Student Competence in Fluid and Electrolyte Management: The Impact of Various Teaching Methods

Weisgerber, Michael; Flores, Glenn; Pomeranz, Al; Greenbaum, Larry; Hurlbut, Pat; Bragg, Dawn

doi:10.1016/j.ambp.2007.01.005

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Volume 7, Issue 3 , Pages 220-225, May 2007

Student Competence in Fluid and Electrolyte Management: The Impact of Various Teaching Methods

Presented in part at the annual meeting of the Pediatric Academic Society, Washington, DC, May 14-17, 2005.

Michael Weisgerber, MD, MS
- Division of Hospital Medicine, Medical College of Wisconsin, Milwaukee, Wis
- Children’s Research Institute and Children’s Hospital of Wisconsin, Milwaukee, Wis.
- Address correspondence to Michael Weisgerber, MD, MS, Pediatric Hospital Medicine Suite C560, CHW Children’s Corporate Center, PO Box 1997, Milwaukee, WI 53201-1997.
Glenn Flores, MD
- Center for the Advancement of Underserved Children, Medical College of Wisconsin, Milwaukee, Wis
- Department of Epidemiology, Health Policy Institute, Medical College of Wisconsin, Milwaukee, Wis
- Children’s Research Institute and Children’s Hospital of Wisconsin, Milwaukee, Wis.
Al Pomeranz, MD
- Division of General Pediatrics, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wis
- Children’s Research Institute and Children’s Hospital of Wisconsin, Milwaukee, Wis.
Larry Greenbaum, MD, PhD
- Division of Nephrology, Emory University and Children’s Healthcare of Atlanta, Atlanta, Ga
- Dr Greenbaum gave the standard fluid and electrolyte management lecture in the Medical College of Wisconsin pediatric clerkship during the study period. He assisted in the design of the quiz and development of a grading algorithm. He did not participate in any of the data collection of quizzes and surveys or in the grading of these.
Pat Hurlbut, MS
- Division of Medical Education, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wis
Dawn Bragg, PhD
- Department of Epidemiology, Health Policy Institute, Medical College of Wisconsin, Milwaukee, Wis

Received 27 April 2006; accepted 11 January 2007.

Objective

The goal of this study was to evaluate 1) the competency of junior medical students (M3s) in fluid and electrolyte management upon completion of their pediatric clerkship; 2) the frequency and perceived helpfulness of fluid and electrolyte management–based interactions with the following sources of education: a lecture, first-year residents (PL1s), senior residents (PL3s), and faculty; and 3) the relationship between points 1 and 2.

Methods

Upon completion of the clerkship, M3 competency was evaluated by a quiz with multiple-choice questions and a clinical vignette concerning the intravenous fluid (IVF) management of a dehydrated child. Junior medical students completed a survey to identify the fluid and electrolyte management case-based practice frequency with PL1s, PL3s, and faculty, and the perceived helpfulness of the lecture, PL1s, PL3s, and faculty, rated on a 10-point Likert scale.

Results

One hundred eighty-seven M3s took the quiz and 180 completed surveys. The mean clinical vignette score was 7.0 (range, 0–12). Eighty-one percent of M3s wrote inadequate IVF orders for a dehydrated infant. The median-perceived helpfulness for each source was lecture, 9 points; PL1, 5 points; PL3, 4 points; and faculty, 3 points. In multivariate regression, only a higher perceived helpfulness rating for the lecture was significantly associated with higher clinical vignette scores (r = 0.43; P < .001). When asked for ideas to improve fluid and electrolyte management education, 47% of M3s recommended more practice problems.

Conclusions

Most M3s lacked adequate fluid and electrolyte management competency. Junior medical students rated the lecture the most helpful source of fluid and electrolyte management education. Improvements in fluid and electrolyte management education of M3s may result from providing practice problems with immediate feedback and formal training to increase the fluid and electrolyte management educational skills of PL1s, PL3s, and faculty.

Key Words: case-based, electrolytes, fluids, medical student education