Teaching Cardiovascular Physiology Using Patient Simulation

Objective: The Wake Forest University School of Medicine developed a curriculum for medical student education in cardiovascular physiology using patient simulation. Description: Second-year medical students enrolled at the medical school in the fall of 1999 were required to participate in the new cardiovascular curriculum. The core course in cardiovascular physiology consisted of lectures, small-group case discussion, anatomy, histology, physical diagnosis, and the Patient Simulation Laboratory (PSL) course. The PSL experience consisted of three components: a 15-question essay-format worksheet, a one-hour patient simulation, and a one-hour debriefing immediately following the simulation. The PSL uses a life-like mannequin and software technology purchased from METI, Inc. (Sarasota, FL). Completion of the worksheet was required before the patient simulation and debriefing exercise. The average time to complete the worksheet was 2.5 hours. The patient simulation and the debriefing were conducted in groups of ten to 12 students and were led by two faculty members; each session lasted one hour. During the simulation, the students were confronted with a simulated patient in acute congestive heart failure. The students were guided through various pharmacologic therapies and the hemodynamic results recorded. For example, in one simulation, the patient had a course of inotropic therapy alone and then in combination with diuretic therapy. During the debriefing session, the students reviewed both the worksheet and the simulation. The instructor critically evaluated the students' pharmacologic interventions and explained why some therapies worked better than others. General questions and answers were also obtained and provided. The PSL experience counted for 10% of the final cardiovascular course grade (the same as a quiz). After completion of the course, and grade assignments, a survey evaluating the PSL experience was distributed to the medical students. These data were analyzed using simple incidence of response, or chi-square as appropriate; p < .05 between groups was considered significant. All but one of the 104 students completed all three components of the PSL experience, and 82 of them completed the questionnaire. Of these, 95% regarded the experience as worthwhile and 85% as significantly contributing to their understanding of cardiovascular physiology. Further, 92% hoped that the PSL could be applied to future teaching modules, 56% would recommend a medical school that has patient simulation as part of the core curriculum, and 93% considered the PSL an important component of a future residency program. There was no difference in satisfaction between the men and women, students over age 30, or those students with previous health care, engineering, or computer science experience. Discussion: We report our experiences with the patient simulation technology as a required component of second-year medical student core curriculum in cardiovascular physiology. Our data suggest that the PSL had an immediate impact on this medical student course.