Does Simulation-Based Medical Education With Deliberate Practice Yield Better Results Than Traditional Clinical Education? A Meta-Analytic Comparative

PubMed ID: 21512370
Acad Med. 2011 Apr 20. [Epub ahead of print]

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

Abstract
PURPOSE: This article presents a comparison of the effectiveness of traditional clinical education toward skill acquisition goals versus simulation-based medical education (SBME) with deliberate practice (DP).


METHOD: This is a quantitative meta-analysis that spans 20 years, 1990 to 2010. A search strategy involving three literature databases, 12 search terms, and four inclusion criteria was used. Four authors independently retrieved and reviewed articles. Main outcome measures were extracted to calculate effect sizes.


RESULTS: Of 3,742 articles identified, 14 met inclusion criteria. The overall effect size for the 14 studies evaluating the comparative effectiveness of SBME compared with traditional clinical medical education was 0.71 (95% confidence interval, 0.65-0.76; P < .001). CONCLUSIONS: Although the number of reports analyzed in this meta-analysis is small, these results show that SBME with DP is superior to traditional clinical medical education in achieving specific clinical skill acquisition goals. SBME is a complex educational intervention that should be introduced thoughtfully and evaluated rigorously at training sites. Further research on incorporating SBME with DP into medical education is needed to amplify its power, utility, and cost-effectiveness.

PMID: 21512370 [PubMed - as supplied by publisher]

Dr. McGaghie is Jacob R. Suker, MD, Professor of Medical Education, professor of preventive medicine, and director of evaluation, Northwestern University Clinical and Translational Sciences Institute, Northwestern University Feinberg School of Medicine, Chicago, Illinois. Dr. Issenberg is Michael S. Gordon, MD professor of medicine and assistant director, Gordon Center for Research in Medical Education, University of Miami Miller School of Medicine, Miami, Florida. Ms. Cohen is research assistant, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois. Dr. Barsuk is assistant professor of medicine, Division of Hospital Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois. Dr. Wayne is associate professor of medicine and director, Internal Medicine Residency Training Program, Northwestern University Feinberg School of Medicine, Chicago, Illinois.

Structured interdisciplinary rounds in a medical teaching unit: improving patient safety.

PubMed ID: 21482844

Arch Intern Med. 2011 Apr 11;171(7):678-84.

O'Leary KJ, Buck R, Fligiel HM, Haviley C, Slade ME, Landler MP, Kulkarni N, Hinami K, Lee J, Cohen SE, Williams MV, Wayne DB.

Division of Hospital Medicine, Northwestern University Feinberg School of Medicine, 211 E Ontario St, Seventh Floor, Chicago, IL 60611. keoleary@nmh.org

Abstract

BACKGROUND: Effective collaboration and teamwork is essential to providing safe hospital care. The objective of this study was to assess the effect of an intervention designed to improve interdisciplinary collaboration and lower the rate of adverse events (AEs).

METHODS: The study was a controlled trial of an intervention, Structured Inter-Disciplinary Rounds, implemented in 1 of 2 similar medical teaching units in a tertiary care academic hospital. The intervention combined a structured format for communication with a forum for regular interdisciplinary meetings. We conducted a retrospective medical record review evaluating 370 randomly selected patients admitted to the intervention and control units (n = 185 each) in the 24 weeks after and 185 admitted to the intervention unit in the 24 weeks before the implementation of Structured Inter-Disciplinary Rounds (N = 555). Medical records were screened for AEs. Two hospitalists confirmed the presence of AEs and assessed their preventability and severity in a masked fashion. We used multivariable Poisson regression models to compare the adjusted incidence of AEs in the intervention unit to that in concurrent and historic control units.

RESULTS: The rate of AEs was 3.9 per 100 patient-days for the intervention unit compared with 7.2 and 7.7 per 100 patient-days, respectively, for the concurrent and historic control units (adjusted rate ratio, 0.54; P = .005; and 0.51; P = .001). The rate of preventable AEs was 0.9 per 100 patient-days for the intervention unit compared with 2.8 and 2.1 per 100 patient-days for the concurrent and historic control units (adjusted rate ratio, 0.27; P = .002; and 0.37; P = .02). The low number of AEs rated as serious or life-threatening precluded statistical analysis for differences in rates of events classified as serious or serious and preventable.

CONCLUSION: Structured Inter-Disciplinary Rounds significantly reduced the adjusted rate of AEs in a medical teaching unit.

PMID: 21482844 [PubMed - in process]