Death of a Manikin: Adverse Effects on Learning and Mechanisms

Abstract

PURPOSE: Many simulation experts believe that death of the "patient" during a simulation session negatively impacts learning while others believe that manikin death can send an important message to learners. We hypothesized that manikin death during a simulation scenario for final year medical students would increase emotional distress and thereby increase cognitive load. We further hypothesized that this would lead to poorer learning outcomes., METHODS: This was a prospective intervention study in which final year medical students attended a simulation session on "Approach to altered level of consciousness (LOC) in a patient with salicylate overdose". Groups of 5 students were randomly allocated to one of two groups, Death (D) or No Death (ND) of the manikin in the last 3 minutes of the scenario. A 20-minute debriefing by simulation educators focused on core objectives for the case. Following the debriefing, students completed an assessment of emotional states, based on the circumplex model of emotion and a 9-point Likert scale of cognitive load. The students were examined 3 months later on a simulator during a 10-minute OSCE station dealing with altered LOC as part of their scheduled summative clerkship exam. The emotional experience, the cognitive load and final OSCE performance were compared between the Groups D and ND using a two-sample t-tests and chi-square tests., RESULTS: A total of 116 students attended the simulation session on Altered LOC and are included in the analysis. Group D students reported being more nervous, upset, sad, and depressed (p < 0.05 for all), and had higher cognitive load (7.63 vs. 7.25, p = 0.03) than ND students. On the final OSCE examination, ND students were significantly more likely to pass the OSCE station than D students (86.9% vs. 70.9%, p = 0.03)., CONCLUSIONS: Death of the manikin impaired the medical student's ability to tranfer key information taught in the simulation session., CLINICAL IMPLICATIONS: It is likely that emotional distress during simulation increases cognitive load to a point past that which is optimal for learning., DISCLOSURE: The following authors have nothing to disclose: Kristin Fraser, James Huffman, Irene Ma, Bruce Wright, Joann McIlwrick, Kevin McLaughlin, No Product/Research Disclosure Information, Copyright (C) 2011 by the American College of Chest Physicians