Cardiovascular Simulation Cases for Dental Students

Publication ID Published Volume
1722 January 15, 2009 5


Human patient simulation (HPS) exercises are now routinely used in medical school for teaching physiologic principles in a clinical context without patient risks. The use of HPS in dental education, however, is still exceedingly rare. As part of a basic physiology course, we developed two HPS-based cases to expose first-year dental students to the physiological processes related to the most common acute cardiovascular emergencies that occur during daily dental practice. The students were first introduced to a high fidelity HPS during a lecture and reviewed the objective for the subsequent laboratory. The two laboratory simulation cases focused on diagnosis and management of 1.) neurogenic shock and 2.) the angina pectoris that may occur during dental treatment. Eighty-three students participated in lab exercises. Both cases were presented in 1 hour lab sessions with about 20 students in each group with discussion in an active--reflective learning cycle. All students were interactively involved in the case assessment during the process of events and subsequent outcomes. During the scenarios, the basic physiological events were tied to real clinical situations. This innovative model of dental education was designed to provide hands-on experience for managing a cardiovascular emergency in dental practice and for improving conceptual knowledge in critical clinical decision making.

This laboratory exercise requires the use of a high fidelity human patient simulator like the METI ECS. The exercise is best presented in a small group setting. The exercise is designed to be run with two preceptors. One preceptor will specialize in the basic physiology and the other on the clinical aspects of the cases. The preceptors need to be familiar with simulation as an instructional method and active case-based discussion. They must also be capable of highlighting key teaching points as the case unfolds, thereby making it a rewarding learning experience for the students. The instructor must work to make the session very interactive by encouraging participation by all of the students. This educational module involves interactions between biomedical science faculty, clinical faculty, and students. It would begin in year 1 and continue through year 4, with different simulation exercises so students can encounter the basic physiological sciences throughout the curriculum and not see these essential foundations for patient care as isolated, out of context topics to "finish and forget." The achievement of this goal necessitates interdisciplinary course planning among health sciences faculty to permit resource sharing, collaborative relationships and professional development. The dental faculties will help to write the objective driven scenario and be a preceptor for each specific disciplinary case.

To date, HPS is rarely used in dental education. Our case scenarios demonstrate an effective use of HPS for exposing dental students to two of the most common acute cardiovascular medical emergencies that can occur in dental practice. They provided the first year students with skills early in their training, prior to their first encounter with a live patient in a clinical setting. Compared to historic controls, students did not show significant differences in their overall exam scores (82.4% in 08 versus 82.8% in 07). However, there was one question on the ECG arrhythmias which asked about atrial fibrillation which was shown with the simulator exercise in 08 and not in 07. Students did significantly better on that question. (28.3% correct answer in 07 compared to 92.9% in 08). The question regarding shock question had similar outcome in the two groups. Furthermore, a survey found that a vast majority of the students felt these simulation case-based exercises useful for improving their conceptual knowledge of cardiovascular physiology and its application to dental practice. The simulation is useful to illustrate the pathophysiological events underlying cardiovascular emergencies that may occur in dental practice. In future years, each scenario will be evaluated separately. The 50 minutes introductory -- lectured- based and a short active simulation based-discussion in the class (with a group of five volunteered students) worked very well with the following objective: Introduce students to the simulation as part of their new curriculum and save more time for their first lab session.


Kamyab S, Kamyab S, Uijtdehaage S, Gordon C, Roos K. Cardiovascular simulation cases for dental students. MedEdPORTAL Publications. 2009;5:1722.

Educational Objectives

  1. To be able to link basic cardiovascular physiology to real clinical situations.
  2. To be able to help the students retain their basic physiological knowledge by providing realistic scenarios relevant to dentistry.
  3. To be able to review two of the most common clinical situations encountered by dentists.


  • Neurogenic Shock, Angina Pectoris, Dentistry

Prior Scholarly Dissemination

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ISSN 2374-8265