A Comparison of Simulation-Based Education Versus Lecture-Based Instruction for Toxicology Training in Emergency Medicine Residents

Abstract

Simulation-based teaching (SIM) is a common method for medical education. SIM exposes residents to uncommon scenarios that require critical, timely actions. SIM may be a valuable training method for critically ill poisoned patients whose diagnosis and treatment depend on key clinical findings. Our objective was to compare medical simulation (SIM) to traditional lecture-based instruction (LEC) for training emergency medicine (EM) residents in the acute management of critically ill poisoned patients. EM residents completed two pre-intervention questionnaires: (1) a 24-item multiple-choice test of four toxicological emergencies and (2) a questionnaire using a five-point Likert scale to rate the residents' comfort level in diagnosing and treating patients with specific toxicological emergencies. After completing the pre-intervention questionnaires, residents were randomized to SIM or LEC instruction. Two toxicologists and three EM physicians presented four toxicology topics to both groups in four 20-min sessions. One group was in the simulation center, and the other in a lecture hall. Each group then repeated the multiple-choice test and questionnaire immediately after instruction and again at 3 months after training. Answers were not discussed. The primary outcome was comparison of immediate mean post-intervention test scores and final scores 3 months later between SIM and LEC groups. Test score outcomes between groups were compared at each time point (pre-test, post-instruction, 3-month follow-up) using Wilcoxon rank sum test. Data were summarized by descriptive statistics. Continuous variables were characterized by means (SD) and tested using t tests or Wilcoxon rank sum. Categorical variables were summarized by frequencies (%) and compared between training groups with chi-square or Fisher's exact test. Thirty-two EM residents completed pre- and post-intervention tests and comfort questionnaires on the study day. Both groups had higher post-intervention mean test scores (p < 0.001), but the LEC group showed a greater improvement compared to the SIM group (5.6 [2.3] points vs. 3.6 [2.4], p = 0.02). At the 3-month follow-up, 24 (75 %) tests and questionnaires were completed. There was no improvement in 3-month mean test scores in either group compared to immediate post-test scores. The SIM group had higher final mean test scores than the LEC group (16.6 [3.1] vs. 13.3 [2.2], p = 0.009). SIM and LEC groups reported similar diagnosis and treatment comfort level scores at baseline and improved equally after instruction. At 3 months, there was no difference between groups in comfort level scores for diagnosis or treatment. Lecture-based teaching was more effective than simulation-based instruction immediately after intervention. At 3 months, the SIM group showed greater retention than the LEC group. Resident comfort levels for diagnosis and treatment were similar regardless of the type of education.

Same Content, Different Methods:

“…Simulation incorporates communication, teamwork, hands-on practice, and standardized assessments of patient care scenarios without risking patient injury or discomfort. Multiple studies comparing high-fidelity simulation training to standard lectures have found simulation improves long-term knowledge retention, 1 performance…”

Medical simulation in pharmacology learning and retention: A comparison study with traditional teaching in undergraduate medical students

“…To assess effective learning and long‐lasting retention, a 20 multiple‐choice‐question questionnaire on positive inotropic drugs was administered at several time intervals: at baseline, after lecture, immediately after simulation (either Sham or LF or HF) and 3 months after simulation to obtain information on long‐lasting retention, as previously suggested . A 20‐minute period was allowed to complete the questionnaire.…”

Addressing the growing opioid and heroin abuse epidemic: a call for medical school curricula

“…Moreover, studies show that when training medical students on proper critical assessment and management of critically ill patients, students trained via an SBME method outperform students trained via a didactic lecture or problem-based learning method [38,39]. SBME has also been shown to enhance retention of training information compared to lectures [40]. While changing all aspects of medical curricula is important for preparing students to address the heroin and fentanyl crisis, simulation is a necessary component to ensure students are as best prepared as possible.…”