Moderated by Kimberly Dahlman
Session Coordinator: Juan David Coellar-Pauta

Presentation 1 - Utility of Paired, Peer Reviews of Actual Patient Encounters Early in Medical Education    
Leanne M Chrisman-Khawam    
Ohio University Heritage College of Medicine

Purpose
Adequate direct observation of medical students' and other health professionals' clinical skills is limited by faculty numbers, time, and scheduling conflicts. We have utilized a standardized process previously documented in family residencies and later stages of clinical training as beneficial in developing improved patient-centered attitudes, skills, and behavior. This abstract describes this novel curricular element and its outcomes.

Methods
The patient-centered observation form is a standardized patient care, video evaluation tool developed by L Mauksch at the University of Washington family medicine residency. It has primarily been used with family medicine residents and some limited use with late clinical years medical students. Our program instituted this evaluation strategy as a part of an accelerated 3-year medical school to family medicine residency program starting in the first semester of medical school as a part of early clinical participation in their future residency sites. The goals included both offering formative feedback to improve early clinical gains and providing some additional direct observation of specific skills competency.

Results
A pre, post, and retro-survey completed by 2nd and 3rd-year students revealed earlier self-insight, self-correction, skills improvement, and desire and plan to work on specific skills early in their clinical training. A follow-up, de-identified, and anonymous focus group gave specific positive commentary on the environment of feedback created, the benefit of formative feedback in learning, and the quicker progression of skills and professional identity development.

Conclusions
Utilization of mentors to train clinical peer pairs in medical school may lead to improved patient-centered clinical skills. Additionally, the act of learning to give feedback on these skills may be part of the benefit. Ensuring individuals' safety and scaling to larger cohorts to confirm concept will be necessary.

Presentation 2 - The Effect of Catastrophic Outcomes During a Clinical Simulation on Medical Student Learning and Confidence    
Nancy Segura-Azuara    
Tec de Monterrey

Purpose
Clinical simulations prepare students to face real-life situations with confidence and certainty. The patient's outcome is an important part of this learning process, especially if it evokes strong emotions in students. This study assesses the effect of catastrophic outcomes during clinical simulations in medical students' learning and confidence.

Methods
A three-level of difficulty high-fidelity clinical simulation was designed. The difficulty levels included addressing allergy history, laboratory findings interpretation, and correlating electrolyte disorders with EKG abnormalities. If students fail to accomplish any of these satisfactorily, the patient develops catastrophic consequences in the simulation. The sample for this study comprised 67 fourth-year medical students, 49% were male and 51% were female. We randomly assigned the students to teams of 6 to 8 students. They underwent the simulation described and then answered a validated survey. Through a cross-sectional pre-post simulation study, the aim was to measure the effect of suffering catastrophic consequences during clinical simulations on the students' self-perception of confidence and knowledge.

Results
Students that participated in the simulation showed an average increase of 7 points (12%) in self-perceived confidence and knowledge (p-value < 0.001). In the subgroup analysis, there is an increase in self-perceived knowledge of 13% (p-value < 0.001) and 7% in self-perceived confidence (p-value = 0.003). Additionally, 54% of students rated their understanding of the case to be outstanding and 46% felt more confident in taking clinical decisions.

Conclusion
Although clinical simulation is already revolutionizing medical education, there is still room for innovation. Through this study, it was shown that witnessing the consequences of incorrect clinical decisions improves medical students learning experience. Additionally, strong emotions caused by failing to correctly solve a case helps students build long-lasting lessons to avoid future mistakes during clinical practice.

Presentation 3 - Evaluating an Interprofessional Approach to Medical Simulation for First-Year Medical Students: Addressing Communicative Skills, Teamwork, and Professional Identity Formation  
Carlos Brown  
Carle Illinois College of Medicine

Background
Many health profession schools integrate bioethics and health systems science in didactic format in the early years of education but wait until students’ clinical rotations to introduce simulations. However, competencies in communication, teamwork, and medical ethics, are essential to preparing for collaborative healthcare practices and early exposure to these concepts through simulation helps to develop mindful learners, as well as furthers students’ professional identity formation. Introducing interdisciplinary and integrative simulations in the preclinical years is an innovative way to prepare students to be well-rounded health practitioners who provide holistic health care.

Methods
One-hundred and twenty-five nursing and medical students were required to participate in a simulation designed to foster intrapersonal and interpersonal reflection of one’s physical and communicative roles in providing medical care.  These reflections were complimented by the practical reiteration of applying a closed-loop strategy, using the SBAR strategy, assessing the general health and well-being of the standardized patient (SP), providing medical interventions, and examining the imbrication of medical ethics in providing care.  Students were debriefed on their performance by the standardized patient and basic science, bioethics, and clinical faculty.

Results
A retrospective self-assessment showed an increase in confidence to speak up during medical uncertainty and an increased understanding of communication strategies to use with an interprofessional team. Over half of the responses noted an appreciation for teamwork, interdisciplinary practice, and a realistic experience.  Over 90% of students enjoyed the simulation, found it valuable to their education, and stated that they can use the knowledge acquired in their future practice.

Conclusions
This activity highlighted the value of the preclinical introduction of medical ethics and communication in healthcare systems through simulation. However, a limitation is this was a single-institution study.