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End of the "see one, do one, teach one" era: the next generation of invasive bedside procedural instruction.
MedLine Citation:
PMID:  20606241     Owner:  NLM     Status:  In-Process    
Abstract/OtherAbstract:
CONTEXT: Traditionally, an apprenticeship model has been used for the instruction of invasive bedside procedures. Because this approach is subject to nonuniform application, a new model was established to determine the impact of a standardized curriculum on medical students' and residents' medical knowledge and technical skills.
METHODS: A procedural instruction curriculum for medical students and residents was developed, and a pilot program with the curriculum was incorporated into an internal medicine residency program. Five common procedures in osteopathic and allopathic internal medicine training programs were included: central venous catheterization, knee arthrocentesis, lumbar puncture, paracentesis, and thoracentesis. An initial assessment of participants' baseline knowledge and skills was obtained. Teaching methods included video instruction; discussion of key concepts; faculty-led, hands-on, simulation-based instruction; and individual deliberate practice. Postinstruction knowledge and skills were evaluated, respectively, through a written test and a quantified assessment (ie, checklist) using direct observation. Participants were asked to provide written feedback at the conclusion of each instructional module.
RESULTS: A total of 60 participants, all in allopathic medicine, underwent the training component. Fifty-two participants were internal medicine residents (including 2 from an outside program); 4 were trainees in a combined internal medicine-pediatrics residency; and 4 were medical students (1 from an outside program). Participants demonstrated a statistically significant improvement (P<.001) in medical knowledge, as evidenced by preinstruction vs postinstruction test scores. Comparison of initial baseline procedural checklist scores with postinstruction checklist scores, during participants' performance on the first live patient, also showed statistically significant improvement (P<.001).
CONCLUSION: A simulation-based, standardized curriculum in invasive bedside procedural instruction significantly improved the medical knowledge and technical skills of novice physicians.
Authors:
Joshua D Lenchus
Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  The Journal of the American Osteopathic Association     Volume:  110     ISSN:  1945-1997     ISO Abbreviation:  J Am Osteopath Assoc     Publication Date:  2010 Jun 
Date Detail:
Created Date:  2010-07-07     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7503065     Medline TA:  J Am Osteopath Assoc     Country:  United States    
Other Details:
Languages:  eng     Pagination:  340-6     Citation Subset:  IM    
Affiliation:
University of Miami-Jackson Memorial Hospital Center for Patient Safety in Miami, Florida, USA. jlenchus@med.miami.edu
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