title: A randomised controlled trial of extended immersion in multi-method continuing simulation to prepare senior medical students for practice as junior doctors.
abstract: BACKGROUND
  Many commencing junior doctors worldwide feel ill-prepared to deal with their new responsibilities, particularly prescribing. Simulation has been widely utilised in medical education, but the use of extended multi-method simulation to emulate the junior doctor experience has rarely been reported.
  
  
  METHODS
  A randomised controlled trial compared students who underwent two, week-long, extended simulations, several months apart (Intervention), with students who attended related workshops and seminars alone (Control), for a range of outcome measures.
  
  
  RESULTS
  Eighty-four third year students in a graduate-entry medical program were randomised, and 82 completed the study. At the end of the first week, Intervention students scored a mean of 75% on a prescribing test, compared with 70% for Control students (P = 0.02) and Intervention teams initiated cardiac compressions a mean of 29.1 seconds into a resuscitation test scenario, compared with 70.1 seconds for Control teams (P < 0.01). At the beginning of the second week, an average of nine months later, a significant difference was maintained in relation to the prescribing test only (78% vs 70%, P < 0.01).At the end of the second week, significant Intervention vs Control differences were seen on knowledge and reasoning tests, a further prescribing test (71% vs 63% [P < 0.01]) and a paediatric resuscitation scenario test (252 seconds to initiation of fluid resuscitation vs 339 seconds [P = 0.05]).
  
  
  CONCLUSIONS
  The study demonstrated long-term retention of improved prescribing skills, and an immediate effect on knowledge acquisition, reasoning and resuscitation skills, from contextualising learning activities through extended multi-method simulation.
authors.affiliation: School of Medicine, Griffith University, Gold Coast, Queensland 4222, Australia. g.rogers@griffith.edu.au.
authors.forename: Gary D
authors.initials: GD
authors.lastname: Rogers
authors.forename: Harry W
authors.initials: HW
authors.lastname: McConnell
authors.forename: Nicole Jones
authors.initials: NJ
authors.lastname: de Rooy
authors.forename: Fiona
authors.initials: F
authors.lastname: Ellem
authors.forename: Marise
authors.initials: M
authors.lastname: Lombard
mesh_terms: D000328:Adult; D002983:Clinical Competence; D003479:Curriculum; D004501:Education, Medical / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D016544:Patient Simulation; D013337:Students, Medical; D013663:Teaching / Q000379:methods