Introduction: Simulation is used by many medical specialties, throughout the world, as an effective educational adjunct to clinical learning experiences. There is limited prospective research to support the use of table-top, low fidelity, simulation experiences as a suitable replacement for traditional lecture-based modalities in the context of undergraduate emergency medical education. We designed, implemented and evaluated sections of a table-top simulation-based curriculum for fourth year medical students participating in the department’s advanced emergency medicine clerkship. Methods: A prospective, randomized, cross over study comparing lecture-based learning activities to an experimental table-top simulation exercises based on a primary outcome objective, considering the quantitative acquisition of clinical knowledge, and a secondary outcome looking at the results of survey data, considering student perspectives on learning experience. Four student cohorts participated in the study, each spending one month in the department’s advanced emergency medicine medical student elective.Results: Medical knowledge learning outcomes did not show a significant improvement in the experimental modality when compared to the traditional format. Likert scale survey data showed, with statistical significance (P<.05), that students preferred the simulation modality over the traditional lectures finding it to be more interactive, and a more effective format for teaching medical knowledge and applicable clinical information. Conclusion: Findings showed, with statistical significance, that students preferred this learning modality but that more research would be needed to further evaluate our findings of improved learning outcomes. Further research should be pursued to characterize this modality’s benefit, as compared to traditional small group lecture and high-fidelity simulation modalities, in order to evaluate its possible effectiveness for furthering the development of undergraduate emergency medicine education in the future.

Introduction: Over the last several decades simulation, in both graduate and undergraduate emergency medicine education, has continued to develop as a leading and highly effective teaching modality. Limited research exists to evaluate the efficacy of low-fidelity (table-top) simulation, as compared to high-fidelity standards, as it relates to medical knowledge learning outcomes. We sought to assess the efficacy of a low-fidelity simulation modality in undergraduate emergency medicine education, based on quantitative medical knowledge learning outcomes.

Methods: A prospective, randomized, crossover-control study comparing objective medical knowledge learning outcomes between simulation modalities. Analysis was designed to evaluate for the statistical equivalence of learning outcomes between the two cohorts. This was done by comparing a calculated 95% confidence interval (CI) around the mean difference in post-test scores, between experimental and control modalities, to a pre-established equivalence margin. 

Results: Primary outcomes evaluating student performance on post-test examinations demonstrated a total cohort CI (95% CI, -0.22 and 0.68). Additional course-subject subgroup analysis demonstrated non-inferior CIs with: Shortness of Breath (95% CI, -0.35 and 1.27); Chest Pain (95% CI, -0.53 and .94); Abdominal Pain (95% CI, -0.88 and 1.17); Cardiovascular Shock (95% CI, -0.04 and 1.29). Secondary outcome analysis was done to evaluate medical knowledge acquisition by comparing the difference in pre and post-test examination between the cohorts. CI of the full cohort ranged from (95% CI, -0.14 and 0.96).

Conclusion: The student’s performance on quantitative medical-knowledge assessment was equivalent between the high-fidelity control and low-fidelity experimental simulation groups. Analysis of knowledge acquisition between the two groups also demonstrated statistical equivalence.