title: Two third-year medical student-level laboratory shock exercises without large animals.
abstract: BACKGROUND
  Historically, medical schools have taught principles of hemodynamic shock using large animal models. Such exercises are infrequent today due to the increasing aversion of students and the wider community to the use of large animals in teaching. Herein, we describe two alternative exercises that communicated basic science and clinical principles of shock effectively.
  
  
  METHODS
  We developed two complementary, distinct single-afternoon laboratory exercises for third-year medical students. The first exercise (lab) demonstrated three principles: (1) in vitro cytokine-induced apoptosis (illustrating mechanisms and consequences of sepsis), (2) the hemodynamic manifestations of hypovolemia and septic shock in rats, and (3) the effects of fluid resuscitation or vasopressor administration in these same rat models. In the second exercise, students managed the diagnosis, initial resuscitation, surgical treatment, and ICU care of a "patient" with abdominal sepsis, using a manikin-based patient simulator and actual patient test data. Current basic science and clinical literature were incorporated.
  
  
  RESULTS
  Efficacy was evaluated by polling students in one of four rotations (n = 25). Educational value of the lab exercise was rated 3.70 (1, worst rating; 5, best rating), whereas its applicability to clinical care was rated 4.35. Educational value and clinical applicability of the patient simulator were rated 4.52 and 4.76, respectively.
  
  
  CONCLUSIONS
  These exercises combining laboratory demonstrations of the pathophysiologic mechanisms and manifestations of shock with simulation were judged effective and clinically relevant while fulfilling the National Institutes of Health (NIH) mandate to reduce use of experimental animals.
authors.affiliation: Department of Surgery, University of Rochester, Rochester, NY, USA. lkoniaris@med.miami.edu
authors.forename: Leonidas G
authors.initials: LG
authors.lastname: Koniaris
authors.forename: David
authors.initials: D
authors.lastname: Kaufman
authors.forename: Teresa A
authors.initials: TA
authors.lastname: Zimmers
authors.forename: Nathan
authors.initials: N
authors.lastname: Wang
authors.forename: Patrice F
authors.initials: PF
authors.lastname: Spitalnik
authors.forename: Lindsey
authors.initials: L
authors.lastname: Henson
authors.forename: Carol
authors.initials: C
authors.lastname: Miller-Graziano
authors.forename: James V
authors.initials: JV
authors.lastname: Sitzmann
mesh_terms: D000818:Animals; D017209:Apoptosis / Q000502:physiology; D003479:Curriculum; D016207:Cytokines / Q000009:adverse effects; D004504:Education, Medical, Undergraduate / Q000379:methods*; D006439:Hemodynamics; D007753:Laboratories; D008348:Manikins; D023421:Models, Animal; D008954:Models, Biological; D051381:Rats; D012769:Shock / Q000175:diagnosis / Q000503:physiopathology* / Q000628:therapy; D012772:Shock, Septic / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology* / Q000628:therapy
chemical_list: D016207:Cytokines