An educational course including medical simulation for early goal-directed therapy and the severe sepsis resuscitation bundle: An evaluation for medical student training

doi:10.1016/j.resuscitation.2009.02.021

Resuscitation

Volume 80, Issue 6, June 2009, Pages 674-679

https://doi.org/10.1016/j.resuscitation.2009.02.021 Get rights and content

Abstract

Objective

Widespread application of early goal-directed therapy (EGDT) and the severe sepsis resuscitation bundle is limited by clinician knowledge, skills and experience. This study evaluated use of simulation-based teaching during medical training to increase future clinician knowledge in the above therapies for severe sepsis and septic shock.

Methods

A prospective cohort study was performed with medical students at all levels of training. A 5-h course including didactic lectures, skill workshops, and a simulated case scenario of septic shock were administered to the participants. A checklist including 21 tasks was completed during the patient simulation. An 18-question pre-test, post-test and 2-week post-test were given. The participants completed a survey at the end of the course.

Results

Sixty-three students were enrolled. There was statistical difference between the pre-test and each of the post-test scores: 57.5 ± 13.0, 85.6 ± 8.8, and 80.9 ± 10.9%, respectively. 20.6% of participants thought the pre-test was too difficult, whereas all participants thought the post-test was either appropriate or too easy. The task performance during the simulated septic shock patient was 94.1 ± 6.0%. The participants noted improvements in their confidence levels at managing severe sepsis and septic shock, and agreed that the course should be a requirement during medical school training.

Conclusions

Medical simulation is an effective method of educating EGDT and the severe sepsis resuscitation bundle to medical students with limited experience in patient care. The results suggest that our course may be of further benefit at increasing clinical experience with this intensive protocol for the management of severe sepsis and septic shock.

Introduction

After many years of unsuccessful clinical trials examining therapeutic strategies for severe sepsis and septic shock, we now have several treatment options with significant benefit for this illness.1, 2 Quality improvement efforts also advocate the implementation of hospital sepsis protocols and bundles.3, 4 Most important to the management of severe sepsis and septic shock is the early administration of appropriate antibiotics and early goal-directed therapy (EGDT) in the severe sepsis resuscitation bundle.3, 5, 6 Several authors have reported the benefits of EGDT when applied in clinical practice.7, 8, 9, 10, 11 However, the wide implementation of a sepsis protocol utilizing this time-sensitive intervention is fraught with many barriers, including lack of clinician knowledge, limited skills in hemodyamic optimization, and difficulty in recognition of disease severity.¹²

Medical simulation has become an integral part of medical education, patient safety, and crisis preparedness.13, 14, 15, 16, 17, 18, 19, 20 Research funding for simulation is also the ongoing focus of healthcare organizations.21, 22 Medical simulation can enhance physician knowledge and close the gap between research and clinical practice by performing several functions: “identifying unmet needs, identifying contextual barriers to change in practice, identifying changing cultural beliefs that may be barriers to behavior change, and raising physician and nursing awareness simultaneously”.²³

In this study, we applied a severe sepsis and septic shock course including medical simulation to medical students to show that simulation techniques can increase knowledge in EGDT for clinicians at the very beginning of their medical training, and possibly overcome some of the barriers in implementation of the severe sepsis resuscitation bundle.

Section snippets

Study design and setting

This study was a prospective cohort, performed at a university-based medical simulation center (MSC). The study was exempt from the Institutional Review Board review. The MSC is located in a 2500 ft² facility at the School of Medicine, and includes several simulation labs with infant, pediatric and adult patient simulators, a skills lab, multiple computer-based simulators, two multimedia debriefing rooms, and a high fidelity communication and control room. Simulation sessions are digitally

Results

Sixty-three students, 24 females and 39 males, at all levels of medical school were enrolled. The pre-test, post-test, and 2-week post-test scores were 57.5 ± 13.0, 85.6 ± 8.8, and 80.9 ± 10.9%, respectively. There was statistically significant improvement in each of the post-test scores compared to the pre-test scores at every level of medical school (Table 2). MS I, MS II, and MS III had greater improvements in their post-test scores, 30.6 ± 13.6, 30.2 ± 13.9, and 30.0 ± 14.7%, respectively, compared to

Discussion

Our study showed that medical simulation is an effective method for teaching the early management of severe sepsis and septic shock during medical school training. Since EGDT and the severe sepsis resuscitation bundle require a team approach, classroom teaching and simulation may allow participants from multiple disciplines to contribute and gain expertise. Our results suggest the course was easily comprehensible. The most novice participants, including MS I's at the very beginning of their

Conclusions

We showed in this study that our course including medical simulation is an effective method of educating early goal-directed therapy to medical students with limited experience in patient care. The application of medical simulation may overcome some of the barriers in the early management of severe sepsis and septic shock. Our course includes components to enhance clinician knowledge and recognition of disease severity, teach or refresh procedural skills required in hemodynamic optimization,

Conflict of interest

H. Bryant Nguyen, MD, has received lecture honoraria and research funding from Edwards Lifesciences, Irvine, California.

Acknowledgments

We thank the medical students at Loma Linda University, School of Medicine, for their contribution in this study. This study was partially funded by an unrestricted educational grant from Edwards Lifesciences, Irvine, California. Edwards Lifesciences did not contribute in any manner to the design of the study, to the writing of this manuscript nor to the decision of its submission for publication.

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^☆: This study was presented, in part, at the 8th International Meeting on Simulation in Healthcare, San Diego, California, January 2008; and the 12th International Conference on Emergency Medicine, San Francisco, California, April 2008.

^☆☆: A Spanish translated version of the summary of this article appears as Appendix in the final online version at doi:10.1016/j.resuscitation.2009.02.021.

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Simulation and educationAn educational course including medical simulation for early goal-directed therapy and the severe sepsis resuscitation bundle: An evaluation for medical student training☆,☆☆

Abstract

Objective

Methods

Results

Conclusions

Introduction

Section snippets

Study design and setting

Results

Discussion

Conclusions

Conflict of interest

Acknowledgments

Crit Care Clin

Chest

Chest

Anesthesiol Clin

Am J Emerg Med

Ann Emerg Med

Chest

Sepsis: rethinking the approach to clinical research

J Leukoc Biol

Surviving sepsis Campaign: international guidelines for management of severe sepsis and septic shock: 2008

Crit Care Med

Duration of hypotension before initiation of effective antimicrobial therapy is the critical determinant of survival in human septic shock

Crit Care Med

Early goal-directed therapy in the treatment of severe sepsis and septic shock

N Engl J Med

The impact of compliance with 6-hour and 24-hour sepsis bundles on hospital mortality in patients with severe sepsis: a prospective observational study

Crit Care

Implementation and outcomes of the Multiple Urgent Sepsis Therapies (MUST) protocol

Crit Care Med

Implementation of a bundle of quality indicators for the early management of severe sepsis and septic shock is associated with decreased mortality

Crit Care Med

Barriers to implementing protocol-based sepsis resuscitation in the emergency department—results of a national survey

Crit Care Med

Simulation technology for skills training and competency assessment in medical education

J Gen Intern Med

The use of simulation in emergency medicine: a research agenda

Acad Emerg Med

The use of clinical simulation systems to train critical care physicians

J Intensive Care Med

Education and simulation techniques for improving reliability of care

Curr Opin Crit Care

Simulation and education
An educational course including medical simulation for early goal-directed therapy and the severe sepsis resuscitation bundle: An evaluation for medical student training☆,☆☆