Simulation-Based Education for Urgent Medical Complications Common to the Rehabilitation Setting: An Educational Program for Physical Medicine and Rehabilitation Residents

Background: Simulation technology is being increasingly adopted into medical education and is consistently associated with positive effects on knowledge, skills, and patient-related outcomes. There is little evidence on the use of simulation technology for the instruction of urgent medical complications to physical medicine and rehabilitation (PM&R) residents. Objective: To examine whether a simulation-based educational program can improve PM&R resident confidence and knowledge in the assessment and management of urgent medical complications. Design: Pretest-posttest design. Setting: Academic freestanding acute inpatient rehabilitation hospital. Participants: Twelve Post-Graduate Year (PGY)-2 PM&R residents at the start of the academic year. Methods: Residents completed an integrated didactic and simulation-based curriculum on the assessment and management of five urgent medical complications: seizures, agitation, ventricular assist device (VAD)-associated complications, sympathetic storming, and autonomic dysreflexia. Simulations were conducted using a high-fidelity manikin. Main Outcome Measurements: Surveys and knowledge assessments were completed at baseline and immediately following training. Survey responses were recorded on a Likert scale ranging from 1 = strongly disagree to 5 = strongly agree. Multiple-choice knowledge assessments were scored out of 100%. Within-group differences from baseline to postintervention were analyzed. Results: There was a positive correlation between baseline experience and baseline confidence scores (r = 0.877). Improved confidence was demonstrated in the assessment and management of all five topics (P <.05). Knowledge assessment scores significantly improved from 57.8% (95% confidence interval [CI] 50.6% to 65.4%) at baseline to 85.0% (95% CI 81.6% to 88.4%) following the course (P <.001). The education program was rated highly by both learners (mean satisfaction score, Likert score [LS] = 4.6) and instructors (mean satisfaction score, LS = 4.5). Conclusions: Application of a simulation-based educational model to the instruction of urgent medical complications to PM&R residents resulted in increased knowledge with added benefits of confidence building and high levels of enjoyment. Level of Evidence: II.