Student competence in fluid and electrolyte management: the impact of various teaching methods

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.

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.

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.

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.