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J Grad Med Educ. 2012 Dec;4(4):490-5. doi: 10.4300/JGME-D-11-00261.1.

Pilot program using medical simulation in clinical decision-making training for internal medicine interns.

Abstract

BACKGROUND:

The use of high-fidelity medical simulation in cognitive skills training within internal medicine residency programs remains largely unexplored.

OBJECTIVE:

To design a pilot study to introduce clinical decision-making training using simulation into a large internal medicine residency program, explore the practicability of using junior and senior residents as facilitators, and examine the feasibility of using the program to improve interns' clinical skills.

METHODS:

Interns on outpatient rotations participated in a simulation curriculum on a voluntary basis. The curriculum consisted of 8 cases focusing on acute clinical scenarios encountered on the wards. One-hour sessions were offered twice monthly from August 2010 to February 2011. Internal medicine residents and simulation faculty served as facilitators.

RESULTS:

A total of 36 of 75 total interns volunteered to participate in the program, with 42% attending multiple sessions. Of all participants, 88% rated the sessions as "excellent," 97% felt that the program improved their ability to function as an intern and generate a plan, and 81% reported improvement in differential diagnosis skills.

CONCLUSIONS:

Simulation training was well received by the learners and improved self-reported clinical skills. Using residents as facilitators, supervised by faculty, was well received by the learners and enabled the implementation of the curriculum in a large training program. Simulation can provide opportunities for deliberate practice, and learners perceive this modality to be effective.

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