Medical students can learn the basic application, analytic, evaluative, and psychomotor skills of critical care medicine

Objective: To determine whether fourth-year medical students can learn the basic analytic, evaluative, and psychomotor skills needed to initially mana ge a critically ill patient, Design: Student learning was evaluated using a performance examination, the objective structured clinical examination (OSCE). Students were randomly a ssigned to one of two clinical scenarios before the elective. After the ele ctive, students completed the other scenario, using a crossover design. Setting: Five surgical intensive care units in a tertiary care university t eaching hospital, Participants: Forty fourth-year medical students enrolled in the critical c are medicine (CCM) elective. Interventions: AII students evaluated a live "simulated critically ill" pat ient, requested physiologic data from a nurse, ordered laboratory tests, re ceived data in real time, and intervened as they deemed appropriate. Measurements and Main Results: Student performance of specific behavioral o bjectives was evaluated at five stations. They were expected to a) assess a irway, breathing, and circulation in appropriate sequence; b) prepare a man ikin for intubation, obtain an acceptable airway on the manikin, demonstrat e bag-mouth ventilation, and perform acceptable laryngoscopy and intubation ; c) provide appropriate mechanical ventilator settings; d) manage hypotens ion; and e) request and interpret pulmonary artery data and initiate approp riate therapy. OSCEs were videotaped and reviewed by two faculty members ma sked to time of examination, A checklist of key behaviors was used to evalu ate performance. The primary outcome measure was the difference in examinat ion score before and after the rotation. Secondary outcomes included the di fference in scores at each rotation, The mean preelective score was 57.0% /- 8.3% compared with 85.9% +/- 7.4% (p < .0001) after the elective. Signif icant improvement was demonstrated at each station except station I. Conclusion: Fourth-year medical students without a CCM elective do not poss ess the basic cognitive and psychomotor skills necessary to initially manag e critically ill patients. After an appropriate I-month CGM elective, stude nts' thinking and application skills required to initially manage criticall y ill patients improved markedly, as demonstrated by an OSCE using a live s imulated "patient" and manikin.