Article

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

ABSTRACT

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.

Download full-text

Full-text

Available from: William C Mcgaghie, Jul 17, 2015
  • Source
    • "National work-hour restrictions, medicolegal concerns, and the increasing complexity and volume of critical care patients in the United States significantly limit the time allowed for learning key concepts and developing autonomy with mechanical ventilator management during ICU (Intensive Care Unit) rotations [2]. Simulation is effective as a training methodology within medical education [3, 4], including the development and refinement of critical care skills [5, 6], invasive procedures7891011, and crisis resource management [12, 13]. Residents are evaluated on their clinical development by assessing their proficiency in the aforementioned skill sets. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Objectives. Management of mechanically ventilated patients may pose a challenge to novice residents, many of which may not have received formal dedicated critical care instruction prior to starting their residency training. There is a paucity of data regarding simulation and mechanical ventilation training in the medical education literature. The purpose of this study was to develop a curriculum to educate first-year residents on addressing and troubleshooting ventilator alarms. Methods. Prospective evaluation was conducted of seventeen residents undergoing a twelve-hour three-day curriculum. Residents were assessed using a predetermined critical action checklist for each case, as well as pre- and postcurriculum multiple-choice cognitive knowledge questionnaires and confidence surveys. Results. Significant improvements in cognitive knowledge, critical actions, and self-reported confidence were demonstrated. The mean change in test score from before to after intervention was +26.8%, and a median score increase of 25% was noted. The ARDS and the mucus plugging cases had statistically significant improvements in critical actions, p < 0.001 . A mean increase in self-reported confidence was realized (1.55 to 3.64), p = 0.049 . Conclusions. A three-day simulation curriculum for residents was effective in increasing competency, knowledge, and confidence with ventilator management.
    Full-text · Article · Feb 2016 · Critical care research and practice
  • Source
    • "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]. "
    [Show abstract] [Hide abstract]
    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.
    Full-text · Article · Mar 2015 · Epilepsy & Behavior
  • [Show abstract] [Hide abstract]
    ABSTRACT: It is a long held maxim by neurologists and non-neurologists alike that if you want a lumbar puncture performed, call in the neurologist. In a training institution, when a board-certified neurologist is not available, call the neurology resident. With 10, 50, maybe even 100 spinal taps under his or her belt, a neurology resident should certainly know how to perform the procedure and get the job done. In fact, that is what we have been led to believe; a lot of experience means a lot of expertise with any procedure. That was, until this belief started being tested.(1) And so, another medical maxim bites the dust.
    No preview · Article · Jun 2012 · Neurology
Show more