Unexpected Collateral Effects of Simulation-Based Medical Education

Barsuk, Jeffrey H. MD, MS; Cohen, Elaine R.; Feinglass, Joe PhD; McGaghie, William C. PhD; Wayne, Diane B. MD

Purpose: Internal medicine residents who complete simulation-based education (SBE) in central venous catheter (CVC) insertion acquire improved skills that yield better patient care outcomes. The collateral effects of SBE on the skills of residents who have not yet experienced SBE are unknown.

Method: In this retrospective, observational study, the authors used a checklist to test the internal jugular and subclavian CVC insertion skills of 102 Northwestern University second- and third-year internal medicine residents before they received simulation training. The authors compared, across consecutive academic years (2007-2008, 2008-2009, 2009-2010), mean pretraining scores and the percent of trainees who met or surpassed a minimum passing score (MPS).

Results: Mean internal jugular pretest scores improved from 46.7% (standard deviation = 20.8%) in 2007 to 55.7% (+/-22.5%) in 2008 and 70.8% (+/-22.4%) in 2009 (P < .001). Mean subclavian pretest scores changed from 48.3% (+/-25.5%) in 2007 to 45.6% (+/-31.0%) in 2008 and 63.6% (+/-27.3%) in 2009 (P = .04). The percentage of residents who met or surpassed the MPS before training for internal jugular insertion was 7% in 2007, 16% in 2008, and 38% in 2009 (P = .004); for subclavian insertion, the percentage was 11% in 2007, 19% in 2008, and 38% in 2009 (P = .028).

Conclusions: SBE for senior residents had an effect on junior trainees, as evidenced by pretraining CVC insertion skill improvement across three consecutive years. SBE for a targeted group of residents has implications for skill acquisition among other trainees.

Use of simulation-based education to improve resident learning and patient care in the medical intensive care unit: A randomized trial

PMID:

 

22033049

CJ Schroedl, TC Corbridge, ER Cohen, SS Fakhran… - Journal of Critical Care, 2011

Abstract

Purpose

The purpose of this study is to determine the effect of simulation-based education on the knowledge and skills of internal medicine residents in the medical intensive care unit (MICU).

Methods and Materials

From January 2009 to January 2010, 60 first-year residents at a tertiary care teaching hospital were randomized by month of rotation to an intervention group (simulator-trained, n = 26) and a control group (traditionally trained, n = 34). Simulator-trained residents completed 4 hours of simulation-based education before their medical intensive care unit (MICU) rotation. Topics included circulatory shock, respiratory failure, and mechanical ventilation. After their rotation, residents completed a standardized bedside skills assessment using a 14-item checklist regarding respiratory mechanics, ventilator settings, and circulatory parameters. Performance of simulator-trained and traditionally trained residents was compared using a 2-tailed independent-samples t test.

Results

Simulator-trained residents scored significantly higher on the bedside skills assessment compared with traditionally trained residents (82.5% ± 10.6% vs 74.8% ± 14.1%,P = .027). Simulator-trained residents were highly satisfied with the simulation curriculum.

Conclusions

Simulation-based education significantly improved resident knowledge and skill in the MICU. Knowledge acquired in the simulated environment was transferred to improved bedside skills caring for MICU patients. Simulation-based education is a valuable adjunct to standard clinical training for residents in the MICU.

Keywords: Simulation training; Medical education; Medical intensive care unit; Clinical competence; Quality of health care

Medical Education Featuring Mastery Learning With Deliberate Practice Can Lead to Better Health for Individuals and Populations

 Pubmed ID: 22030671

McGaghie WC, Issenberg SB, Cohen ER, Barsuk JH, Wayne DB. 

Medical education can lead to better health for individuals and populations when it has effective, evidence-based features and is delivered under the right conditions. Effective, evidence-based features include mastery learning (ML), deliberate practice (DP), and rigorous outcome measurement (ML and DP are both defined below). The right conditions include a committed and skillful faculty, curriculum integration and institutional endorsement, and health care system acceptance. Translation of medical education outcomes to measurable downstream effects on improved patient care practices and better health for individuals and populations is demonstrated by educational and health services research programs that are thematic, sustained, and cumulative.

ML is an especially stringent form of competency-based education where learners acquire essential knowledge and skill measured rigorously against fixed achievement standards without regard to the time needed to reach the outcome. Mastery indicates a much higher level of performance than competence alone, and evidence shows that ML leads to longer skill maintenance without significant decay. Educational outcomes are uniform in ML with little or no variation, whereas educational time varies among trainees.¹ In medical education, ML has been used chiefly for acquisition and maintenance of clinical procedural skills such as advanced cardiac life support (ACLS), thoracentesis, and central venous catheter (CVC) insertion. ML can also be used to acquire and refine cognitive and affective educational outcomes. The ability to engage a family in a difficult conversation about end-of-life issues is a clinical skill amenable to ML just like performance of a lumbar puncture. Work is now under way to evaluate these and other clinical mastery outcomes.

DP embodies strong and consistent educational interventions grounded in information processing and behavioral theories of skill acquisition and maintenance.² DP has at least nine elements: (1) highly motivated learners with good concentration, (2) well-defined learning objectives that address knowledge or skills that matter clinically, at an (3) appropriate level of difficulty for the medical learners, with (4) focused, repetitive practice of the knowledge or skills, that leads to (5) rigorous measurements that yield reliable data, which provide (6) informative feedback from educational sources (e.g., teachers, simulators) that promotes frequent (7) monitoring, error correction, and more DP that enables (8) performance evaluation toward reaching a mastery standard, and allows (9) advancement toward the next clinical task or unit. The goal of DP is constant skill improvement. Research shows that DP is a much more powerful predictor of professional accomplishment than experience or academic aptitude.

Medical education and evaluation research programs that incorporate ML and DP principles, and evaluate outcomes with measurement and methodological rigor, are beginning to show translational results in patient care practices and patient outcomes.³ Many of these educational programs use health care simulation technology as a curriculum driver. Examples of improved patient care include reduced complications and higher success rates at CVC insertion, improvement in laparoscopic surgical skill, better adherence to guidelines during ACLS team responses, and increased competence in several types of endoscopy. Better health for individuals and populations linked directly to medical education programs has been demonstrated through reduced rates of catheter-related bloodstream infections; reduced birth complications due to shoulder dystocia (brachial plexus injury), low Apgar scores, and infant brain injury from neonatal hypoxic–ischemic encephalopathy; and lower postsurgical complications among cataract surgery patients.³ Advancements in medical education, evaluated rigorously, can produce better patient health as judged statistically and clinically.

Powerful and effective medical education programs do not exist in a vacuum. They include not only such curriculum features as ML, DP, and reliable outcome measurement but also faculty and administrative commitment, curriculum support expressed as financial and human capital, and a health care system whose culture embraces professional competence evaluation in service of patient care quality and patient safety at all levels. Medical education programs are being recognized as complex service interventions that are affected by the context in which they are delivered. This context is highly variable but has a powerful role in determining the ultimate success of the program. A new, interdisciplinary academic field called implementation science, and the scholarly journal that bears its name, holds promise to teach the medical education community how to develop, launch, and sustain educational programs that improve health for individuals and populations.

Medical school and residency curricula must change to adopt a competency-based approach featuring structured learning experiences tied to assessments that yield reliable data. Research shows convincingly that ML and DP linked to competence assessment can improve health outcomes. Expansion of this model is needed to better prepare trainees for independent and group practice and to ensure competent medical care for patients and society.

Is It the Athlete Or the Equipment? An analysis of the top swim performances from 1990-2010.

O'Connor LM, Vozenilek JA.
J Strength Cond Res. 2011 Sep 29. [Epub ahead of print]
PMID: 21964430

Abstract

Forty-three world record swims were recorded at the 2009 Fédération Internationale de Natation (FINA) World Championship meet in Rome. Of the 20 FINA recognized long-course (50m pool) swimming events, men set new world records in 15 of those events while women did the same in 17 events. Each of the men's world records and 14 of the 17 women's records still stand. These performances were unprecedented; never before had this many world records been broken in such a short period of time. There was much speculation that full-body, polyurethane, technical swimsuits were the reason for the conspicuous improvement in world records. Further analysis led FINA to institute new rules on January 1, 2010, that limited the types of technical swimsuits that could be worn by athletes. No long-course world record has been broken since then. We sought to understand this phenomenon by analyzing publically available race data and exploring other possible causes including: improvements in other sports; improvements in training science; changes in rules and regulations; gender differences; anaerobic vs. aerobic events; unique talent; and membership data.

PMID:

21964430

[PubMed - as supplied by publisher]

Simulation and quality improvement in anesthesiology.

Anesthesiol Clin. 2011 Mar;29(1):13-28. Epub 2010 Dec 16.

Abstract

Simulation, a strategy for improving the quality and safety of patient care, is used for the training of technical and nontechnical skills and for training in teamwork and communication. This article reviews simulation-based research, with a focus on anesthesiology, at 3 different levels of outcome: (1) as measured in the simulation laboratory, (2) as measured in clinical performance, and (3) as measured in patient outcomes. It concludes with a discussion of some current uses of simulation, which include the identification of latent failures and the role of simulation in continuing professional practice assessment for anesthesiologists.

Copyright © 2011 Elsevier Inc. All rights reserved.

PMID:

 

21295750

 

[PubMed - indexed for MEDLINE]

Simulation-based team training in healthcare.

Simulation-based team training in healthcare.

Posted:

Simul Healthc. 2011 Aug;6 Suppl:S14-9
Authors: Eppich W, Howard V, Vozenilek J, Curran I
: Simulation-based team training (SBTT) in healthcare is gaining acceptance. Guidelines for appropriate use of SBTT exist, but the evidence base remains limited. Insights from other academic disciplines with sophisticated models of team working may point to opportunities to build on current frameworks applied to team training in healthcare. The purpose of this consensus statement is threefold: (1) to highlight current best practices in designing SBTT in healthcare and to identify gaps in current implementation; (2) to explore validated concepts and principles from relevant academic disciplines and industries; and (3) to identify potential high-yield areas for future research and development.
PMID: 21817858 [PubMed - in process]

Evaluating the Impact of Simulation on Translational Patient Outcomes.

Pubmed ID:21705966

Simul Healthc. 2011 Jun 23. [Epub ahead of print]

McGaghie WC, Draycott TJ, Dunn WF, Lopez CM, Stefanidis D.

Source

From the Center for Education in Medicine (W.C.M.), Northwestern University Feinberg School of Medicine, Chicago, IL; Southmead Hospital (T.J.D.), Bristol, UK; College of Medicine, Mayo Clinic (W.F.D.), Rochester, MN; Kaiser Permanente Program Offices (C.M.L.), Oakland, CA; and Department of Surgery (D.S.), Carolinas Healthcare System, Charlotte, NC.

Abstract

INTRODUCTION:

A long and rich research legacy shows that under the right conditions, simulation-based medical education (SBME) is a powerful intervention to increase medical learner competence. SBME translational science demonstrates that results achieved in the educational laboratory (T1) transfer to improved downstream patient care practices (T2) and improved patient and public health (T3).

METHOD:

This is a qualitative synthesis of SBME translational science research (TSR) that employs a critical review approach to literature aggregation.

RESULTS:

Evidence from SBME and health services research programs that are thematic, sustained, and cumulative shows that measured outcomes can be achieved at T1, T2, and T3 levels. There is also evidence that SBME TSR can yield a favorable return on financial investment and contributes to long-term retention of acquired clinical skills. The review identifies best practices in SBME TSR, presents challenges and critical gaps in the field, and sets forth a TSR agenda for SBME.

CONCLUSIONS:

Rigorous SBME TSR can contribute to better patient care and improved patient safety. Consensus conference outcomes and recommendations should be presented and used judiciously.

PMID:

21705966

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