Brett Linowes

Albany Medical Center Emergency Medicine

"Pre-Clinical Trauma Simulation with Early Focus on Clinical Reasoning Skills"
SAEMF Emergency Medicine Medical Student Interest Group 


The purpose of this workshop is to expose pre-clinical students to basic ATLS trauma assessment and stabilization of the critical patient. Students will meet together first in a large group setting where the basic trauma assessment will be reviewed and the necessary skills taught based on current ATLS guidelines, emphasizing common injuries with the greatest threat to life encountered in the primary and secondary surveys.

This is a departure from traditional clinical skills curriculum and is a marked change for the students with an early emphasis on clinical reasoning. Instead of progressing in a step-wise fashion through the traditional patient assessment, students will be exposed to concept-map thought processes, utilizing multiple domains of thinking at once.

Simultaneously, this workshop will serve to develop Entrustable Professional Activities in the pre-entrustable practitioner. We aim to begin the process of observing and measuring student’s performance with a specific rubric created for three trauma scenarios.

For the above reasons, this project is crucial to developing students for their Emergency Medicine clerkship to be taken during their fourth year, as it requires higher-level thinking. As well, it exposes students to the synthesis of cognitive domains –part of the daily duties of an EM resident.

Research Results

The workshop included 30 pre-clinical students. Twenty minutes were spent introducing the primary survey and basic roles within a trauma situation.  This was followed by students rotating through three, 45 minute stations: Major Trauma, Minor Trauma, and FAST Ultrasound Exam. For the two trauma stations, students were assigned roles, ranging from attending physician to emergency department technician, and had to interview and examine the patient working as a team.  This year, the major trauma station involved a medical mannequin that is unable to speak, but will allow the students to interpret vital signs and react to changes as the trauma simulation goes on.  We also had a standardized patient play a worried family member who interrupted the team’s management by asking questions, thus forcing the team to adapt to this unexpected scenario and address the family member’s needs as well.  The minor trauma station involved a standardized patient that was able to interact with the trauma team’s questions and concerns, as well as give feedback on the physical exam.  In the FAST Ultrasound Exam, students were exposed to the basic workings of a FAST exam and how it can be applied during a trauma situation.  Students were able to use FAST simulators as well as practice on standardized patients.  At the beginning and the end of the workshop, students were evaluated objectively with a pre-workshop quiz on basic trauma patient management, and subjectively with a post-workshop feedback worksheet designed to assess workshop value, learning experience, and confidence levels.