Spotting Sepsis: Blended Learning to Assess Student Recognition and Management

BACKGROUND: Program directors have expressed concern that some medical school graduates are unprepared for residency. Trainees should be able to perform the AAMC’s Entrustable Professional Activities (EPAs) without supervision on day 1. We describe an innovative approach for evaluating performance in EPA 4 (orders and prescriptions) within a flipped, blended “Ready 4 Residency” (R4R) course. We assessed fourth year medical students’ recognition and management of sepsis in an online case. METHODS: Students took R4R in March or April of 2017. R4R included two sepsis workshops and a simulation involving a septic patient. In the online component a patient presented with sepsis from soft-tissue infection. After receiving history and exam findings, 141 students submitted order sets. In March, 35% of students engaged in the training before the order set due date, while all April students engaged in these activities beforehand. Orders were assessed for entrustment using a rubric guided by the AAMC’s description of EPA 4. Each criterion (4.1–4.4) was scored as “not entrustable”, “developing entrustment”, or “entrustable”, and given an overall rating. We recorded which components of the sepsis bundle were included. Two reviewers independently assessed the de-identified data. Data analysis included the t-test, significant at α=0.05. RESULTS: Overall, 50% of students recognized sepsis (42% in March vs. 57% in April), 74% ordered blood cultures (74% vs. 75%), 62% ordered a lactate (58% vs. 66%), 60% ordered appropriate antibiotics (63% vs. 57%), and 40% ordered adequate fluid resuscitation (30% vs. 50%, P = 0.02). Entrustment was different by month (March vs. April) but was not significant: 70% vs. 54% were not entrustable, 18% vs. 28% were developing entrustment, 12% vs. 18% were entrustable. CONCLUSION: A flipped, blended residency preparedness course is an innovative approach to assessing entrustment prior to residency. Virtual online patients can help educators identify knowledge gaps in recognizing and managing emergent conditions (i.e., sepsis). Students had difficulties with sepsis recognition and management, particularly with fluid resuscitation and antibiotic choice. We will bolster the curriculum to develop students’ abilities to detect and manage sepsis to improve patient safety and outcomes. DISCLOSURES: All authors: No reported disclosures.