Mastery learning of thoracentesis skills by internal medicine residents using simulation technology and deliberate practice.

Thoracentesis has been identified as a core competency for hospitalists. Residency training may not provide adequate preparation to perform this procedure. Our aim was to use a thoracentesis simulation to assess graduating residents' proficiency in thoracentesis procedural skills and to evaluate the impact of an educational intervention on skill development to mastery standards. This was a pretest-posttest mastery learning design without a control group. Participants were 40 third-year internal medicine residents in a university-affiliated program. Using an observational checklist, each resident underwent baseline assessment of thoracentesis skill using a standardized clinical history, radiograph, and thoracentesis simulation. After baseline testing, residents received two 2-hour education sessions featuring a videotaped presentation and deliberate practice with the thoracentesis simulator. Residents were retested after the intervention. Skill mastery was defined as meeting or exceeding the minimum passing score (MPS) set by an expert panel at thoracentesis posttest. Those who did not achieve the MPS had additional deliberate practice and were retested until the MPS was reached. Performance improved 71% from pretest to posttest on the clinical skills examination. All residents met or exceeded the mastery standard. The amount of practice time needed to reach the MPS was the only predictor (negative) of posttest performance. The education program was rated highly. A curriculum featuring deliberate practice dramatically increased the skills of residents in thoracentesis. Residents enjoy training and receiving evaluation and feedback in a simulated clinical environment. This mastery program illustrates a feasible and reliable mechanism to achieve procedural competency.

Wayne DB ，Barsuk JH ，O'Leary KJ ，Fudala MJ ，McGaghie WC ... -  《-》

Mastery learning of advanced cardiac life support skills by internal medicine residents using simulation technology and deliberate practice.

Wayne DB ，Butter J ，Siddall VJ ，Fudala MJ ，Wade LD ，Feinglass J ，McGaghie WC ... -  《-》

Mastery learning of temporary hemodialysis catheter insertion by nephrology fellows using simulation technology and deliberate practice.

Barsuk JH ，Ahya SN ，Cohen ER ，McGaghie WC ，Wayne DB ... -  《-》

Simulation-based mastery learning reduces complications during central venous catheter insertion in a medical intensive care unit.

Barsuk JH ，McGaghie WC ，Cohen ER ，O'Leary KJ ，Wayne DB ... -  《-》

Use of simulation-based mastery learning to improve the quality of central venous catheter placement in a medical intensive care unit.

Central venous catheter (CVC) insertions are performed frequently by internal medicine residents. Complications, including arterial puncture and pneumothorax, decrease when operators use fewer needle passes to insert the CVC. In this study, we evaluated the effect of simulation-based mastery learning on CVC insertion skill. This was a cohort study of internal jugular (IJ) and subclavian (SC) CVC insertions by 41 internal medicine residents rotating through the medical intensive care unit (MICU) over a five-month period. Thirteen traditionally-trained residents were surveyed about the number of needle passes, complications, and procedural self-confidence on CVCs inserted in the MICU. Concurrently, 28 residents completed simulation-based training in IJ and SC CVC insertions. Simulator-trained residents were expected to perform CVC insertions to mastery standards on a central line simulator. Simulator-trained residents then rotated through the MICU and were surveyed regarding CVC placement. The impact of simulation training was assessed by comparing group survey results. No resident met the minimum passing score (MPS) (79.1%) for CVC insertion at baseline: mean (M) (IJ) = 48.4%, standard deviation (SD) = 23.1, M(SC) = 45.2%, SD = 26.3. All residents met or exceeded the MPS at testing after simulation training: M(IJ) = 94.8%, SD = 10.0, M(SC) = 91.1%, SD = 17.8 (p < 0.001). In the MICU, simulator-trained residents required fewer needle passes to insert a CVC than traditionally-trained residents: M = 1.79, SD = 1.0 versus M = 2.78, SD = 1.77 (p = 0.04). Simulator-trained residents displayed more self-confidence about their procedural skills: (M = 81, SD = 11 versus M = 68, SD = 20, p = 0.02). Simulation-based mastery learning increased residents' skills in simulated CVC insertion, decreased the number of needle passes when performing actual procedures, and increased resident self-confidence.

Barsuk JH ，McGaghie WC ，Cohen ER ，Balachandran JS ，Wayne DB ... -  《-》