Design and Effectiveness of a Required Pre-Clinical Simulation-based Curriculum for Fundamental Clinical Skills and Procedures

Figures & data

Table 1. Overview of Clinical Skills Laboratory curriculum: Sessions, competency-based learning objectives, and performance applications/formats

SPM 200 Clinical Skills Lab
Lab #	Lab Title	Objectives/Competencies	Applications
1	Standard Precautions/Sterile Technique	Demonstrate and review the use of gowns, gloves, and eye protection when the risk of exposure to body fluids. Demonstrate and review hand hygiene, and surgical hand scrub technique. Also maintaining a sterile field. Nosocomial infections: magnitude and prevention of these infections	Scrub Don Sterile clothing Maintain sterile field
2	Emergency Assessment of Vital Signs	Demonstrate and review pain scale, temperature, pulse, respiratory rate and blood pressure in the adult and pediatric patients.	Student to Student Patient Simulators
3	Basic Life Support (BLS) American Heart Association	Demonstrate and review American Heart Association Standards	Patient Simulator
4	Cardiac Monitor and Pulse Oximetry	Demonstrate and review reading and assessment of Pulse Oximeter and ECG monitor	Student to Student Patient Simulators
5	C-Spine Immobilization, Hemorrhage Control and Splinting Extremities	Demonstrate and review appropriate cervical spine immobilization. Demonstrate and review appropriate measures to control external hemorrhage and splinting techniques for extremity injuries.	Student to Student
6	Simple Suture	Demonstrate and review appropriate Simple Suturing: indications, contraindications, technique and equipment. Demonstrate proper technique of wound irrigation.	Cadavers Patient Simulators
7	Emergency Assessment	Demonstrate and review vital signs abnormalities of temperature, pulses, respirations and blood pressure for disease states. Generate Differential Diagnosis from altered vital signs.	Patient Simulators
SPM 200 Clinical Skills Lab
Lab #	Lab Title	Objectives/Competencies	Applications
1	Heart Sounds and Ultrasound	Demonstrate and review proper technique for cardiac exam. Assessment of basic (S1 and S2) sounds and murmurs (systolic, diastolic, S3 and S4) Identify the anatomy of the heart in the transthoracic apical view.	Patient Simulator Student
2	GU (Foley) Catheterization/Pelvic/Rectal/Breast/Testicular Examinations	Demonstrate and review appropriate Urethral Catheterization (Male /Female) and Pelvic, Breast, Rectal, Testicular Examinations: indications, contraindications, technique and equipment	GU Cath Simulators: M/F Pelvic, Breast, Testicular, Rectal Simulators
3	IV/Venipuncture	Demonstrate and review appropriate IV catheterization: indications, contraindications, technique and equipment. Demonstrate Standard Precautions	Patient Simulator Student to Student
4	Local Anesthesia/Digital Block	Demonstrate and review appropriate Local Anesthetic and Digital Block: indications, contraindication, technique, and equipment. Demonstrate Standard Precautions	Cadaver
5	Lumbar Puncture	Demonstrate and review appropriate Lumber Puncture: indications, contraindications, technique and equipment. Demonstrate standard precautions and sterile technique	Simulator
6	Oral/Nasalgastic Tube/Oral/Nasal Airway (Intubation)/O2 Delivery Devices	Demonstrate and review appropriate Oral/Nasogastic tube intubation, Oral endotracheal intubation with Nasal and Oral airways: indications, contraindications, technique and equipment.	Patient Simulator Gastic Model Intubation Models: (Adult, Child, Infant)
7	Abnormal ECG Interpretation and Treatment	Demonstrate and review primary ABCD survey use to asses and guide initial treatment Demonstrate and review secondary survey and provide advance management of patient. Demonstrate and review the use of antiarrhythmic drugs verses electrical (shock) for treatment	Patient Simulator
8	Basic Trauma Life Support and Trauma Resuscitation	Evaluate trauma patient utilizing primary and secondary survey. Recognize immediate life threatening conditions associated with trauma. Demonstrate appropriate surgical consultation and diagnosis planning for trauma patients.	Patient Simulator

Table 2. Comparison of second-year students’ self-perceived expertise for performing eight clinical procedures before and after clinical skills lab training.

		Novice	Advanced Beginner	Competent	Proficient	Expert
CPR^a	Pre-CSL^b	21.4%	40.8%	22.5%	13.3%	2.0%
	Post-CSL	7.8%	29.9%	31.8%	24.7%	5.8%
Mask Ventilation	Pre-CSL	48.0%	27.6%	18.4%	5.1%	1.0%
	Post-CSL	13.6%	31.8%	33.1%	15.6%	5.8%
GU Cath	Pre-CSL	84.7%	7.1%	8.1%	0.0%	0.0%
	Post-CSL	18.8%	44.2%	22.7%	10.4%	3.9%
Pelvic exam	Pre-CSL	76.5%	16.3%	2.0%	5.1%	0.0%
	Post-CSL	18.8%	42.2%	29.2%	7.8%	2.0%
IV	Pre-CSL	67.4%	18.4%	8.2%	5.1%	1.0%
	Post-CSL	16.2%	46.4%	25.3%	6.5%	2.6%
Skin suturing	Pre-CSL	71.4%	15.3%	6.1%	4.1%	3.1%
	Post-CSL	9.7%	39.0%	32.5%	14.3%	4.6%
Lumbar puncture	Pre-CSL	50.0%	36.7%	12.2%	1.0%	0.0%
	Post-CSL	10.4%	47.4%	31.2%	11.0%	0.0%
Intubation	Pre-CSL	50.0%	36.7%	12.2%	1.0%	0.0%
	Post-CSL	10.4%	47.4%	31.2%	11.0%	0.0%

^a The difference between pre-CSL and post-CSL is statistically significant (χ² test): cardiopulmonary resuscitation (CPR), p = 0.0011; mask ventilation, p < 0.0001; GU catheterization, p < 0.0001; pelvic exam, p < 0.0001; intravenous placement (IV), p < 0.0001; skin suturing, p < 0.0001; lumbar puncture, p < 0.0001; intubation, p < 0.0001.

^b Pre-CSL, n = 98; post-CSL, n = 154

Table 3. Comparison of number of procedure performed by students in the second year before and after clinical skills lab training.

		0	1–2	3–10	11–20	>20
CPR^a	Pre-CSL^b	39.8%	38.8%	17.4%	3.1%	1.1%
	Post-CSL	3.9%	32.5%	41.6%	18.8%	3.3%
Mask Ventilation	Pre-CSL	64.3%	25.5%	8.2%	0.0%	2.0%
	Post-CSL	9.7%	52.0%	27.3%	5.8%	5.2%
GU Cath	Pre-CSL	88.8%	6.1%	3.1%	2.0%	0.0%
	Post-CSL	9.1%	68.8%	14.9%	3.9%	3.3%
Pelvic exam	Pre-CSL	78.6%	10.2%	6.1%	3.1%	2.0%
	Post-CSL	9.1%	68.8%	16.2%	3.3%	2.6%
IV	Pre-CSL	70.4%	19.4%	7.1%	0.0%	3.1%
	Post-CSL	8.4%	67.5%	18.2%	2.0%	3.9%
Skin suturing	Pre-CSL	61.2%	25.5%	8.2%	0.0%	5.1%
	Post-CSL	2.6%	45.5%	40.3%	9.7%	2.0%
Lumbar puncture	Pre-CSL	46.9%	51.0%	1.0%	1.0%	0.0%
	Post-CSL	6.5%	59.1%	31.8%	2.6%	0.0%
Intubation	Pre-CSL	51.0%	32.7%	14.3%	2.0%	0.0%
	Post-CSL	5.2%	35.1%	52.0%	5.8%	2.0%

^a The difference between pre-CSL and post-CSL is statistically significant (χ² test): cardiopulmonary resuscitation (CPR), p < 0.0001; mask ventilation, p < 0.0001; GU catheterization, p < 0.0001; pelvic exam, p < 0.0001; intravenous placement (IV), p < 0.0001; skin suturing, p < 0.0001; lumbar puncture, p < 0.0001; intubation, p < 0.0001.

^b Pre-CSL, n = 98; post-CSL, n = 154

Table 4. Correlation between self-efficacy level in performing procedures and the number of procedure performed in second year.

Procedure	CPR	Mask Ventilation	GU Cath	Pelvic exam	IV	Skin suturing	Lumbar puncture	Intubation
Spearman r^a	0.45	0.65	0.77	0.70	0.65	0.77	0.53	0.63

^a All eight Spearman rank order correlation coefficients are statistically significant, p < 0.0001.

Figure 1.  Mean scores for medical students’ self-efficacy/confidence ratings (5-point Likert scale) for performing eight clinical skills at four points during medical school: 1) Beginning, immediately prior to starting curriculum (L1), 2) End of second year, immediately after CSL training (L2), 3) End of third year, completion of core clerkships (L3), and 4) At the end of medical school, just prior to graduation (L4).