Background: In 2014, the Association of American Medical Colleges (AAMC) published a list of Entrustable Professional Activities (EPAs) that students should be able to perform upon starting residency. The University of Pittsburgh School of Medicine (UPSOM) has surveyed our neurology clerkship students in regard to EPAs since 2017; according to this data, we have been deficient in addressing EPAs 4 (enter and discuss orders/prescriptions), 11 (obtain informed consent for tests and/or procedures), and 12 (perform general procedures of a physician). We therefore developed a hybrid simulation experience encompassing these three skills, centered around lumbar puncture (LP). Methods: We created a hybrid LP simulation for students on the neurology clerkship encompassing EPAs 4, 11, and 12. Students first obtained informed consent for LP from a Standardized Patient, then performed LP on a specialized manikin. They then entered orders on CSF into a simulated patient chart. Real-time feedback was provided for all three components. Students filled out surveys to assess their perceived confidence and skill with these activities both pre-and post-simulation. Results: The percentage of students who increased their confidence with LP from minimal or less to average or more was 58.24%, 38.47%, and 26.38% for LP, informed consent, and order entry, respectively. The percentage of students who improved from not being able to perform/needing significant supervision to being able to perform with minimal supervision/ independently was 25.27%, 47.25% and 28.58%, for LP, informed consent, and order entry, respectively. These differences were all statistically significant (p <0.0001). Conclusions/Significance: Hybrid LP simulation was effective in increasing medical student confidence and perceived skill with EPAs 4, 11, and 12.
Author Revision Notes-clarification of terms: definition of "clerkships", "PGY-1", and "MS-4" as these terms pertain to US medical education -correction of minor error in data reporting: 49 students completed the end-of-clerkship survey, not 50 as previously reported. Results and percentages from this survey were corrected to address this error. -introduction and results section edited for clarity: introduction section includes more background of the structure of the US medical education system. Results section has been reorganized into subheadings covering confidence and perceived skill with each EPA, preceptor evaluation of students, and comparison of real-world experience between simulation and no-simulation cohort. -tables edited for clarity: order of EPAs in table changed to reflect order in text, and column headings changed to the name of each specific EPA as opposed to EPA number.
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