Undergraduate Medical Education Simulation

The OHSU School of Medicine has integrated several methods of simulation into multiple areas of the curriculum.   

Standardized Patients:  Students in Principles of Clinical Medicine participate in 12 Observed Structured Clinical Exams (OSCEs) with standardized patients in each of Year One and Year Two .  These are both formative and summative evaluations, and the standardized patients give immediate feedback to the students participating.  Cases emphasize communication, history taking and physical exam skills.  In addition, the interactions are taped and stored so that a student can review their interactions and progress throughout medical school.  In Year Three, students on their required Family Medicine clerkship also have exposure to standardized patients in the OSCE format; direct faculty observation and required video review are used to share formative feedback.  Year Three culminates in the CPX exam, which is a series of OSCEs similar to the USLME Step 2 Clinical Skills exam.   

Manikin based Simulation:  Year One students in Systems Processes and Homeostasis have a demonstration of the use and pitfalls of using neuromuscular blockers using SimMan®.  In addition, SPH students may also participate in a lab section that demonstrates what happens with a "patient" who has a major bleeding episode after a car crash.  Students are then guided through reflection on what happened with the hemodynamics and the options for treatment.   Year Two students in the cardiac portion of the Circulation course participate in simulations of patients presenting to the emergency room with cardiac complaints whom they can evaluate and begin initial treatment.  The students are guided through debriefing with each scenario to maximize learning for each scenario, and highlight key take-home messages. 

Task Training:  Year One students in the Principles of Clinical Medicine course practice breast, pelvic and scrotal exam skills with task trainers. 

Year Two students may take a simulation elective which highlights the decision making involved with emergent situations.  This elective goes for several weeks and involves a small number of students for maximum student benefit.  Students participating in the Transition to Clerkship week participate in simulations about emergency airway management where they get the chance to make decisions about how to manage a patient who is in respiratory distress.  Year Two students in the Transition to Clerkship week practice several skills with task trainers, including airway management with bag-mask ventilation, LMA placement and endotracheal intubation.  

Year Three students participating in the Continuity Week participate in simulations of code-scenarios getting the chance to practice team skills as well as basic BLS.   Debriefing is ongoing with the scenario to help highlight important considerations. During the required Family Medicine Clerkship, Year Three students interact with virtual patients created in a simulated Electronic Health Record (sim-EHR) in two manners. Sim-EHRs and  standardized patients are combined to teach the art of maintaining patient rapport while using an EHR. Students also use a sim-EHR case to demonstrate their skills in medication reconciliation, order entry, chart maintenance and evidence based chronic disease management.      

Simulation experiences are coordinated by faculty from several departments, including anesthesiology, emergency medicine, pediatrics, family medicine, internal medicine and surgery.