Board #118 - Research Abstract Real Time Quantification of Stress during High-fidelity Human Simulation for a Standardized Learning Experience (Submission #9956)

Abstract

Hypothesis: A resident's first lumbar puncture (LP) often occurs in a high-stakes environment where patient management depends on its success. Unfortunately, most junior residents do not achieve the competency level required for this important skill. Simulation with deliberate practice may be an important instructional method to facilitate skill development in trainees, but is often restricted due to human resource limitations. If students could learn equally well from peer teaching (as compared to instructor led teaching) this could enable medical schools an opportunity to increase the pool of instructors and the amount of teaching it can provide. The main objectives of this pilot study were: 1) To determine if students taught LP skills by their peers perform as well on a simulated LP task trainer as students taught by experts; and 2) To determine if teaching peers results in improved performance of the student doing the teaching.Methods: We conducted a block randomized trial comparing three groups of third year medical students' LP skill acquisition at the Montreal Children's Hospital. Students (n=60) were given two 30 minute sessions with the LP task trainer . Group 1 (control group, n=20) was initially taught via deliberate practice by an expert and then had 30 minutes of self-guided practice. Group 2 (student teachers, n=20) were similarly taught by an expert and then had 30 minutes to teach a peer. Group 3 (peer taught, n=20) was taught by group 2 and then given an additional 30 minutes of self-guided practice. All students had an equal amount of time with the task trainer. Assessments of students were conducted 4-6 weeks after training with a previously validated 15-point checklist by an assessor blinded to group allocation. The main outcome measure was the mean score on the 15-point checklist compared using independent sample t-tests. Results:The mean score of students taught by an expert (i.e. group 1) was 11.9 (SD 2.2) and those taught by their peers (i.e. group 3) was 11.7 (SD 2.0); the difference between groups was not statistically significant (p=0.83). Moreover, the mean score of students who taught their peers (i.e. group 2) was 12.9 (SD 1.9); there was no statistically significant difference when compared to group 1 (p=0.13). Conclusion:The students taught by their peers achieved the same degree of competency as students taught by experts. This could potentially provide medical schools with valuable new resources for teaching. We did not observe a benefit to the learner from, 'teaching the skill' to their peers as compared to practicing on their own, though the study may have been underpowered to detect a small difference.Hypothesis: A curvilinear relationship exists between stress and learning, implying that both extremes of high or low stress negatively impacts learning and performance. Stress is a central component of the High-fidelity Human Simulation (HFHS), which is increasingly being used in nursing education as an active learning tool. A degree of stress during participation arises from fa...