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Using High-Fidelity Medical Simulation to Assess Critical Thinking in Medical Students

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Using High-Fidelity Medical Simulation to Assess Critical Thinking in Medical Students Andrews University Digital Commons @ Andrews University Dissertations Graduate Research 2016 Using High-fidelity Medical Simulation ot Assess Critical Thinking in Medical Students Lynda Daniel-Underwood Andrews University, [email protected] Follow this and additional works at: https://digitalcommons.andrews.edu/dissertations Part of the Educational Psychology Commons, and the Higher Education Commons Recommended Citation Daniel-Underwood, Lynda, "Using High-fidelity Medical Simulation ot Assess Critical Thinking in Medical Students" (2016). Dissertations. 1606. https://digitalcommons.andrews.edu/dissertations/1606 This Dissertation is brought to you for free and open access by the Graduate Research at Digital Commons @ Andrews University. It has been accepted for inclusion in Dissertations by an authorized administrator of Digital Commons @ Andrews University. For more information, please contact [email protected]. ABSTRACT USING HIGH-FIDELITY MEDICAL SIMULATION TO ASSESS CRITICAL THINKING IN MEDICAL STUDENTS by Lynda Daniel-Underwood Chair: Robson Marinho ABSTRACT OF GRADUATE STUDENT RESEARCH Dissertation Andrews University School of Education Title: USING HIGH-FIDELITY MEDICAL SIMULATION TO ASSESS CRITICAL THINKING IN MEDICAL STUDENTS Name of researcher: Lynda Daniel-Underwood Name and degree of faculty chair: Robson Marinho, Ph.D. Date completed: February 2016 Problem Graduating competent physicians is an imperative societal need. The development of critical thinking skills during medical school is important to meet this societal need and for the care of ill patients. Research shows this skill is key in decreasing medical errors, which in turn decreases cost. (Norman and Eva, 2010) Missing from the literature is a method to assess critical thinking in the setting of caring for the critically ill patient. This instrumental case study tests medical simulation as a method of assessing critical thinking, which incorporates all six competency domains, by looking at the assessment environment, summative patient experience, and participant’s reflection on the case and environment. Method A qualitative instrumental case study design was used to evaluate twelve senior medical students’ critical thinking skills in the setting of identified competency domains. A single simulation patient encounter was administered to each student and data collected from the videotape of the encounter, their written documentation, and oral presentation of the case, mimicking the real-life scenario. The participants were also asked five questions regarding this case. These data were analyzed and presented in narrative format. Results The analysis revealed six major themes: assessment environment, coalescence of knowledge and skills, decision-making and deep thinking/reasoning, integrative experience, lack of depth in thought process, and safe environment. This research identified gaps in the students’ knowledge, skill, and behaviors of competency domains as they apply to critical thinking. Despite all students successfully completing medical school, errors were made in their individual care of the simulated patient. Four cases ended in “death” of the patient. The documentation of their patient encounter also lacked sufficient detail to allow other medical professionals to understand the issues during the case. The students’ opinion of the patient encounter was positive. Several students noted they had not had similar encounters as the sole provider of patient care. The experience gave them the opportunity to apply what they had learned and reflect on their gaps in knowledge. Conclusions The ability for physicians to think critically is key in reducing medical errors. An effective instrument to assess critical thinking as it applies to competency is high-fidelity medical simulation. In addition, allowing senior medical students to manage the case as the physician in charge exposes knowledge, skills, and behaviors of critical thinking, making these processes accessible for assessment. Andrews University School of Education USING HIGH-FIDELITY MEDICAL SIMULATION TO ASSESS CRITICAL THINKING IN MEDICAL STUDENTS A Dissertation Presented in Partial Fulfillment of the Requirements for the Degree Doctor of Philosophy by Lynda Daniel-Underwood February 2016 © Copyright by Lynda Daniel-Underwood 2016 All Rights Reserved USING HIGH-FIDELITY MEDICAL SIMULATION TO ASSESS CRITICAL THINKING IN MEDICAL STUDENTS A dissertation presented in partial fulfillment of the requirements for the degree Doctor of Philosophy by Lynda Daniel-Underwood APPROVAL BY THE COMMITTEE: ____________________________ Chair: Robson Marinho Dean, School of Education Robson Marinho ____________________________ Member: Stephen Corbett ____________________________ Member: Shirley Freed _____________________________ External: Loretta Johns Date approved TABLE OF CONTENTS LIST OF TABLES ........................................................................................................ vii ACKNOWLEDGMENTS ............................................................................................ viii Chapter 1. INTRODUCTION ............................................................................................ 1 Background of the Problem ........................................................................ 2 Problem Statement ...................................................................................... 4 Purpose of Study ......................................................................................... 5 Research Questions ..................................................................................... 5 Rationale for the Study ............................................................................... 5 Theoretical Framework ............................................................................... 6 Significance of the Study ............................................................................ 10 Definition of Terms..................................................................................... 10 Basic Assumptions ...................................................................................... 11 General Methodology ................................................................................. 11 Limitations .................................................................................................. 13 Delimitations ............................................................................................... 14 Summary ..................................................................................................... 14 2. LITERATURE REVIEW ................................................................................. 15 Critical Thinking ......................................................................................... 15 Development of Physician Skills ................................................................ 17 High-Fidelity Medical Simulation .............................................................. 21 Historical Development of Simulation in Medical Education ........................................................................................ 21 Simulation as an Assessment Tool ....................................................... 23 Assessment of Critical Thinking in Medical Education ............................. 27 Measurement Tools of Critical Thinking in Medical Education ........................................................................................ 28 Script Concordance Testing ............................................................ 28 Objective Structured Clinical Evaluation ....................................... 29 Direct Observation .......................................................................... 29 Competency for Medical School Graduates ......................................... 31 Liaison Committee for Medical Education ..................................... 31 Accreditation Council for Graduate Medical Education (ACGME) ................................................................ 35 iii Patient Safety .............................................................................................. 36 Error Prevention .................................................................................... 37 Analytical Versus Non-analytic Errors ........................................... 37 Learning Without Harm .................................................................. 38 Clinical Effects of Medical Error .......................................................... 39 Summary ..................................................................................................... 41 3. METHODOLOGY ........................................................................................... 42 Introduction ................................................................................................. 42 Qualitative Methods Design ....................................................................... 42 Purposeful Sampling ................................................................................... 43 Data Collection ........................................................................................... 44 Procedure .............................................................................................. 45 Sources of Data ..................................................................................... 45 Written Note.................................................................................... 46 Videotape Simulation
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