“I think those might have been my most fruitful three hours of learning since beginning medical school,” said Maggie Wright, first-year medical student, of the afternoon she spent in the Simulation Technology and Immersive Learning center during the week-long Synthesis and Application Module (SAM), a new component of the Northwestern University Feinberg School of Medicine curriculum.
Intimidated at first, Wright said her initial strategy was to go through the motions and hope not to kill the simulated patient.
“The resident leading my group encouraged us to think out loud and offer our ideas on how to direct the patient’s care,” she said. “By the end of the session I was confident in applying physiological and pharmacological principles that I had previously only thought of in abstract terms.”
Over the past 12 weeks, Wright and her peers studied the basic functioning of the cardiovascular, respiratory, and renal systems in the classroom. They learned how to examine the heart, lungs, and kidneys, and how to diagnose various diseases, the determinants of those diseases, and how to prevent and care for them. During SAM, the students applied this knowledge through simulation exercises.
An aspect of the new curriculum, the module creates an integrated educational environment, closely aligning classroom instruction with relevant, hands-on clinical experiences.
“SAM typifies everything that is unique and exciting about our new curriculum,” said Pat Garcia, MD, MPH, course director of problem-based learning and professor in obstetrics and gynecology-maternal fetal medicine. “Talented faculty from all disciplines come together to put learning into context and challenge students to apply their knowledge in a variety of unique learning environments.”
SAM features active, self-directed learning integrated across foundational science, clinical medicine, and ethics.
“It provides students with the opportunity to revisit, apply, and integrate material from the preceding modules in order to create meaningful learning rather than rote memorization,” said Garcia.
The week started off with a review of the class’s performance on past exams so students could focus on gaps in learning.
A simulated medical scenario was presented to the entire class each morning. After the presentation, students broke into small groups to develop individual responses to guided questions. Then each student presented answers to the rest of the team members.
During afternoon simulation and clinical skills sessions, groups encountered “patients” – computerized mannequins and trained actors – who exhibited cardiovascular, pulmonary, and renal problems. Students diagnosed and explained the patients’ problems and used evidence-based principles to counsel and treat them. They also watched the movie Critical Care to examine and discuss health system issues around end of life care.
Jason Chodakowski, a first-year medical student, thought the week was a great way to practice team-building skills and integrate the cardio, pulmonary, and renal units they recently covered in class.
“It was cool to review the concepts we learned in a way that integrated the information in real world scenarios,” he said. “I was impressed by how they put it together. During the sessions, we got together as a team and went through the entire process of doing an interview, getting the labs, trying to figure out what to do, and have discussions with the patient.”
“When we designed the simulations, we wanted to have students apply concepts to a new situation and work in a dynamic, changing environment,” Salzman said. “In the morning large group simulation, we integrated multiple organ systems because in practice there is never an issue with only one organ system. We wanted the students to be able to integrate all three organ systems and apply the relevant concepts to a simulated patient. By doing these activities, it accomplishes early exposure to a clinical environment.”
Toshiko Uchida, MD, facilitator in the clinical exams case and assistant professor of general internal medicine and geriatrics, said the case studies gave students the opportunity to put together communication, history taking, and physical exam skills, in addition to developing a diagnosis and counseling the patient.
“The clinical medicine case was designed as a team activity with each student performing one part,” Uchida said. “They had to work together to create a coherent clinical picture and then convey information to the patient about what to do next. The students were engaged and thinking critically. It was exciting to see them put all the pieces of the puzzle together.”
“This week synthesized all the major concepts that we‘ve learned about in the past few months in a way that we have never done before,” said Omar Uddin, a first-year medical student. “Coming into SAM week, I thought it would be a lot of review. I had read these concepts but didn’t see how they were intertwined until this week, and I think that was really helpful and those are things I don’t think I will forget very quickly.”