Abstract:
Purpose: Despite curricula on Evidence-Based Medicine (EBM) and population health, first-year medical students at the University of Missouri did not see these topics as relevant to future practice. We piloted a standardized patient (SP) simulation designed to increase student engagement in EBM topics and enabling students to integrate them into clinical care.
Methods: In April 2021, we introduced a 15-minute simulated encounter for first-year medical students taking a required course in EBM, epidemiology, and public health: an average-risk 46-year-old woman asking for a mammogram. Students were to review USPSTF and ACS recommendations, discuss risks/benefits of mammography by age, and engage in shared decision-making. Trained SPs scored student performance. Pre/post surveys assessed students’ comfort, self-perceived competence, perceived relevance of EBM in clinical care, and usefulness of the encounter. Faculty surveys assessed usefulness and invited feedback.
Results: Of 128 students, 77% responded to a pre- and 61% to a post-encounter survey. Though 90% “somewhat” or “strongly” agreed that applying research and guideline recommendations to patient care decisions was valuable and that EBM was relevant to future practice beforehand, we still saw a trend upward post-encounter. The encounter increased the number who felt comfortable discussing EBM concepts (62% vs 84%), with two-thirds agreeing that it increased their comfort and over half (57%) agreeing that it increased their skills. The mean simulation score of 84% confirms these self-assessments. Compared to the previous year (N=111), student end-of-course evaluations also improved, with Likert ratings for developing patient care skills, applying course content, emphasizing EBM and delivering patient-centered care all improved from a mean of 3.35 to 3.84. Of 21 faculty, 33% responded to a survey; 100% agreed that the simulation “was useful in training students to discuss EBM topics with patients” and 100% agreed it “should continue to be incorporated into the curriculum.”
Conclusions: This pilot determined that simulated patient encounters can be a valuable tool to prepare students to lead evidence-based, patient-centered discussions in clinical settings. It improved student self-assessments and course evaluations regarding applying EBM to patient care and improved skills and comfort with facilitating discussions of EBM with patients. Faculty response was highly favorable.
Objectives:
On completion of this session the participants should be able to...
- Identify challenges in engaging medical students to apply evidence-based medicine and population health content to clinical care.
- Evaluate the effect of standardized-patient simulation encounters on student understanding of evidence-based medicine content and application to clinical care.
- Evaluate the effect of standardized-patient simulation encounters on course satisfaction.
- Develop a standardized-patient simulation encounter to increase student understanding of evidence-based medicine and population health and apply these concepts to unique patient care scenarios.
References: (Character Limit: 1500)
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- “Family Medicine Milestones” The Accreditation Council for Graduate Medical Education. Revised October 2019. https://www.acgme.org/portals/0/pdfs/milestones/familymedicinemilestones.pdf. Accessed June 3, 2021
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- McGaghie WC, Issenberg SB, Barsuk JH, Wayne DB. A critical review of simulation-based mastery learning with translational outcomes. Med Educ. 2014;48(4):375-385. https://doi.org/10.1111/medu.12391