Advertisement

Journal of Medical Toxicology

, Volume 10, Issue 4, pp 364–368 | Cite as

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

  • Joseph K. MaddryEmail author
  • Shawn M. Varney
  • Daniel Sessions
  • Kennon Heard
  • Robert E. Thaxton
  • Victoria J. Ganem
  • Lee A. Zarzabal
  • Vikhyat S. Bebarta
Toxicology Investigation

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.

Keywords

Toxicology Simulation Education Training Residency 

Supplementary material

13181_2014_401_MOESM1_ESM.docx (48 kb)
ESM 1 (DOCX 48 kb)
13181_2014_401_MOESM2_ESM.doc (915 kb)
ESM 2 (DOC 915 kb)
13181_2014_401_MOESM3_ESM.doc (32 kb)
ESM 3 (DOC 31 kb)

References

  1. 1.
    Dasgupta A, Emerson L (1998) Neutralization of cardiac toxins oleandrin, oleandrigenin, bufalin, and cinobufotalin by Digibind: monitoring the effect by measuring free digitoxin concentrations. Life Sci 63:781PubMedCrossRefGoogle Scholar
  2. 2.
    Lapostolle F, Borron SW, Verdier C et al (2008) Digoxin-specific Fab fragments as single first-line therapy in digitalis poisoning. Crit Care Med 36:3014PubMedCrossRefGoogle Scholar
  3. 3.
    Bond WF, Lammers RL, Spillane LL, Smith-Coggins R, Fernandez R, Reznek MA, Vozenilek JA et al (2007) The use of simulation in emergency medicine: a research agenda. Acad Emerg Med 14(4):353–363PubMedCrossRefGoogle Scholar
  4. 4.
    Issenberg SB, Scalese RJ (2008) Simulation in health care education. Perspect Biol Med 51(1):31–46PubMedCrossRefGoogle Scholar
  5. 5.
    Rosen KR, McBride JM, Drake RL (2009) The use of simulation in medical education to enhance students’ understanding of basic sciences. Med Teach 31(9):842–846PubMedCrossRefGoogle Scholar
  6. 6.
    Holmstrom SW, Downes K, Mayer JC, Learman LA (2011) Simulation training in an obstetric clerkship: a randomized controlled trial. Obstet Gynecol 118(3):649–654PubMedCrossRefGoogle Scholar
  7. 7.
    Ziv A, Ben-David S, Ziv M (2005) Simulation based medical education: an opportunity to learn from errors. Med Teach 27(3):193–199PubMedCrossRefGoogle Scholar
  8. 8.
    Cook DA, Hatala R, Brydges R, Zendejas B, Szostek JH, Wang AT, Erwin PJ et al (2011) Technology-enhanced simulation for health professions education: a systematic review and meta-analysis. JAMA 306(9):978–988PubMedCrossRefGoogle Scholar
  9. 9.
    McFetrich J (2006) A structured literature review on the use of high fidelity patient simulators for teaching in emergency medicine. Emerg Med J 23(7):509–511PubMedCentralPubMedCrossRefGoogle Scholar
  10. 10.
    Lam G, Ayas NT, Griesdale DE, Peets AD (2010) Medical simulation in respiratory and critical care medicine. Lung 188(6):445–457PubMedCrossRefGoogle Scholar
  11. 11.
    Halm BM, Lee MT, Franke AA (2010) Improving medical student toxicology knowledge and self-confidence using mannequin simulation. Hawaii Med J 69(1):4–7PubMedCentralPubMedGoogle Scholar
  12. 12.
    Zigmont JJ, Kappus LJ, Sudikoff SN (2011) Theoretical foundations of learning through simulation. Semin Perinatol 35(2):47–51PubMedCrossRefGoogle Scholar
  13. 13.
    Issenberg SB, McGaghie WC, Petrusa ER, Lee Gordon D, Scalese RJ (2005) Features and uses of high-fidelity medical simulations that lead to effective learning: a BEME systematic review. Med Teach 27(1):10–28PubMedCrossRefGoogle Scholar
  14. 14.
    Yarris LM, Deiorio NM (2011) Education research: a primer for educators in emergency medicine. Acad Emerg Med 18(Suppl 2):S27–S35PubMedCrossRefGoogle Scholar

Copyright information

© American College of Medical Toxicology (outside the USA) 2014

Authors and Affiliations

  • Joseph K. Maddry
    • 1
    Email author
  • Shawn M. Varney
    • 1
  • Daniel Sessions
    • 1
  • Kennon Heard
    • 2
  • Robert E. Thaxton
    • 1
  • Victoria J. Ganem
    • 1
  • Lee A. Zarzabal
    • 1
  • Vikhyat S. Bebarta
    • 1
  1. 1.San Antonio Military Medical CenterFt Sam HoustonUSA
  2. 2.Rocky Mountain Poison and Drug CenterDenverUSA

Personalised recommendations