Teaching and training of invasive procedures on cadavers.

The Lancet (Impact Factor: 39.06). 12/1988; 2(8619):1078-9. DOI: 10.1016/S0140-6736(88)90098-0
Source: PubMed
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    ABSTRACT: Procedure skill training and competency certification are an important part of internal medicine residency training. Expert guidelines exist on the minimum number of procedures recommended to attain competence, but these have not been validated. To study the validity of the American Board of Internal Medicine (ABIM) recommended procedure guidelines. We performed a retrospective review of all monthly procedure log sheets collected during residency training for the graduates of our internal medicine residency program. The number of procedure attempts and the length of time needed to be certified as competent in 13 different procedures were recorded and compared with ABIM guidelines. There were 69 graduates with an average of 32.7 monthly procedure log sheets per resident. There was a wide variation in the number of attempts and time needed to attain competence in the measured procedures. Overall, our residents received their competency certification for each required procedure within 1 SD of the corresponding ABIM recommendation. Our study suggests that the ABIM recommended guidelines on procedure skill competence may be valid on the program level
    Teaching and Learning in Medicine 02/2003; 15(3):175-9. · 0.94 Impact Factor
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    ABSTRACT: We developed an instructional program to teach aspiration and injection techniques of the knee and shoulder to medical students and residents. Residents and fourth-year medical students participating in a rheumatology elective were assigned by deterministic allocation into 3 groups: the Traditional group received no specific instruction in arthrocentesis but simply rotated through rheumatology, learning injection techniques only if they saw patients who required them; the Lecture-only group received only the didactic lecture and did not have the opportunity to practice on the models; the Program group participated in the newly developed program of instruction that combined a didactic lecture and a hands-on workshop using the anatomic models to practice arthrocentesis techniques. The scores on the written examination for those in the Program group (mean score 37.46 out of 40 possible) and the Lecture-only group (mean 37.75) were significantly higher than those of the Traditional group (mean 33.15) (P <.05). The scores on the practical examination for those in the Program group (mean score 24.08 out of 26 possible) were significantly higher than those of the Lecture-only (mean 20.50) and Traditional (mean 17.33) (P <.05) The addition of this type of instruction to supplement a traditional internal medicine rotation can enhance a learner's ability to perform joint/soft-tissue injection and aspiration.
    Journal of General Internal Medicine 06/2002; 17(6):441-5. · 3.28 Impact Factor
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    ABSTRACT: To examine the ethical issues raised by physicians performing, for skill development, medically nonindicated invasive medical procedures on newly dead and dying patients. Literature review; issue analysis employing current normative ethical obligations, and evaluation against moral rules and utilitarian assessments manifest in other common perimortem practices. Practicing medical procedures for training purposes is not uncommon among physicians in training. However, empiric information is limited or absent evaluating the effects of this practice on physician competence and ethics, assessing public attitudes toward practicing medical procedures and requirements for consent, and discerning the effects of a consent requirement on physicians' clinical competence. Despite these informational gaps, there is an obligation to secure consent for training activities on newly and nearly dead patients based on contemporary norms for informed consent and family respect. Paradigms of consent-dependent societal benefits elsewhere in health care support our determination that the benefits from physicians practicing procedures does not justify setting aside the informed consent requirement. Current ethical norms do not support the practice of using newly and nearly dead patients for training in invasive medical procedures absent prior consent by the patient or contemporaneous surrogate consent. Performing an appropriately consented training procedure is ethically acceptable when done under competent supervision and with appropriate professional decorum. The ethics of training on the newly and nearly dead remains an insufficiently examined area of medical training.
    Journal of General Internal Medicine 11/2002; 17(10):774-8. · 3.28 Impact Factor