The Simulated Shock Objective Standardized Clinical Assessment.

John Su, Steven Shen, David Bahner


To develop an Objective Structured Clinical Examination (OSCE) on shock using the Heartworks trans-thoracic echocardiography simulator and to validate the instrument on fourth-year medical students.


Fourth-year medical students participate in an Advanced Medicine and Hospital Based Care – Emergency Medicine (AMHBC-EM) seminar on shock, a standard, mandatory educational component in Part 3 or the final unit of the Lead.

Serve. Inspire (LSI) medical curriculum at the Ohio State University College of Medicine. The Simulated Shock OSCE is an optional assessment integrated into the AMHBC-EM seminar that students can complete after the shock seminar.

The assessment includes: Demographic Survey, Shock Knowledge Exam, Heartworks Simulation Exam, and Post-OSCE Survey. The Simulation Exam consists of 3 shock cases and includes: Cardiac Tamponade, Global LV Dysfunction, and Hypovolemia.

For each case, participants acquire 3 specific TTE views on the simulator and interpret their cardiac ultrasound images with accompanying multiple-choice questions. Ultrasound images are graded anonymously on a 0 to 4 sliding scale by the ultrasound division in the Department of Emergency Medicine.

The results of the Demographic Survey are used to draw conclusions about the OSCE with respect between students who took or did not take the seminar and their final composite score.


Data collection was completed with 18 fourth-year medical students.

In the experimental group, we recruited 12 students who completed the shock seminar. In the control group, we recruited 6 students who did not complete the shock seminar.

A 24-item Demographic Survey was constructed to ask participants about ultrasound training in medical schools and how many scans they have taken from either models or patients.

Questions also consisted of five-point Likert-like ranging from 1 (very unskilled) to 5 (very skilled) to assess competency with acquiring 5 cardiac views: Subxiphoid, Parasternal Long Axis, Parasternal Short Axis, Apical 4 Chamber and Inferior Vena Cava.

In the Knowledge Exam, 20 questions were constructed around the 5 different categories of shock related to cardiac ultrasound. There was a maximum of 20 possible points participants could earn.

In the Simulation Exam, participants obtained in total 9 TTE images and answered 18 additional multiple-choice questions. Given that each TTE image, as graded, was worth between 0 and 4 points, there was a maximum of 54 possible points participants could earn. The Simulated Shock OSCE was worth 74 points.


As the popularity and applications for point-of-care ultrasound continues to grow, it demands new modalities to teach learners how to use this operator dependent machine. Simulation provides learners a non-threatening environment that can help them master the basic ultrasound skills and make a tremendous impact in emergent clinical scenarios, such as shock.

The Simulated Shock OSCE was developed using a cardiac ultrasound simulator to assess shock competency and was tested on 4th year medical students. More research will be needed to validate this tool among other cohorts that use the cardiac ultrasound simulator including faculty, residents and other medical students

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