title: High-fidelity simulation is superior to case-based discussion in teaching the management of shock.
abstract: BACKGROUND
  Case-based discussion (CBD) is an established method for active learning in medical education. High-fidelity simulation has emerged as an important new educational technology. There is limited data from direct comparisons of these modalities.
  
  
  OBJECTIVE
  The primary purpose of this study was to compare the effectiveness of high-fidelity medical simulation with CBD in an undergraduate medical curriculum for shock.
  
  
  METHODS
  The subjects were 85 third-year medical students in their required surgery rotation. Scheduling circumstances created two equal groups. One group managed a case of septic shock in simulation and discussed a case of cardiogenic shock, the other group discussed septic shock and experienced cardiogenic shock through simulation. Student comprehension of the assessment and management of shock was then evaluated by oral examination (OE).
  
  
  RESULTS
  Examination scores were superior in all comparisons for the type of shock experienced through simulation. This was true regardless of the shock type. Scores associated with patient evaluation and invasive monitoring, however, showed no difference between groups or in crossover comparison.
  
  
  CONCLUSIONS
  In this study, students demonstrated better understanding of shock following simulation than after CBD. The secondary finding was the effectiveness of an OE with just-in-time deployment in curriculum assessment.
authors.affiliation: University of Virginia, Charlottesville, VA 22908-0862, USA. klittlewood@virginia.edu
authors.forename: Keith E
authors.initials: KE
authors.lastname: Littlewood
authors.forename: Ashley M
authors.initials: AM
authors.lastname: Shilling
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Stemland
authors.forename: Elisabeth B
authors.initials: EB
authors.lastname: Wright
authors.forename: Mark A
authors.initials: MA
authors.lastname: Kirk
mesh_terms: D002983:Clinical Competence; D016001:Confidence Intervals; D004504:Education, Medical, Undergraduate; D004521:Educational Measurement; D006801:Humans; D012770:Shock, Cardiogenic / Q000628:therapy; D012772:Shock, Septic / Q000628:therapy*; D013663:Teaching / Q000379:methods*