A Multipatient Simulation Session: Evaluation of Six Simulated Patients with Different Shock Syndromes

INTRODUCTION: This multipatient simulation exercise was designed for second-year medical students to illustrate the four different categories of shock (hypovolemic, cardiogenic, obstructive, distributive) during a single simulation session. The comparative design of this simulation was intended to help students develop a conceptual framework for diagnosing and treating each type of shock. METHODS: Students worked together in teams of five under specified time constraints to solve six simulated shock cases. The simulation exercise was implemented with a class of 60 second-year medical students. Teams collected key history and physical findings, established a working diagnosis, and administered treatment within an 8-minute window for each simulated patient. Following the simulations, a 90-minute facilitated discussion prompted students to compare and contrast the diagnoses and the basic management strategies for different types of shock using a preformatted shock evaluation matrix designed for the event. RESULTS: The students applied basic science knowledge to the simulated clinical scenarios to diagnose the class and etiology of shock for each patient. The teams' ability to diagnose class of shock was better than their ability to determine the etiology. Students completed a voluntary evaluation of the educational exercise immediately following the simulation. DISCUSSION: The unique, comparative design of this simulation provides educational value by exposing students to the various patterns of the four classes of shock in a single simulation session, presenting realistic clinical cases, and demonstrating the importance of teamwork in a time-pressured environment.