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MEDICAL STUDENTS' APPROACH TO SIMULATED CRITICAL EVENTS

Pamela J Morgan, MD, CCFP, FRCPC^*, Doreen Cleave-Hogg, PhD, Susan Eveleigh, RRT^* and Jordan Tarshis, FRCPC^*

^* Department of Anesthesia, Sunnybrook & Women's College Health Sciences Centre and
Centre for Research in Education, University of Toronto

INTRODUCTION

The purpose of this study was to examine how medical students approach the management of critical events using a high-fidelity patient mannequin

METHODS

The Undergraduate Education Committee developed ten scenarios based on the objectives of the anesthesia undergraduate curriculum. Performance protocols were designed by asking fifteen faculty involved in undergraduate education to propose expected performance items at a level appropriate for medical students. These items consisted of essential management maneuvers as well as critical omissions. Items endorsed by less than 20% of faculty were deleted. Each item was weighted according to the number of faculty listing the response with a possible total score of 100. These protocols were used to score the students' videotaped performances. Incorrect responses were subtracted from correct responses and a negative score was possible if students committed multiple management errors. Mistakes were categorized into management omissions and critical omissions.

RESULTS

Performance data of 165 students were analyzed with some students having managed more than one case. Mean performance scores for the 10 scenarios was 47.39 (Range–24.44 to 79.88). The management of ventricular tachycardia was associated with the lowest scores and the management of postoperative hypotension in the recovery room associated with the highest scores. Common management omissions (% occurrence) were failure of adequate airway management (44%), failure to check blood pressure (38%), and failure to increase FiO₂ (33%). Students reliably performed the following during critical event management: air entry check (92%), administration of intravenous fluids (89%), verbalization of differential diagnosis or management plan (86%), and initiation of treatment (76%). The most common critical omissions were failure to call for help (80%), failure to take a history/do physical examination (59%), and failure to prepare airway equipment (31%).

DISCUSSION

Management and critical omissions noted during performance assessments provide information regarding students' educational needs enabling faculty to focus attention on demonstrated areas of weakness. Emphasis on the importance of calling for help and performing a focussed history and physical examination during critical event management are two areas where educational efforts should be improved.

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