Simulation-based education with mastery learning improves residents' lumbar puncture skills

Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
Neurology (Impact Factor: 8.29). 06/2012; 79(2):132-7. DOI: 10.1212/WNL.0b013e31825dd39d
Source: PubMed


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.

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Available from: William C Mcgaghie, Jul 17, 2015
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    • "Training and evaluation of leadership and communication skills were major objectives of this study and were prominent components of our checklist (items 9 and 10) and scoring system. Medical simulation has also been shown to improve technical skills such as lumbar puncture in medical residents [18] and enhance PGY1 surgical resident skills to the level of a PGY2 resident [19]. Observer ratings of team skills have been shown to correlate with team performance during a simulated task [20], and debriefing modestly enhances performance [21]. "
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    ABSTRACT: Patient safety is critical for epilepsy monitoring units (EMUs). Effective training is important for educating all personnel, including residents and nurses who frequently cover these units. We performed a needs assessment and developed a simulation-based team training curriculum employing actual EMU sentinel events to train neurology resident-nurse interprofessional teams to maximize effective responses to high-acuity events. A mixed-methods design was used. This included the development of a safe-practice checklist to assess team response to acute events in the EMU using expert review with consensus (a modified Delphi process). All nineteen incoming first-year neurology residents and 2 nurses completed a questionnaire assessing baseline knowledge and attitudes regarding seizure management prior to and following a team training program employing simulation and postscenario debriefing. Four resident-nurse teams were recorded while participating in two simulated scenarios. Employing retrospective video review, four trained raters used the newly developed safe-practice checklist to assess team performance. We calculated the interobserver reliability of the checklist for consistency among the raters. We attempted to ascertain whether the training led to improvement in performance in the actual EMU by comparing 10 videos of resident-nurse team responses to seizures 4-8months into the academic year preceding the curricular training to 10 that included those who received the training within 4-8months of the captured video. Knowledge in seizure management was significantly improved following the program, but confidence in seizure management was not. Interrater agreement was moderate to high for consistency of raters for the majority of individual checklist items. We were unable to demonstrate that the training led to sustainable improvement in performance in the actual EMU by the method we used. A simulated team training curriculum using a safe-practice checklist to improve the management of acute events in an EMU may be an effective method of training neurology residents. However, translating the results into sustainable benefits and confidence in management in the EMU requires further study. Copyright © 2015 Elsevier Inc. All rights reserved.
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    ABSTRACT: Purpose: Patient care quality worsens during academic year turnover. Incoming interns' uneven clinical skills likely contribute to this phenomenon, known as the "July effect." The aim of this study was to evaluate the impact of a simulation-based mastery learning (SBML) boot camp on internal medicine interns' clinical skills. Method: This was a cohort study of an SBML intervention at Northwestern University. In 2011, 47 interns completed boot camp; 109 interns (from 2009 and 2010) who did not participate in boot camp were historical controls. Boot-camp-trained interns participated in three days of small-group teaching sessions, deliberate practice, and individualized feedback. Primary outcome measures were performance of boot-camp-trained interns and historical controls on five parts of a clinical skills examination (CSE). Assessments included recognition of physical examination findings (cardiac auscultation), performance of procedures (paracentesis and lumbar puncture), management of critically ill patients (intensive care unit skills), and communication with patients (code status discussion). Boot camp participants were required to meet or exceed a minimum passing standard (MPS) before beginning their internship. Results: Boot-camp-trained interns all eventually met or exceeded the MPS and performed significantly better than historical control interns on all skills (P < .01), even after controlling for age, gender, and USMLE Step 1 and 2 scores (P < .001). The authors detected no relationship between CSE scores and age, gender, prior experience, self-confidence, or USMLE Step 1 and 2 scores. Conclusions: An SBML boot camp allows for individualized training, assessment, and documentation of competence before interns begin providing medical care.
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    ABSTRACT: Resumen Introducción: La neurofobia es el temor hacia las neurociencias y neurología clínica. Por el impacto mundial de las enfer-medades neurológicas, este temor podría afectar el manejo de dichas enfermedades. No hay datos de este fenómeno en Ecuador. Objetivos: El objetivo es evaluar la dificultad, conocimiento, confianza e interés hacia la neurología, afinidad a especiali-dades en neurociencias, factores para la dificultad en neurología y entrenamiento neurológico entre los estudiantes de medicina. Materiales y Métodos: Se realizó un estudio transversal descriptivo en la Universidad Católica Santiago de Guayaquil, encuestando: dificultad, conocimiento, confianza e interés entre especialidades; afinidad hacia las neurociencias como especia-lidad; factores para que neurología sea percibida como difícil y, entrenamiento neurológico en pregrado. Resultados: La tasa de respuesta fue de 78.32% (401/512). Neurología fue la más difícil (3.01±0.048), la segunda con menos confianza clínica (2.01±0.056), y tercera con menor conocimiento (1.96±0.058). Las diferencias fueron significativas (p< 0.001). 70.82% no planean seguir con una especialidad afín a las neurociencias, 59.85% por ausencia de afinidad personal, 10,97% por pobre enseñanza. Por el otro lado, 29.18% desea una especialidad afín a las neurociencias, 19.95% por afinidad personal y 9.23% por buena enseñanza. Necesidad de saber neurociencia básica fue el factor más importante para la percepción de dificultad (2.76±0.055) seguido por pobre enseñanza en semiología neurológica (2.68±0.57). La formación en semiología neurológica la más baja (1.70±0.061) seguida por Neuroanatomía (1.98±0.58) y Neurología (2.52±0.81). Semiología neurológica presentó el mayor porcentaje de insuficiencia en la formación (20.45%), comparado con Neuroanatomía (9.47%) y Neurología (6.16%). Conclusiones: Existe neurofobia entre nuestros estudiantes. Investigaciones y cambios en la enseñanza deben desarrollar-se para prevenir la neurofobia y contribuir a la " neurofilia. " Palabras Claves: Neurofobia, Educación Basada en Evidencia, Estudiantes de Medicina, Ecuador, Enfermedades Neurológicas Abstract Background: Neurophobia is defined as fear to neuroscience and clinical neurology. By the impact of neurological diseases worldwide, management of these disorders could be affected. No data exist of this phenomenon in Ecuador. Objectives: To evaluate the difficulty, knowledge, confidence and interest in neurology, neuroscience specialties, affinity factors for difficulty in neurology and neurological training among medical students. Methods and Materials: A descriptive study was conducted at the Catholic University of Santiago de Guayaquil, surveying: difficulty, knowledge, confidence and interest among specialties; affinity to neuroscience as a specialty, factors contributing neurology´s perception as difficult, and neurological undergraduate training. Results: The response rate was 78.32% (401/512). Neurology was the most difficult (3.01±0.048), the second with less clinical confidence (2.01±0.056), and third with less knowledge (1.96±0.058). The differences were significant (p <0.001). 70.82% did not plan to pursue a specialty related to neuroscience, 59.85% for absent personal affinity; 10.97% for poor teaching ; Contrary, 29.18% want a related specialty in neuroscience, 19.95% by personal affinity and 9.23% for good teaching. Need to know basic neuroscience was the most important for the perception of difficulty (2.76±0.055) followed by poor teaching factor in neurological involvement (2.68±0.57). Training in Neurological Semiology the lowest (1.70±0.061) followed by Neuroanatomy (1.98±0.58) and Neurology (2.52±0.81). Neurologic semiology had the highest percentage of inadequate training (20.45%) compared to Neuroanatomy (9.47%) and Neurology (6.16%). Conclusions: There is neurophobia among our students. Research and modifications in teaching must be developed to prevent neurophobia and contribute to " neurophilia. "
    Revista Ecuatoriana de Neurologia 02/2013; 22(1-3):46-52. · 0.02 Impact Factor
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