular and respiratory
  exams with SimMan experience increased
  significantly compared to non SimMan experience.

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Cardiovascular Physiology Cardiovascular Exams
correct
SEM 5.30
SEM 2.01
SEM 2.84
SEM 2.25
SEM 6.50
Pre SIM-MAN 2000 - 2002
2003
2004
2005
No SIM-MAN 2006
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Respiratory Physiology Respiratory Questions
Correct
SEM 7.14
SEM 5.65
SEM 4.76
SEM 9.84
SEM 3.45
No SIM-MAN 2006
2004
2005
Pre SIM-MAN 2000 - 2002
2003
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Modified TBL 2007

• Day before SimMan Experience
• IRAT- based on lecture concepts
• GRAT-group quiz and discussion over same
  questions as IRAT
• Application quiz administered during classroom
  review of SimMan exercise

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• More experience with TBL needed to demonstrate
  improvement by TBL use
• Critical to get all concerned faculty involved
• Need to Examine impact of TBL on Learning
  Physiologic concepts using SimMan
• Collect more data to determine whether TBL has an
  impact on learning.

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SIM-Man/TBL 2007

• Three mannequins allowed smaller group size (6)
  and more time enhanced SIM-Man experience
• Problems in test administration nullified our
  ability to measure impact of TBL

Results
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Conclusions

• Simulator encounters reinforce Basic Science
  Concepts presented in Physiology Lectures
• Simulator experience Significantly Impacted
  Learning
• TBL Enhanced student Preparation for the SIM-Man
  experience

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Future Plans
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Rationale

• To shift focus from learning key concepts to
  using concepts
• To replace lecture format with a more hands on
  experience
• To encourage students to come prepared

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Rationale

• Demonstrate cardiovascular and pulmonary
  physiology concepts in a Medical Physiology
  course using simulation.

• Examine student performance on exam questions in
  cardiovascular and respiratory physiology before
  and after the simulation experience.

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Cardiovascular Physiology
Question Topic Pre SIM-MAN correct SIM-MAN correct NO SIM-MAN correct
ECG Interpretation 65 85 72
Cardiac Blood Flow 56 84 52
Ischemic Heart Disease/Heart Failure 60 82 48
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Respiratory Physiology
Question Topic Pre SIM-MAN correct SIM-MAN correct NO SIM-MAN correct
Airway Resistance 56 90 51
Obstructive Lung Disease 53 82 70
Restrictive Lung Disease 50 72 54