title: Simulation curriculum can improve medical student assessment and management of acute coronary syndrome during a clinical practice exam.
abstract: BACKGROUND
  It has been noted that increased focus on learning acute care skills is needed in undergraduate medical curricula. This study investigated whether a simulation-based curriculum improved a senior medical student's ability to manage acute coronary syndrome as measured during a clinical performance examination (CPX). The authors hypothesized that simulation training would improve overall performance when compared with targeted didactics or historical controls.
  
  
  METHODS
  All 4th-year medical students (n = 291) over 2 years at the authors' institution were included in this study. In the 3rd year of medical school, the "control" group received no intervention, the "didactic" group received a targeted didactic curriculum, and the "simulation" group participated in small group simulation training and the didactic curriculum. For intergroup comparison on the CPX, the authors calculated the percentage of correct actions completed by the student. Data are presented as mean ± standard deviation with significance defined as P < 0.05.
  
  
  RESULTS
  There was a significant improvement in overall performance with simulation versus both didactics and control (P < 0.001). Performance on the physical examination component was significantly better in simulation versus both didactics and control, as was for diagnosis: simulation versus both didactics and control (P < 0.02 for all comparisons).
  
  
  CONCLUSIONS
  Simulation training had a modest impact on overall CPX performance in the management of a simulated acute coronary syndrome. Additional studies are needed to evaluate how to further improve curricula regarding unstable patients.
authors.affiliation: Department of Internal Medicine (DJD), the Department of Family Medicine (DHK), the Department of Public Health Sciences (PJN), Medical University of South Carolina, Charleston, South Carolina; and Department of Anesthesia (MDM, LAA), Vanderbilt University School of Medicine, Nashville, Tennessee.
authors.forename: Deborah J
authors.initials: DJ
authors.lastname: DeWaay
authors.forename: Matthew D
authors.initials: MD
authors.lastname: McEvoy
authors.forename: Donna H
authors.initials: DH
authors.lastname: Kern
authors.forename: Louise A
authors.initials: LA
authors.lastname: Alexander
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Nietert
mesh_terms: D054058:Acute Coronary Syndrome / Q000175:diagnosis* / Q000628:therapy*; D002983:Clinical Competence / Q000592:standards*; D003479:Curriculum / Q000592:standards*; D019468:Disease Management; D004521:Educational Measurement / Q000379:methods / Q000592:standards*; D006801:Humans; D013337:Students, Medical