Simulation-based education with mastery learning improves paracentesis skills.
ABSTRACT: BACKGROUND: Paracentesis is a commonly performed bedside procedure that has the potential for serious complications. Therefore, simulation-based education for paracentesis is valuable for clinicians. OBJECTIVE: To assess internal medicine residents' procedural skills before and after simulation-based mastery learning on a paracentesis simulator. METHODS: A team with expertise in simulation and procedural skills developed and created a high fidelity, ultrasound-compatible paracentesis simulator. Fifty-eight first-year internal medicine residents completed a mastery learning-based intervention using the paracentesis simulator. Residents underwent baseline skill assessment (pretest) using a 25-item checklist. Residents completed a posttest after a 3-hour education session featuring a demonstration of the procedure, deliberate practice, ultrasound training, and feedback. All residents were expected to meet or exceed a minimum passing score (MPS) at posttest, the key feature of mastery learning. We compared pretest and posttest checklist scores to evaluate the effect of the educational intervention. Residents rated the training sessions. RESULTS: Residents' paracentesis skills improved from an average pretest score of 33.0% (SD = 15.2%) to 92.7% (SD = 5.4%) at posttest (P < .001). After the training intervention, all residents met or exceeded the MPS. The training sessions and realism of the simulation were rated highly by learners. CONCLUSION: This study demonstrates the ability of a paracentesis simulator to significantly improve procedural competence.
Project description:To evaluate the effect of simulation-based mastery learning (SBML) on internal medicine residents' lumbar puncture (LP) skills, assess neurology residents' acquired LP skills from traditional clinical education, and compare the results of SBML to traditional clinical education.This study was a pretest-posttest design with a comparison group. Fifty-eight postgraduate year (PGY) 1 internal medicine residents received an SBML intervention in LP. Residents completed a baseline skill assessment (pretest) using a 21-item LP checklist. After a 3-hour session featuring deliberate practice and feedback, residents completed a posttest and were expected to meet or exceed a minimum passing score (MPS) set by an expert panel. Simulator-trained residents' pretest and posttest scores were compared to assess the impact of the intervention. Thirty-six PGY2, 3, and 4 neurology residents from 3 medical centers completed the same simulated LP assessment without SBML. SBML posttest scores were compared to neurology residents' baseline scores.PGY1 internal medicine residents improved from a mean of 46.3% to 95.7% after SBML (p < 0.001) and all met the MPS at final posttest. The performance of traditionally trained neurology residents was significantly lower than simulator-trained residents (mean 65.4%, p < 0.001) and only 6% met the MPS.Residents who completed SBML showed significant improvement in LP procedural skills. Few neurology residents were competent to perform a simulated LP despite clinical experience with the procedure.
Project description:BACKGROUND: Internal medicine residents must be competent in advanced cardiac life support (ACLS) for board certification. OBJECTIVE: To use a medical simulator to assess postgraduate year 2 (PGY-2) residents' baseline proficiency in ACLS scenarios and evaluate the impact of an educational intervention grounded in deliberate practice on skill development to mastery standards. DESIGN: Pretest-posttest design without control group. After baseline evaluation, residents received 4, 2-hour ACLS education sessions using a medical simulator. Residents were then retested. Residents who did not achieve a research-derived minimum passing score (MPS) on each ACLS problem had more deliberate practice and were retested until the MPS was reached. PARTICIPANTS: Forty-one PGY-2 internal medicine residents in a university-affiliated program. MEASUREMENTS: Observational checklists based on American Heart Association (AHA) guidelines with interrater and internal consistency reliability estimates; deliberate practice time needed for residents to achieve minimum competency standards; demographics; United States Medical Licensing Examination Step 1 and Step 2 scores; and resident ratings of program quality and utility. RESULTS: Performance improved significantly after simulator training. All residents met or exceeded the mastery competency standard. The amount of practice time needed to reach the MPS was a powerful (negative) predictor of posttest performance. The education program was rated highly. CONCLUSIONS: A curriculum featuring deliberate practice dramatically increased the skills of residents in ACLS scenarios. Residents needed different amounts of training time to achieve minimum competency standards. Residents enjoy training, evaluation, and feedback in a simulated clinical environment. This mastery learning program and other competency-based efforts illustrate outcome-based medical education that is now prominent in accreditation reform of residency education.
Project description:<h4>Introduction</h4>Structured procedural education and assessment of competency are growing needs for residency and fellowship programs. Simulation is a useful way to learn, experience, and practice procedural skills with competence. Paracentesis is a common procedure encountered in internal medicine. This educational resource for paracentesis education includes didactics, cases, and assessments to address cognitive skills, a simulation experience to address psychomotor procedural skills, and an entrustment-based assessment tool.<h4>Methods</h4>Prior to the simulation, learners completed preprocedural didactics and self-assessments. Utilizing a paracentesis trainer, ultrasound, and paracentesis kit, the case of a 46-year-old male with ascites in need of a paracentesis was presented. During the simulation, learners initially performed a paracentesis step by step, with assistance and feedback from the case instructor. This was immediately followed by paracentesis without assistance, where the instructor evaluated the learners with an assessment tool encompassing a procedural checklist, global skill assessment scale, and entrustment scale. Afterwards, learners completed case-based reviews and returned to the simulation lab several months later to repeat an unassisted paracentesis.<h4>Results</h4>The curriculum was used with internal medicine and medicine-pediatric residents of all training levels. To date, over 120 residents have completed the curriculum. Residents reported an increase in self-confidence and competence using ultrasound to identify ascites and performing a paracentesis. Learners provided positive feedback.<h4>Discussion</h4>This curriculum offers the opportunity for both cognitive and psychomotor paracentesis education in a low-risk simulation environment. The comprehensive strategy with didactics, cases, and multiple simulations is designed to promote knowledge and skill retention.
Project description:BACKGROUND: Simulation is increasingly used for teaching medical procedures. The goal of this study was to assess learner preferences for how simulators should be used in a procedural curriculum. METHODS: A 26-item survey was constructed to assess the optimal use of simulators for the teaching of medical procedures in an internal medicine residency curriculum. Survey domains were generated independently by two investigators and validated by an expert panel (n = 7). Final survey items were revised based on pilot survey and distributed to 128 internal medicine residents. RESULTS: Of the 128 residents surveyed, 106 (83%) responded. Most responders felt that simulators should be used to learn technical skills (94%), refine technical skills (84%), and acquire procedural teaching skills (87%). Respondents felt that procedures most effectively taught by simulators include: central venous catheterization, thoracentesis, intubation, lumbar puncture, and paracentesis. The majority of learners felt that teaching should be done early in residency (97%). With regards to course format, 62% of respondents felt that no more than 3-4 learners per simulator and an instructor to learner ratio of 1:3-4 would be acceptable.The majority felt that the role of instructors should include demonstration of technique (92%), observe learner techniques (92%), teach evidence behind procedural steps (84%) and provide feedback (89%). Commonly cited barriers to procedural teaching were limitations in time, number of instructors and simulators, and lack of realism of some simulators. CONCLUSIONS: Our results suggest that residents value simulator-based procedural teaching in the form of small-group sessions. Simulators should be an integral part of medical procedural education.
Project description:<h4>Background</h4>Breaking bad news (BBN) to patients and their relatives is a complex and stressful task. The ideal structure, training methods and assessment instruments best used to teach and assess BBN for anesthesiology residents remain unclear. The purpose of this study is to evaluate the effectiveness of an education intervention for BBN based on immersive experiences with a high fidelity simulator and role-play with standardized patients (SPs). A secondary purpose is to gather validity evidence to support the use of a GRIEV_ING instrument to assess BBN skills.<h4>Methods</h4>The communication skills for BBN of 16 residents were assessed via videotaped SP encounters at baseline and immediately post-intervention. Residents' perceptions about their ability and comfort for BBN were collected using pre and post workshop surveys.<h4>Results</h4>Posttest scores were significantly higher than the pretest scores for the GRIEV_ING checklist, as well as on the communication global rating. The GRIEV_ING checklist had acceptable inter-rater and internal-consistency reliabilities. Performance was not related to years of training, or previous BBN experience.<h4>Conclusion</h4>Anesthesiology residents' communication skills when BBN in relation to a critical incident may be improved with educational interventions based on immersive experiences with a high fidelity simulator and role-play with SPs.
Project description:BACKGROUND:Training for ultrasound-guided central venous catheterization (CVC) is typically conducted on static manikin simulators with real-time feedback from a skilled observer. Dynamic haptic robotic trainers (DHRTs) are an alternative method that simulates various patient anatomies and provides consistent feedback for each insertion. This study evaluates CVC needle insertion efficiency and skill gains of both methods. MATERIALS AND METHODS:Fifty-two first-year surgical residents were trained by placing internal jugular (IJ) CVC needles in manikins (n = 26) or robots (n = 26). Manikin-trained participants received verbal feedback from an experienced observer, whereas robotically trained participants received quantitative feedback from the personalized DHRT learning interface. All participants were pretested on a Blue Phantom manikin; participants completed posttesting on a Blue Phantom manikin (n = 26) or a novel manikin (n = 26) with different vessel depth and position. During pretests and posttests residents were timed, motion-tracked, and scored on an IJ CVC checklist. RESULTS:(1) All skills on the IJ CVC checklist showed significant (P < 0.014) improvements from pretests to posttest; (2) Average angle of insertion, path length, and jerk improved significantly (P < 0.005); (3) Average procedural completion time, with standard error (SE) reported, decreased significantly from pretest (M = 3.516 min, SE = 0.277) to posttest (M = 1.997, SE = 0.409). CONCLUSIONS:No significant group differences were observed in overall skill gains, but residents' average procedural completion time decreased significantly from pretests to posttest. Overall results support DHRT as an effective method for training IJ CVC skills.
Project description:Introduction:The number of abdominal hysterectomies (AHs) performed by OB/GYN residents has decreased dramatically. Thus, there is a need for simulation training to complement operating room experience. Methods:A low-fidelity AH simulator was constructed from craft-store supplies costing less than $40. OB/GYN residents in a single academic program completed the simulation between July and September of 2015. The 1-hour simulation experience included a pretest, a 5-minute presentation, the simulation, and a posttest. On the pre- and posttests, participants rated their confidence with the steps of AH as not at all, somewhat, or very confident. Results:Eighty-six percent (32 of 37) of possible residents completed the session, with even representation from all levels of training (nine PGY 1, seven PGY 2, eight PGY 3, and eight 8 PGY 4 residents). Knowledge of the steps of the procedure and instrumentation improved for all levels of trainees (p < .001). One hundred percent (16 out of 16) of the PGY 1 and PGY 2 residents rated their confidence as increased afterwards, while only 25% (four out of 16) of the PGY 3 and PGY 4 residents did so. Ninety-four percent (30 out of 32) rated the session as very helpful on a scale of not at all, somewhat, or very helpful. Discussion:A low-fidelity, low-cost simulator showed an increase in trainee confidence with AH, particularly in the first- and second-year trainees. Nearly all participants found the exercise helpful, suggesting that it may be beneficial to incorporate into OB/GYN training programs nationwide.
Project description:IntroductionEarly formal instruction in procedural skills may increase the frequency with which residents perform procedures in the clinical setting. This workshop trained internal medicine residents in ultrasound skills and manual skills required to perform procedures common on medicine wards and required for board eligibility.MethodsSince 2016, our internal medicine residency program has executed three annual half-day workshops for interns during orientation, before clinical duties began. Prior to the workshop, we directed interns to relevant educational resources in the form of online modules and videos. At the workshop, trainees rotated in small groups through facilitated stations to learn basics of procedural ultrasound and to practice manual tasks performed during paracentesis, thoracentesis, lumbar puncture, and peripheral intravenous catheter placement. We administered questionnaires before and immediately after the workshop and used Wilcoxon signed rank tests to compare self-assessed independence and confidence.ResultsTwo hundred four interns with little prior procedural training participated in the workshop. Most participants (85%) indicated that orientation was the best timing for this training experience when compared to later options. Confidence and independence increased for ultrasound-marked thoracentesis, paracentesis, and peripheral intravenous catheters and for lumbar puncture without ultrasound.DiscussionThis internal medicine intern orientation workshop on procedures and procedural ultrasound was well received and increased participants’ confidence and sense of independence. This publication contains materials needed to reproduce the training experience.
Project description:Background: Frequent simulation-based education is recommended to improve health outcomes during neonatal resuscitation but is often inaccessible due to time, resource, and personnel requirements. Digital simulation presents a potential alternative; however, its effectiveness and reception by healthcare professionals (HCPs) remains largely unexplored. Objectives: This study explores HCPs' attitudes toward a digital simulator, technology, and mindset to elucidate their effects on neonatal resuscitation performance in simulation-based assessments. Methods: The study was conducted from April to August 2019 with 2-month (June-October 2019) and 5-month (September 2019-January 2020) follow-up at a tertiary perinatal center in Edmonton, Canada. Of 300 available neonatal HCPs, 50 participated. Participants completed a demographic survey, a pretest, two practice scenarios using the RETAIN neonatal resuscitation digital simulation, a posttest, and an attitudinal survey (100% response rate). Participants repeated the posttest scenario in 2 months (86% response rate) and completed another posttest scenario using a low-fidelity, tabletop simulator (80% response rate) 5 months after the initial study intervention. Participants' survey responses were collected to measure attitudes toward digital simulation and technology. Knowledge was assessed at baseline (pretest), acquisition (posttest), retention (2-month posttest), and transfer (5-month posttest). Results: Fifty neonatal HCPs participated in this study (44 females and 6 males; 27 nurses, 3 nurse practitioners, 14 respiratory therapists, and 6 doctors). Most participants reported technology in medical education as useful and beneficial. Three attitudinal clusters were identified by a hierarchical clustering algorithm based on survey responses. Although participants exhibited diverse attitudinal paths, they all improved neonatal resuscitation performance after using the digital simulator and successfully transferred their knowledge to a new medium. Conclusions: Digital simulation improved HCPs' neonatal resuscitation performance. Medical education may benefit by incorporating technology during simulation training.
Project description:BACKGROUND: To date, no standardized presentation format is taught to emergency medicine (EM) residents during patient handoffs to consulting or admitting physicians. The Situation-Background-Assessment-Recommendation (SBAR) is a common format that provides a consistent framework to communicate pertinent information. OBJECTIVE: The objective of this study was to describe and evaluate the feasibility of using SBAR to teach interphysician communication skills to first-year EM residents to use during patient handoffs. METHODS: An educational study was designed as part of a pilot curriculum to teach first-year EM residents handoff communication skills. A standardized SBAR reporting format was taught during a 1-hour didactic intervention. All residents were evaluated using pretest/posttest simulated cases using a 17-item SBAR checklist initially, and then within 4 months to assess retention of the tool. A survey was distributed to determine resident perceptions of the training and potential clinical utility. RESULTS: There was a statistically significant improvement from the resident scores on the pretest/posttest of the first case (P = .001), but there was no difference between posttest of the first case and pretest of the second case (P = .34), suggesting retention of the material. There was a statistically significant improvement from the pretest and posttest scores on the second case (P = .001). The survey yielded good reliability for both sessions (Cronbach alpha = 0.87 and 0.89, respectively), demonstrating statistically significant increases for the perceived quality of training, presentation comfort level, and the use of SBAR (P = .001). CONCLUSION: SBAR was acceptable to first-year EM residents, with improvements in both the ability to apply SBAR to simulated case presentations and retention at a follow-up session. This format was feasible to use as a training method and was well received by our resident physicians. Future research will be useful in examining the general applicability of the SBAR model for interphysician communications in the clinical environment and residency training programs.