UCF College of Medicine

UCF Stands for Opportunity

Integrating Basic Sciences and Patient Care in a Core Clerkship

Curriculum:

Transforming Medical Education Through Simulation and Technology

Lynn M. Crespo, Ph.D.Assistant Dean

Undergraduate Medical Education

UCF College of Medicine

UCF Stands for Opportunity

ChallengesLast Century Medical School Curriculum:• Emphasizes knowledge and skill• Lacks emphasis on critical thinking, judgment,

decision-making or teamwork• Silos basic science and clinical knowledge - not

integrated• Relies on lecture-based teaching methods• Not appealing to “digital natives”

UCF College of Medicine

UCF Stands for Opportunity

Addressing the Challenges

• Use simulation and technology as a tool• Change model from “see one, do one,

teach one” to…– “See many, practice many, then…do one”

UCF College of Medicine

UCF Stands for Opportunity

Evolution of Medical Education

StandardizedPatients

AdvantagesSafe, controlled environment

LimitationsLimited opportunities for practice

Expensive

Lecture

AdvantagesEfficient

LimitationsLow fidelity

No skills training

Virtual Patient

Repetitive practice

Standardized

Exposure to many populations

Safe practice environment

Mannequin

AdvantagesProcedural skills

LimitationsPoor communication skills training

Expensive

Clerkship & Internship

AdvantagesReal patients

LimitationsLimited opportunities for practice

Negative role modeling

UCF College of Medicine

UCF Stands for Opportunity5

Background• Simulation-based instruction has been

shown to enhance learning & skill acquisition

• Few Medical Schools are using simulation to its full potential

UCF College of Medicine

UCF Stands for Opportunity6

State of the Practice in Medical Simulation

• Mostly mannequin based– Sophisticated systems that respond to

trainee actions– Used primarily for team training and

advanced skill development

• Limited use of electronic simulations (exception = laparoscopic surgery)

• Deficit of simulation/modeling to enhance acquisition of basic knowledge, attitudes or behavior

UCF College of Medicine

UCF Stands for Opportunity7

Opportunity• Introduce a simulation-based curriculum “out of the

gate” starting Day 1 • Possibilities:

– Enhance paper-based problem/case presentation with simulated environments

– Improve mental model development using 3-D graphics and visualization techniques

– Augment standardized patient exercises– Provide virtual environment for practice of communication

and empathy– Virtual patients that can be followed through time

UCF College of Medicine

UCF Stands for Opportunity

Simulation-Specific Plans

• live and simulated patients• real-world situations in a protected

environment• experiential learning– context in which future learning can

be situated

Create an “Immersive Experience”

UCF College of Medicine

UCF Stands for Opportunity

Virtual Patients

• Extensive use of avatars/computerized cases

• Integrated context in which cases are scripted and presented

• Augments and enhances in-class and clinical learning

UCF College of Medicine

UCF Stands for Opportunity

Virtual Patient Case Characteristics

• Interactive case management environment

• Critical thinking and diagnostic skills

• Collect information, order tests, and make diagnoses

• Justify decisions based on science• Track and measure performance • Immediate feedback• Analyze decision making processes

UCF College of Medicine

UCF Stands for Opportunity

E-Log Books

• Basic Science Development of Specified Cases– EXAMPLE

• Medicine – Cardiology– CHF: Based on patient case entered, discuss:

» Physiological basis for symptoms» Explanation of tests ordered» Mechanism of therapeutic benefit for

treatment ordered

UCF College of Medicine

UCF Stands for Opportunity

Capstone Cases

• Introduced in Year 1• Followed throughout basic science years• Transfer of knowledge to real patients in

Clerkship Years

UCF College of Medicine

UCF Stands for Opportunity

Capstone Case Example• TY is a 32 year old woman who presents to her physician for

new onset leg edema. She has been a type 2 diabetic since age 17, on insulin since age 22. Her mother and two of her sisters also have type 2 diabetes, and are obese. Her glucoses have been poorly controlled, and she neglects to check her glucose levels. She has gained 30 pounds over the last year, now weighing 250 pounds (she is 5”1” tall). She complains of vague chest pains on walking up stairs. Her physician finds that she has significant leg edema, numbness in her toes, an elevated serum glucose concentration (200 mg/dL), and heavy (4+) proteinuria on urinalysis.

UCF College of Medicine

UCF Stands for Opportunity

Mapping of Capstone Case

• Biochemistry – Metabolic pathways for glucose metabolism.

• Genetics – Pedigree, modes of inheritance• Physiology – Effects of insulin, glucagon• Pathology – Complications of diabetes• Pharmacology – Treatment, adverse effects

UCF College of Medicine

UCF Stands for Opportunity

Years 3 and 4

• OB/Gyn – Complications of pregnancy• Medicine – Cardiovascular complications• Neuro – CVA, retinopathy• Pediatrics – Type 1 vs Type 2; increasing

childhood obesity • Family medicine – Diagnosis, prevention,

lifestyle modification• Surgery – Risks, complications in diabetic

UCF College of Medicine

UCF Stands for Opportunity

Summary

• Virtual patients provide opportunity to revisit basic science concepts, track critical thinking, apply knowledge to real scenarios

• Electronic log-books require basic science work-up of real cases

• Capstone cases provide virtual longitudinal experience of patient across disciplines and specialties

UCF College of Medicine

UCF Stands for Opportunity

UCF College of Medicine

UCF Stands for Opportunity

UCF College of Medicine

UCF Stands for Opportunity

UCF College of Medicine

UCF Stands for Opportunity

THANK YOU!

Questions??? Discussion