UCF College of Medicine
Integrating Basic Sciences and
Patient Care in a Core Clerkship
Curriculum:
Transforming Medical Education
Through Simulation and Technology
Lynn M. Crespo, Ph.D.
Assistant Dean
Undergraduate Medical Education
UCF
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UCF College of Medicine
Challenges
Last Century Medical School Curriculum:
• Emphasizes knowledge and skill
• Lacks emphasis on critical thinking, judgment,
decision-making or teamwork
• Silos basic science and clinical knowledge - not
integrated
• Relies on lecture-based teaching methods
• Not appealing to “digital natives”
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Addressing the Challenges
• Use simulation and technology as a tool
• Change model from “see one, do one,
teach one” to…
– “See many, practice many, then…do one”
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UCF College of Medicine
Evolution of Medical Education
Lecture
Clerkship &
Internship
Standardized
Patients
Mannequin
Advantages
Advantages
Advantages
Advantages
Efficient
Real patients
Safe, controlled
environment
Procedural skills
Virtual Patient
Repetitive practice
Standardized
Limitations
Limitations
Limitations
Limitations
Low fidelity
Limited
opportunities for
practice
Limited
opportunities for
practice
Poor communication
skills training
No skills training
Negative role
modeling
Expensive
Expensive
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Exposure to many
populations
Safe practice
Stands forenvironment
Opportunity
UCF College of Medicine
Background
• Simulation-based instruction has been
shown to enhance learning & skill
acquisition
• Few Medical Schools are using simulation
to its full potential
5
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UCF College of Medicine
State of the Practice in Medical Simulation
• Mostly mannequin based
– Sophisticated systems that respond to
trainee actions
– Used primarily for team training and
advanced skill development
• Limited use of electronic
simulations (exception =
laparoscopic surgery)
• Deficit of simulation/modeling to
enhance acquisition of basic
knowledge, attitudes or behavior
6
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UCF College of Medicine
Opportunity
• Introduce a simulation-based curriculum “out of the
gate” starting Day 1
• Possibilities:
– Enhance paper-based problem/case presentation with
simulated environments
– Improve mental model development using 3-D graphics and
visualization techniques
– Augment standardized patient exercises
– Provide virtual environment for practice of communication
and empathy
– Virtual patients that can be followed through time
7
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Simulation-Specific Plans
Create an “Immersive Experience”
• live and simulated patients
• real-world situations in a protected
environment
• experiential learning
– context in which future learning can
be situated
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Virtual Patients
• Extensive use of
avatars/computerized
cases
• Integrated context in which
cases are scripted and
presented
• Augments and enhances
in-class and clinical learning
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Virtual Patient Case
Characteristics
• Interactive case management
environment
• Critical thinking and diagnostic
skills
• Collect information, order tests,
and make diagnoses
• Justify decisions based on science
• Track and measure performance
• Immediate feedback
• Analyze decision making processes
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E-Log Books
• Basic Science Development of Specified
Cases
– EXAMPLE
• Medicine – Cardiology
– CHF: Based on patient case entered, discuss:
» Physiological basis for symptoms
» Explanation of tests ordered
» Mechanism of therapeutic benefit for
treatment ordered
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Capstone Cases
• Introduced in Year 1
• Followed throughout basic science years
• Transfer of knowledge to real patients in
Clerkship Years
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Capstone Case Example
• TY is a 32 year old woman who presents to her physician for
new onset leg edema. She has been a type 2 diabetic since
age 17, on insulin since age 22. Her mother and two of her
sisters also have type 2 diabetes, and are obese. Her glucoses
have been poorly controlled, and she neglects to check her
glucose levels. She has gained 30 pounds over the last year,
now weighing 250 pounds (she is 5”1” tall). She complains of
vague chest pains on walking up stairs. Her physician finds
that she has significant leg edema, numbness in her toes, an
elevated serum glucose concentration (200 mg/dL), and
heavy (4+) proteinuria on urinalysis.
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Mapping of Capstone Case
• Biochemistry – Metabolic pathways for
glucose metabolism.
• Genetics – Pedigree, modes of inheritance
• Physiology – Effects of insulin, glucagon
• Pathology – Complications of diabetes
• Pharmacology – Treatment, adverse effects
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Years 3 and 4
•
•
•
•
OB/Gyn – Complications of pregnancy
Medicine – Cardiovascular complications
Neuro – CVA, retinopathy
Pediatrics – Type 1 vs Type 2; increasing
childhood obesity
• Family medicine – Diagnosis, prevention,
lifestyle modification
• Surgery – Risks, complications in diabetic
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Summary
• Virtual patients provide opportunity to revisit
basic science concepts, track critical thinking,
apply knowledge to real scenarios
• Electronic log-books require basic science
work-up of real cases
• Capstone cases provide virtual longitudinal
experience of patient across disciplines and
specialties
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UCF College of Medicine
UCF
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UCF College of Medicine
UCF
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UCF College of Medicine
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Questions???
Discussion
THANK YOU!
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