Sepsis Module for Medical Students

Life-Threatening Organ Dysfunction
A Sepsis Module for Medical Students

Montano NM, Navlyt AV, Valino HB, Maciey SM

Audience: The target audiences for this podcast are medical students preparing for and/or currently enrolled in clinical clerkships and acting internships in which they will encounter critically-ill patients in sepsis and septic shock (e.g., Emergency Medicine, Critical Care Medicine, Internal Medicine, etc.). Secondary target audiences include: Physician assistant and nurse practitioner students, paramedics, registered nurses, and other healthcare providers interested in learning more about sepsis.

Objectives: The purpose of this project was to develop an asynchronous online learning module focused on the early identification and management of sepsis and septic shock in adult and pediatric patients, with the goal of increasing medical student knowledge, comfort, and confidence in caring for critically-ill patients with life threatening organ dysfunction (i.e., sepsis & septic shock). Objectives are achieved via audio summary and supporting video included within the podcast. The conversational style of this podcast, along with section recaps/summaries, enhance the learner experience; the 15-minute duration of this podcast ensures adequate time to complete the podcast without distraction or inattention.

Detailed objectives by SMART Criteria:

  • Specific
    • Identify and prognosticate septic patients using SIRS criteria
    • Identify and prognosticate septic patients using qSOFA criteria
    • State the recommended resuscitation volume for septic patients
    • State the indications for vasopressor therapy in septic patients
  • Measurable
    • [Optional] Achieve a passing score of 80% on the post-module quiz (appendix 1)
  • Attainable
    • Discuss the benefits and limitations of the SIRS criteria for sepsis
    • Discuss the benefits and limitations of the qSOFA criteria for sepsis
    • Discuss the role of IV fluids in the early management of septic patients
    • Discuss the role of vasopressors in the early management of septic patients
    • Discuss the role of antibiotics in the early management of septic patients
  • Relevant
    • Differentiate the metabolic effects (e.g., pH) of 0.9% NaCl vs Ringer’s lactate
    • Differentiate the physiologic effects of push-dose norephinephrine vs epinephrine
    • Discuss the differences in diagnosis and management of sepsis in pediatric patients versus that of adults
  • Time-bound
    • Students will complete the 15-minute online learning module, “Life Threatening Organ Dysfunction, A Sepsis Module for Medical Students”
    • [Optional] Complete, and pass, the post-module quiz [Appendix 1]

Background

There is a significant lack of ability and confidence in the application of critical care skills, including the diagnosis and early management of sepsis, that exists among both graduating medical students and intern-year residents1,2. This gap in clinical skill not only hinders the physician’s ability to perform effectively, but places the patient directly in harm’s way3. Currently, the Society of Critical Care Medicine recommends teaching medical students critical care skills during undergraduate medical education (UGME)1. It is thought that incorporating education in the diagnosis and early management of sepsis and septic shock during undergraduate medical education will improve the critical care skills of graduating medical students. In this project, we have designed an online education module (i.e., video podcast) for medical students that focuses on the diagnosis and early management of sepsis and septic shock in both adult and pediatric patients.

Methods

We designed and produced a 15-minute video podcast-style asynchronous online learning module directed at the following four content areas relative to sepsis and septic shock: 1) Pathophysiology & clinical manifestations, 2) Diagnostic criteria (eg, SIRS vs qSOFA), 3) Early management & core measures, and 4) Differences in pediatric populations. Podcast design involved conversational-style discussion by three 4th-year medical students, with section recaps/summaries and image-guided video to both orient and inform the listener. A sample clinical case was introduced at the start of the podcast as a means of demonstrating the importance of understanding the diagnosis and early management of sepsis and septic shock, thus incentivizing learner interest. This case was concluded at the end of the podcast to facilitate integration of new knowledge with clinical context and spaced-repetition of key concepts discussed during the podcast.

Podcast Topics

  1. Introduction
  2. Pathophysiology
  3. Clinical Case Study: History & Physical
  4. Diagnostic Criteria (SIRS vs qSOFA)
  5. Management: IV Fluids
  6. Management: Vasopressors
  7. Role of Steroids in Severe Sepsis
  8. Management: Antibiotics
  9. Summary of Adult Sepsis
  10. Differences in Pediatric Populations
  11. Clinical Case Study: Resolution
  12. Final Summary & Conclusion

Pre-reading for Instructors

  • The Third International Consensus on Sepsis & Septic Shock (Sepsis-3)4,5
  • FOAMeds on Sepsis and Septic Shock6–8
  • Pediatric Sepsis & Septic Shock9,10

Pre-reading for students

  • The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3)4
  • Surviving Sepsis Campaign Guidelines 2017, by FOAMCast8
  • Six Myths Promoted by the New Surviving Sepsis Guidelines, by PulmCrit6

We recommend this podcast to be administered as a component of the flipped classroom learning model, where the learner first listens to the podcast independently (i.e., prior to in-class activity session). This podcast may also be assigned to learners prior to participation in simulation-based learning involving a case focused on sepsis and septic shock.

Discussion

Expected Outcomes: We hypothesize survey responses to favor increased comfort and confidence in managing septic patients, both adult and pediatric, after completion of the asynchronous online learning module. Furthermore, the results of this study may be used to direct additional education in critical care medicine in undergraduate medical education. Anticipated Problems: Student participation is limited by concurrent MD curriculum and access to online media. Additionally, any simulation activity added to this module requires time and resources directly from the Center for Virtual Care; it is anticipated that simulation-based resources will be limited.

Bibliography

  1. Fessler HE. Undergraduate medical education in critical care. Crit Care Med. 2012;40(11):3065-3069. doi:10.1097/CCM.0b013e31826ab360.
  2. Harrison GA, Hillman KM, Fulde GW, Jacques TC. The need for undergraduate education in critical care. (Results of a questionnaire to year 6 medical undergraduates, University of New South Wales and recommendations on a curriculum in critical care). Anaesth Intensive Care. 1999;27(1):53-58. http://www.ncbi.nlm.nih.gov/pubmed/10050225. Accessed June 6, 2017.
  3. Smith CM, Perkins GD, Bullock I, Bion JF. Undergraduate training in the care of the acutely ill patient: a literature review. Intensive Care Med. 2007;33(5):901-907. doi:10.1007/s00134-007-0564-8.
  4. Singer M, Deutschman CS, Seymour CW, et al. The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). JAMA. 2016;315(8):801. doi:10.1001/jama.2016.0287.
  5. Seymour CW, Liu VX, Iwashyna TJ, et al. Assessment of Clinical Criteria for Sepsis: For the Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). JAMA. 2016;315(8):762-774. doi:10.1001/jama.2016.0288.
  6. Farkas J. Six myths promoted by the new surviving sepsis guidelines. PulmCrit. https://emcrit.org/pulmcrit/sepsis-myths/. Published 2017. Accessed March 1, 2017.
  7. Weingart S. SSC guidelines 2016 (in 2017). Practical Evidence Podcast. https://emcrit.org/practicalevidence/ssc-guidelines-2016/. Published 2017. Accessed March 1, 2017.
  8. Westafer L. Surviving sepsis compaign guidelines 2017. FOAMCast. http://foamcast.org/2016/02/21/sepsis-redefined/. Published 2017. Accessed March 1, 2017.
  9. Brierley J, Carcillo JA, Choong K, et al. Clinical practice parameters for hemodynamic support of pediatric and neonatal septic shock: 2007 update from the American College of Critical Care Medicine*. Crit Care Med. 2009;37(2):666-688. doi:10.1097/CCM.0b013e31819323c6.
  10. Goldstein B, Giroir B, Randolph A, International Consensus Conference on Pediatric Sepsis. International pediatric sepsis consensus conference: Definitions for sepsis and organ dysfunction in pediatrics*. Pediatr Crit Care Med. 2005;6(1):2-8. doi:10.1097/01.PCC.0000149131.72248.E6.
Cite this work as:

Montano NM, Navlyt AV, Valino HB, Maciey SM. Life-Threatening Organ Dysfunction: A Sepsis Module for Medical Students. Acting|Intern Project. Published on April 4, 2017. Available at [https://actingintern.com/portfolio/sepsis-module/].