Simulation Encounter to Promote Patient-Centered Discussions of Evidence-Based Medicine

01-27-2022 16:22


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.​




On completion of this session the participants should be able to...

  1. Identify challenges in engaging medical students to apply evidence-based medicine and population health content to clinical care.
  2. Evaluate the effect of standardized-patient simulation encounters on student understanding of evidence-based medicine content and application to clinical care.
  3. Evaluate the effect of standardized-patient simulation encounters on course satisfaction.
  4. 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)

  1. “Functions and Structure of a Medical School: Standards for Accreditation of Medical Education Programs Leading to the MD Degree,” Liaison Committee on Medical Education. Published March 20201. Accessed June 3, 2021
  2. “Family Medicine Milestones” The Accreditation Council for Graduate Medical Education. Revised October 2019. Accessed June 3, 2021
  3. Al-Elq, Abdulmohsen H. “Simulation-based medical teaching and learning.” Journal of family & community medicine 17,1 (2010): 35-40. doi:10.4103/1319-1683.68787
  1. 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.

Author(s):Alicia Ludden-Schlatter, MD, MSAM, Hugh Blumenfeld MD, PhD , Amelia Frank, MD, MSAM
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