1. Enhancing a SimMan Experience through Team-Based Learning J. Pasley, M. Petty, M. Jennings, M. Soulsby, J. Firnhaber, M. Palacios, J.White UAMS, Little Rock, AR, USA J. Pasley, M. Petty, M. Jennings, M. Soulsby, J. Firnhaber, M. Palacios, J.White UAMS, Little Rock, AR, USA

2. Introduction Physiology educators formerly used animal- based laboratory exercises to reinforce basic physiological concepts. Medical simulation is now used to provide a link between basic science education and clinical bedside teaching. Physiology educators formerly used animal- based laboratory exercises to reinforce basic physiological concepts. Medical simulation is now used to provide a link between basic science education and clinical bedside teaching.

3. Introduction Patient simulation brings learning concepts to life in a clinical setting.

4. Overview Implementation of Simulation in Physiology Cardiovascular Pulmonary Implementation of Simulation in Physiology Cardiovascular Pulmonary Implementation of TBL to encourage Preparation for SimMan Experience

5. The Process Spring 2000 - 2002 Spring 2003 - 2005 Spring 2005 2007 Modification of Courses Included TBL Modified TBL Added 3 mannequins

6. Spring 2000-2002 Standard use of ECG and Spirometer Cardiovascular Physiology ECG interpretation Myocardial blood flow Heart failure Respiratory Physiology Airway resistance Restrictive lung disease Obstructive lung disease Mediocre Examination Performance by Students in both areas of Physiology Standard use of ECG and Spirometer Cardiovascular Physiology ECG interpretation Myocardial blood flow Heart failure Respiratory Physiology Airway resistance Restrictive lung disease Obstructive lung disease Mediocre Examination Performance by Students in both areas of Physiology

7. Spring 2003-2005 Modified courses to include SimMan computer-driven patient simulator Groups of 10 students 20 minute experience Observations Students not well prepared prior to simulator Hands-on activity by 3-5 students Interested students, but still passive Modified courses to include SimMan computer-driven patient simulator Groups of 10 students 20 minute experience Observations Students not well prepared prior to simulator Hands-on activity by 3-5 students Interested students, but still passive

8. Spring 2005 Added TBL to encourage preparation First implementation in medical curriculum at UAMS Group size = 10 IRAT given as members arrive for Simulator in waiting area GRAT given just outside of Simulator Lively questioning by most students Faculty learned how lecture/questions needed clarification Application Next classroom session In conjunction with review session for test Problematic Added TBL to encourage preparation First implementation in medical curriculum at UAMS Group size = 10 IRAT given as members arrive for Simulator in waiting area GRAT given just outside of Simulator Lively questioning by most students Faculty learned how lecture/questions needed clarification Application Next classroom session In conjunction with review session for test Problematic

9. Results Scores on the cardiovascular and respiratory exams with SimMan experience increased significantly compared to non SimMan experience.

10. 200320042005No SIM-MAN 2006 Pre SIM-MAN 2000 - 2002 SEM 5.30 SEM 2.01 SEM 2.84 SEM 2.25 SEM 6.50 Cardiovascular Physiology Cardiovascular Exams % correct

11. % Correct SEM 3.45 Respiratory Physiology Respiratory Questions SEM 7.14 SEM 5.65 SEM 4.76 SEM 9.84 Pre SIM-MAN 2000 - 2002 2003 20042005 No SIM-MAN 2006

13. Modified TBL 2007 Day before SimMan Experience IRAT- based on lecture concepts GRAT-group quiz and discussion over same questions as IRAT Application quiz administered during classroom review of SimMan exercise Day before SimMan Experience IRAT- based on lecture concepts GRAT-group quiz and discussion over same questions as IRAT Application quiz administered during classroom review of SimMan exercise

14. More experience with TBL needed to demonstrate improvement by TBL use Critical to get all concerned faculty involved Need to Examine impact of TBL on Learning Physiologic concepts using SimMan Collect more data to determine whether TBL has an impact on learning.

15. SIM-Man/TBL 2007 Three mannequins allowed smaller group size (6) and more time enhanced SIM-Man experience Problems in test administration nullified our ability to measure impact of TBL Three mannequins allowed smaller group size (6) and more time enhanced SIM-Man experience Problems in test administration nullified our ability to measure impact of TBL Results

16. Conclusions Simulator encounters reinforce Basic Science Concepts presented in Physiology Lectures Simulator experience Significantly Impacted Learning TBL Enhanced student Preparation for the SIM-Man experience Simulator encounters reinforce Basic Science Concepts presented in Physiology Lectures Simulator experience Significantly Impacted Learning TBL Enhanced student Preparation for the SIM-Man experience

17. Future Plans

19. Rationale To shift focus from learning key concepts to using concepts To replace lecture format with a more hands on experience To encourage students to come prepared To shift focus from learning key concepts to using concepts To replace lecture format with a more hands on experience To encourage students to come prepared

20. Rationale Demonstrate cardiovascular and pulmonary physiology concepts in a Medical Physiology course using simulation. Examine student performance on exam questions in cardiovascular and respiratory physiology before and after the simulation experience.

21. Cardiovascular Physiology Question TopicPre SIM-MAN % correct SIM-MAN % correct NO SIM-MAN % correct ECG Interpretation 658572 Cardiac Blood Flow 568452 Ischemic Heart Disease/Heart Failure 608248

22. Question TopicPre SIM-MAN % correct SIM-MAN % correct NO SIM-MAN % correct Airway Resistance 569051 Obstructive Lung Disease 538270 Restrictive Lung Disease 507254 Respiratory Physiology