Long-Term Educational Impact of a Simulator Curriculum on Medical Student Education in an Internal Medicine Clerkship

Background: Medical simulation is frequently used in postgraduate medical training, but its value and sustainability in medical student education are less clear. We report the first long-term experience of mannequin simulation in an internal medicine clerkship. Methods: During a 6-year period (2002-2009), 327 Harvard medical students participated in a simulator-based teaching experience designed to expose students to the principles of myocardial infarction (MI). This experience was additive to a 12-week clerkship curriculum. Through blinded survey instruments, we sought to determine how the simulator exercise modified student exposure to a core curricular objective in the traditional clerkship. We also sought student and faculty perception of this educational tool and factors important to sustainability. Results: Three hundred twenty-seven consecutive students were exposed to the simulation exercise and their experiences evaluated. Three hundred twenty-six students (99%) described the simulation experience as valuable, with >69% requesting multiple sessions be provided during each clerkship. Although a core objective, only 78% of students reported having a didactic teaching session on MI during the clerkship, and only 47% of students reported exposure to a live patient with MI. Furthermore, only 15% of students reported exposure to at least two different clinical presentations of MI, allowing comparison and reflection. Thus, the simulation exercise provided the only exposure to this topic for 22% of students and facilitated comparisons of different clinical presentations for 85% of students. When students participated in both the simulator and the didactic sessions, 74% favored the simulation exercise. Faculty cited small group size, once monthly delivery and focused curricula as key points for sustainability of this effort. Conclusion: Mannequin simulation is a valuable and sustainable addition to a third-year internal medicine clerkship. For some students, simulation provides otherwise unavailable exposure to core content material. For the majority of students, simulation also provides the only means of exposure to multiple presentations of a single illness. Together, these data strongly suggest that simulation promotes both experiential learning and comparative analysis in a clerkship setting. (Sim Healthcare 5:75-81, 2010)