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McGaghie WC, Barsuk JH, Wayne DB. Use of Mastery Learning to Mitigate Bias. Acad Med 2024; 99:348. [PMID: 38166325 DOI: 10.1097/acm.0000000000005623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2024]
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Barsuk JH, Cohen ER, Patel RV, Keswani RN, Aadam AA, Wayne DB, Cameron KA, Komanduri S. Effect of Polypectomy Simulation-Based Mastery Learning on Skill Retention Among Practicing Endoscopists. Acad Med 2024; 99:317-324. [PMID: 37934830 PMCID: PMC10922268 DOI: 10.1097/acm.0000000000005538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2023]
Abstract
PURPOSE Practicing endoscopists frequently perform and teach screening colonoscopies and polypectomies, but there is no standardized method to train and assess physicians who perform polypectomy procedures. The authors created a polypectomy simulation-based mastery learning (SBML) curriculum and hypothesized that completion of the curriculum would lead to immediate improvement in polypectomy skills and skill retention at 6 and 12 months after training. METHOD The authors performed a pretest-posttest cohort study with endoscopists who completed SBML and were randomized to follow-up at 6 or 12 months from May 2021 to August 2022. Participants underwent SBML training, including a pretest, a video lecture, deliberate practice, and a posttest. All learners were required to meet or exceed a minimum passing standard on a 17-item skills checklist before completing training and were randomized to follow-up at 6 or 12 months. The authors compared simulated polypectomy skills performance on the checklist from pretest to posttest and posttest to 6- or 12-month follow-up test. RESULTS Twenty-four of 30 eligible participants (80.0%) completed the SBML intervention, and 20 of 24 (83.3%) completed follow-up testing. The minimum passing standard was set at 93% of checklist items correct. The pretest passing rate was 4 of 24 participants (16.7%) compared with 24 of 24 participants (100%) at posttest ( P < .001). There were no significant differences in passing rates from posttest to combined 6- and 12-month posttest in which 18 of 20 participants (90.0%) passed. CONCLUSIONS Before training and despite years of clinical experience, practicing endoscopists demonstrated poor performance of polypectomy skills. SBML was an effective method for practicing endoscopists to acquire and maintain polypectomy skills during a 6- to 12-month period.
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Abstract
INTRODUCTION Powerful medical education (PME) involves the use of new technologies informed by the science of expertise that are embedded in laboratories and organizations that value evidence-based education and support innovation. This contrasts with traditional medical education that relies on a dated apprenticeship model that yields uneven results. PME involves an amalgam of features, conditions and assumptions, and contextual variables that comprise an approach to developing clinical competence grounded in education impact metrics including efficiency and cost-effectiveness. METHODS This article is a narrative review based on SANRA criteria and informed by realist review principles. The review addresses the PME model with an emphasis on mastery learning and deliberate practice principles drawn from the new science of expertise. Pub Med, Scopus, and Web of Science search terms include medical education, the science of expertise, mastery learning, translational outcomes, cost effectiveness, and return on investment. Literature coverage is comprehensive with selective citations. RESULTS PME is described as an integrated set of twelve features embedded in a group of seven conditions and assumptions and four context variables. PME is illustrated via case examples that demonstrate improved ventilator patient management learning outcomes compared to traditional clinical education and mastery learning of breaking bad news communication skills. Evidence also shows that PME of physicians and other health care providers can have translational, downstream effects on patient care practices, patient outcomes, and return on investment. Several translational health care quality improvements that derive from PME include reduced infections; better communication among physicians, patients, and families; exceptional birth outcomes; more effective patient education; and return on investment. CONCLUSIONS The article concludes with challenges to hospitals, health systems, and medical education organizations that are responsible for producing physicians who are expected to deliver safe, effective, and cost-conscious health care.
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Affiliation(s)
- William C McGaghie
- Departments of Medical Education and Preventive Medicine and Northwestern Simulation, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Jeffrey H Barsuk
- Departments of Medicine and Medical Education and Northwestern Simulation, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Diane B Wayne
- Departments of Medicine and Medical Education and Northwestern Simulation, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - S Barry Issenberg
- Departments of Medicine and Medical Education and the Gordon Center for Research in Medical Education, University of Miami Miller School of Medicine, Miami, FL, USA
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Feinsmith SE, Amick AE, Feinglass JM, Sell J, Davis EM, Spencer TR, Koepke L, Pastoral J, Wayne DB, Barsuk JH. Performance of peripheral catheters inserted with ultrasound guidance versus landmark technique after a simulation-based mastery learning intervention. J Vasc Access 2023; 24:630-638. [PMID: 34524038 DOI: 10.1177/11297298211044363] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
PROBLEM Ultrasound-guided peripheral intravenous catheter (USGPIV) insertion is an effective method to gain vascular access in patients with difficult intravenous access (DIVA). While USGPIV success rates are reported to be high, some studies have reported a concerning incidence of USGPIV premature failures. AIMS The purpose of this study was to compare differences in USGPIV and landmark peripheral intravenous catheter (PIV) utilization and failure following a hospital-wide USGPIV training program for nurses. METHODS The authors performed a retrospective, electronic medical record review of all USGPIVs and PIVs inserted at a tertiary, urban, academic medical center from September 1, 2018, through September 30, 2019. The primary outcome was differences between USGPIV and PIV time to failure. RESULTS A total of 43,470 short peripheral intravenous catheters (PIVCs) were inserted in 23,713 patients. Of these, 7972 (16.8%) were USGPIV. At 30 days of follow-up, for PIVCs with an indication for removal documented, USGPIVs had higher Kaplan-Meier survival probabilities than PIVs (p < 0.001). CONCLUSIONS The use of simulation-based mastery associated with USGPIVs, demonstrated lower failure rates than standard PIVs after 2 days and USGPIVs exhibited improved survival rates in patients with DIVA. These findings suggest that rigorous simulation-based insertion training demonstrates improved USGPIV survival when compared to traditional PIVCs. SBML is an extremely useful tool to ensure appropriately trained clinicians acquire the necessary knowledge and skillset to improve USGPIV outcomes.
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Affiliation(s)
| | - Ashley E Amick
- Department of Emergency Medicine, University of Washington, Seattle, WA, USA
| | - Joseph M Feinglass
- Division of General Internal Medicine and Geriatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Jordan Sell
- Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Evan M Davis
- Emergency Medicine, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Timothy R Spencer
- School of Public Health & Community Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Lydia Koepke
- Northwestern Memorial Hospital, Chicago, IL, USA
| | | | - Diane B Wayne
- Dr. John Sherman Appleman Professor of Medicine and Medical Education, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Jeffrey H Barsuk
- Feinberg School of Medicine, Departments of Medicine and Medical Education, Northwestern University, Chicago, IL, USA
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Barsuk JH, Mitra D, Cohen ER, Wayne DB. Necessity of Pretests in Central Venous Catheter Insertion Simulation-Based Mastery Learning: A Randomized Controlled Trial. Acad Med 2023; 98:821-827. [PMID: 36780693 DOI: 10.1097/acm.0000000000005170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
PURPOSE Simulation-based mastery learning (SBML) is a rigorous form of competency-based learning. Components of SBML include a pretest, deliberate practice, and a posttest; all learners must meet or exceed a minimum passing standard (MPS) on the posttest before completing training. The authors aimed to explore whether a modified SBML curriculum (without a pretest assessment) was as effective as the standard SBML curriculum (with a pretest assessment). METHOD The authors performed a randomized controlled trial of internal medicine residents who participated in an internal jugular central venous catheter insertion SBML curriculum at a tertiary care academic medical center in Chicago, Illinois, from December 2018 through December 2021. Residents were randomly assigned to complete the usual SBML intervention (pretest group) or to complete a modified SBML intervention without a pretest (no pretest group). The authors compared initial posttest performance and training time between groups. RESULTS Eighty-nine of 120 eligible residents (74.1%) completed the study: 43 in the pretest group and 46 in the no pretest group. Median (IQR) initial posttest scores were not statistically different between the pretest group (96.6 [93.1-100]) and the no pretest group (96.6 [92.4-100]). However, all 43 residents (100%) in the pretest group reached the MPS at the initial posttest compared with 41 of the 46 (89%) in the no pretest group ( P = .06). Residents in the pretest group required 16.5 hours more faculty and learning time than the no pretest group. CONCLUSIONS More residents who completed a pretest reached the MPS at initial posttest. However, incorporating a pretest during the internal jugular central venous catheter SBML curriculum required substantially more learner and faculty time without clear performance benefits.
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Affiliation(s)
- Jeffrey H Barsuk
- J.H. Barsuk is Robert Hirschtick Professor of Medicine and professor of medicine and medical education, Department of Medicine and Medical Education, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Debi Mitra
- D. Mitra is assistant professor of medicine, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Elaine R Cohen
- E.R. Cohen is research associate, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Diane B Wayne
- D.B. Wayne is professor of medicine and medical education, Department of Medicine and Medical Education, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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Smith MM, Secunda KE, Cohen ER, Wayne DB, Vermylen JH, Wood GJ. Clinical Experience Is Not a Proxy for Competence: Comparing Fellow and Medical Student Performance in a Breaking Bad News Simulation-Based Mastery Learning Curriculum. Am J Hosp Palliat Care 2023; 40:423-430. [PMID: 35641315 DOI: 10.1177/10499091221106176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND It is unknown whether traditional medical education ensures competence among fellows in the key skill of breaking bad news (BBN). While simulation-based mastery learning (SBML) has been used to train fourth-year medical students (M4s) in BBN, it is unclear if it adds similar value for fellows. OBJECTIVE We examined the effect of traditional medical training on BBN skills by comparing baseline fellow and M4 skills and confidence and assessed the impact of a BBN SBML curriculum for fellows. METHODS Fellows training in six programs at Northwestern University from November 2018 to May 2019 were eligible for inclusion. Fellows completed a BBN SBML curriculum including a pretest, individualized feedback using a previously published assessment tool, and ongoing deliberate practice until all achieved a minimum passing standard (MPS). The primary outcomes were checklist and scaled item scores on the assessment tool. Fellow performance was compared to a historical M4 cohort. RESULTS Twenty-eight of 38 eligible fellows completed the curriculum and were included for analysis. Fellows reported significantly more experience and confidence in BBN compared to M4s, yet their pre-training performance was significantly worse on checklist (57.1% vs 65.0%, P = .02) and scaled items; only 4% reached the MPS. After training, fellow performance significantly improved on checklist (57.1% to 92.6%, SD = 5.2%, P < .001) and scaled items; all reached the MPS. CONCLUSIONS Despite higher confidence and BBN clinical experience, fellows performed worse than untrained M4s, confirming that experience is not a proxy for skill. Programs must develop competency-based assessments to ensure entrustment of communication skills.
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Affiliation(s)
- Melanie M Smith
- Department of Medicine, 24560Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Katharine E Secunda
- Department of Medicine, 14640University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Elaine R Cohen
- Department of Medicine, 24560Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Diane B Wayne
- Department of Medicine, 24560Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Julia H Vermylen
- Department of Medicine, 24560Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Gordon J Wood
- Department of Medicine, 24560Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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McGaghie WC, Barsuk JH, Wayne DB. Point-of-Care Cardiopulmonary Resuscitation Training and Survival With Favorable Neurologic Outcome in Cardiac Arrest in Pediatric ICUs. JAMA 2022; 328:479. [PMID: 35916851 DOI: 10.1001/jama.2022.9473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- William C McGaghie
- Department of Medical Education, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Jeffrey H Barsuk
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Diane B Wayne
- Department of Medical Education, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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Bradley S, Lindquist LA, Jones EM, Rowe TA, O'Brien KT, Dobschuetz D, Argento AC, Mitra DL, Leonard C, Cohen ER, Wayne DB, Barsuk JH. Development and evaluation of a simulation-based mastery learning maintenance of certification course. Gerontol Geriatr Educ 2022; 43:397-406. [PMID: 33629646 DOI: 10.1080/02701960.2021.1891417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
BACKGROUND/OBJECTIVES To develop and evaluate a post-acute care simulation-based mastery learning (SBML) continuing medical education (CME)/maintenance of certification (MOC) procedure course. DESIGN Pretest-posttest study of the SBML intervention. SETTING A 2-day post-acute care procedures course. PARTICIPANTS Sixteen practicing clinicians (5 physicians,11 advanced practice providers). Participants engaged in a skills pretest on knee aspiration/injection, gastrostomy tube removal/replacement, tracheostomy tube exchange, and basic suturing using a checklist created for each procedure. Participants received a didactic on each procedure followed by deliberate practice with feedback. Using the same checklists, participants completed a skills posttest and were required to meet a minimum passing standard (MPS) to obtain CME/MOC credit. MEASUREMENTS The MPS for each skills checklist was determined by a multidisciplinary panel of 11 experts. Participants completed surveys on procedure self-confidence and a course evaluation. RESULTS There was statistically significant improvement between pre- and posttests for all four procedures (p < .001). All participants were able to meet or exceed the MPS for each skill during the 2-day course. Participants' self-confidence regarding each procedure improved significantly (p < .001). CONCLUSION An SBML training course granting CME/MOC credit for post-acute care providers significantly improves performance of knee aspiration/injection, gastrostomy tube removal/replacement, tracheostomy tube exchange, and basic suturing.
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Affiliation(s)
- Sara Bradley
- Department of Medicine, Northwestern University Feinberg School of Medicine , Division of General Internal Medicine and Geriatrics
- Department of Medical Education , Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Lee A Lindquist
- Department of Medicine, Northwestern University Feinberg School of Medicine , Division of General Internal Medicine and Geriatrics
| | - Emily M Jones
- Department of Medicine, Northwestern University Feinberg School of Medicine, Division of Sports Medicine, Chicago, Illinois, USA
| | - Theresa A Rowe
- Department of Medicine, Northwestern University Feinberg School of Medicine , Division of General Internal Medicine and Geriatrics
| | - Katherine T O'Brien
- Department of Medicine, Northwestern University Feinberg School of Medicine , Division of General Internal Medicine and Geriatrics
| | - Dwayne Dobschuetz
- Department of Medicine, Northwestern University Feinberg School of Medicine , Division of General Internal Medicine and Geriatrics
| | - Angela C Argento
- Department of Medicine, Northwestern University Feinberg School of Medicine, Division of Pulmonary and Critical Care, Chicago, Illinois, USA
| | - Debi L Mitra
- Department of Medicine, Northwestern University Feinberg School of Medicine, Division of Hospital Medicine, Chicago, Illinois, USA
| | - Craig Leonard
- Department of Respiratory Care, Northwestern Memorial Hospital, Chicago, Illinois, USA
| | - Elaine R Cohen
- Department of Medical Education , Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Diane B Wayne
- Department of Medicine, Northwestern University Feinberg School of Medicine , Division of General Internal Medicine and Geriatrics
- Department of Medical Education , Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Jeffrey H Barsuk
- Department of Medical Education , Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Department of Medicine, Northwestern University Feinberg School of Medicine, Division of Hospital Medicine, Chicago, Illinois, USA
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Amick AE, Feinsmith SE, Sell J, Davis EM, Wayne DB, Feinglass J, Barsuk JH. Ultrasound-Guided Peripheral Intravenous Catheter Insertion Training Reduces Use of Midline Catheters in Hospitalized Patients With Difficult Intravenous Access. J Patient Saf 2022; 18:e697-e703. [PMID: 34570003 DOI: 10.1097/pts.0000000000000910] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVES Difficult intravenous (IV) access (DIVA) is a prevalent condition in the hospital setting and increases utilization of midline catheters (MCs) and peripherally inserted central catheters (PICCs). Ultrasound-guided peripheral intravenous (USGPIV) insertion is effective at establishing intravenous access in DIVA but remains understudied in the inpatient setting. We evaluated the effect of an USGPIV simulation-based mastery learning (SBML) curriculum for nurses on MC and PICC utilization for hospitalized patients. METHODS We performed a quasi-experimental observational study. We trained nurses across all inpatient units at a large tertiary care hospital. We queried the electronic medical record to compare PICC and MC utilization for patients with DIVA during 3 periods: before USGPIV SBML training (control), during pilot testing of the intervention, and during the SBML intervention. To account for variations in insertion practices over time, we performed an interrupted time series (ITS) analysis between 2 periods, the combined control and pilot periods and the intervention period. RESULTS One hundred forty-eight nurses completed USGPIV SBML training. Midline catheters inserted monthly per 1000 patient-days for DIVA decreased significantly from 1.86 ± 0.51 (control) to 2.31 ± 0.28 (pilot) to 1.33 ± 0.51 (intervention; P = 0.001). The ITS analysis indicated a significant intervention effect (P < 0.001). Peripherally inserted central catheters inserted monthly per 1000 patient-days for DIVA also significantly decreased over the study periods; however, the ITS failed to show an intervention effect as PICC insertions were already decreasing during the control period. CONCLUSIONS A hospital-wide USGPIV SBML curriculum for inpatient nurses was associated with a significant reduction in MCs inserted for DIVA.
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Affiliation(s)
- Ashley E Amick
- From the Department of Internal Medicine and Emergency Medicine, University of Washington, Seattle, Washington
| | | | - Jordan Sell
- Northwestern University McGaw School of Medicine, Chicago, Illinois
| | - Evan M Davis
- Department of Emergency Medicine, University of Michigan Medical School, Ann Arbor, Michigan
| | - Diane B Wayne
- Department of Medicine, Northwestern University, Evanston, Illinois
| | - Joseph Feinglass
- Department of Medicine, Northwestern University, Evanston, Illinois
| | - Jeffrey H Barsuk
- Department of Medicine, Northwestern University, Evanston, Illinois
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Bradley SM, Heiman HL, Bierman JA, O'Brien K, Cohen ER, Wayne DB. A mastery learning approach to education about fall risk and gait assessment. Gerontol Geriatr Educ 2022; 43:84-91. [PMID: 31378157 DOI: 10.1080/02701960.2019.1651725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Mastery learning is a form of competency-based education in which learning time varies but outcomes are uniform. Trainees must meet a minimum passing standard (MPS) before completing a mastery learning curriculum. The objective of this study was to establish a curriculum for fall risk and gait assessment for medical students, determine an MPS for a fall risk and gait assessment clinical skills examination (CSE), and apply the MPS to a sample of medical students completing a fall risk and gait assessment CSE. Medical students completed an interactive session about fall risk and gait assessment including the Timed Up and Go (TUG) test and completed deliberate practice with 3 patients. Skills were evaluated using an 18-item skills checklist. A panel of clinical experts set the MPS at 82%. Eighty-seven medical students participated. The average score on the checklist was 14.7 of 18 (81.4%.) Although almost all performed the TUG correctly, only 61% met the MPS for the checklist. Our results suggest that a mastery learning approach may better prepare the 39% of students that did not meet MPS to complete a fall risk and gait assessment.
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Affiliation(s)
- Sara M Bradley
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Heather L Heiman
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Department of Medical Education, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Jennifer A Bierman
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Department of Medical Education, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Katherine O'Brien
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Elaine R Cohen
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Diane B Wayne
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Department of Medical Education, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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McGaghie WC, Adams WH, Cohen ER, Wayne DB, Barsuk JH. Psychometric Validation of Central Venous Catheter Insertion Mastery Learning Checklist Data and Decisions. Simul Healthc 2021; 16:378-385. [PMID: 33156260 DOI: 10.1097/sih.0000000000000516] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Resident physicians are expected to acquire competence at central venous catheter (CVC) insertion to a mastery standard. Valid competence decisions about resident physicians' CVC performance rely on reliable data and rigorous achievement standards. This study used data from 3 CVC simulation-based mastery learning studies involving internal medicine (IM) and emergency medicine (EM) residents to address 2 questions: What is the effectiveness of a CVC mastery learning education intervention? Are minimum passing standards (MPSs) set by faculty supported by item response theory (IRT) analyses? METHODS Pretraining and posttraining skills checklist data were drawn from 3 simulation-based mastery learning research reports about CVC internal jugular (IJ) and subclavian (SC) insertion skill acquisition. Residents were required to meet or exceed a posttest skills MPS. Generalized linear mixed effect models compared checklist performance from pre to postintervention. Minimum passing standards were determined by Angoff and Hofstee standard setting methods. Item response theory models were used for cut-score evaluation. RESULTS Internal medicine and EM residents improved significantly on every IJ and SC checklist item after mastery learning. Item response theory analyses support the IJ and SC MPSs. CONCLUSIONS Mastery learning is an effective education intervention to achieve clinical skill acquisition among IM and EM residents. Item response theory analyses reveal desirable measurement properties for the MPSs previously set by expert faculty panels. Item response theory analysis is useful for evaluating standards for mastery learning interventions. The CVC mastery learning curriculum, reliable outcome data, and high achievement standards together contribute to reaching valid decisions about the competence of resident physicians to perform the clinical procedure.
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Affiliation(s)
- William C McGaghie
- From the Departments of Medical Education (W.C.M., D.B.W., J.H.B.), Feinberg School of Medicine, Northwestern University, Chicago; and Department of Medical Education and Public Health Sciences, Loyola University Chicago Stritch School of Medicine (W.H.A.), Maywood; and Department Medicine (E.R.C., D.B.W., J.H.B.), Feinberg School of Medicine, Northwestern University, Chicago
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Cameron KA, Cohen ER, Hertz JR, Wayne DB, Mitra D, Barsuk JH. Barriers and Facilitators to Central Venous Catheter Insertion: A Qualitative Study. J Patient Saf 2021; 17:e1296-e1306. [PMID: 29543666 DOI: 10.1097/pts.0000000000000477] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVES The aims of the study were to identify perceived barriers and facilitators to central venous catheter (CVC) insertion among healthcare providers and to understand the extent to which an existing Simulation-Based Mastery Learning (SBML) program may address barriers and leverage facilitators. METHODS Providers participating in a CVC insertion SBML train-the-trainer program, in addition to intensive care unit nurse managers, were purposively sampled from Veterans Administration Medical Centers located in geographically diverse areas. We conducted semistructured interviews to assess perceptions of barriers and facilitators to CVC insertion. Deidentified transcripts were analyzed using a grounded theory approach and the constant comparative method. We subsequently mapped identified barriers and facilitators to our SBML curriculum to determine whether or not the curriculum addresses these factors. RESULTS We interviewed 28 providers at six Veterans Administration Medical Centers, identifying the following five overarching factors of perceived barriers to CVC insertion: (1) equipment, (2) personnel/staff, (3) setting or organizational context, (4) patient or provider, and (5) time-related barriers. Three overarching factors of facilitators emerged: (1) equipment, (2) personnel, and (3) setting or organizational context facilitators. The SBML curriculum seems to address most identified barriers, while leveraging many facilitators; building on the commonly identified facilitator of nursing staff contribution by expanding the curriculum to explicitly include nurse involvement could improve team efficiency and organizational culture of safety. CONCLUSIONS Many identified facilitators (e.g., ability to use ultrasound, personnel confidence/competence) were also identified as barriers. Evidence-based SBML programs have the potential to amplify these facilitators while addressing the barriers by providing an opportunity to practice and master CVC insertion skills.
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Affiliation(s)
- Kenzie A Cameron
- From the Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Elaine R Cohen
- From the Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Joelle R Hertz
- Medical Error Reduction and Certification, Inc, Seattle, Washington
| | | | - Debi Mitra
- From the Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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Patel RV, Barsuk JH, Cohen ER, Wani SB, Rastogi A, McGaghie WC, Wayne DB, Keswani RN, Komanduri S. Simulation-based training improves polypectomy skills among practicing endoscopists. Endosc Int Open 2021; 9:E1633-E1639. [PMID: 34790525 PMCID: PMC8589541 DOI: 10.1055/a-1525-5620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 06/04/2021] [Indexed: 11/01/2022] Open
Abstract
Background and study aims Practicing endoscopists have variable polypectomy skills during colonoscopy and limited training opportunities for improvement. Simulation-based training enhances procedural skill, but its impact on polypectomy is unclear. We developed a simulation-based polypectomy intervention to improve polypectomy competency. Methods All faculty endoscopists at our tertiary care center who perform colonoscopy with polypectomy were recruited for a simulation-based intervention assessing sessile and stalked polypectomy. Endoscopists removed five polyps in a simulation environment at pretest followed by a training intervention including a video, practice, and one-on-one feedback. Within 1-4 weeks, endoscopists removed five new simulated polyps at post-test. We used the Direct Observation of Polypectomy Skills (DOPyS) checklist for assessment, evaluating individual polypectomy skills, and global competency (scale: 1-4). Competency was defined as an average global competency score of ≥ 3. Results 83 % (29/35) of eligible endoscopists participated and 95 % (276/290) of planned polypectomies were completed. Only 17 % (5/29) of endoscopists had average global competency scores that were competent at pretest compared with 52 % (15/29) at post-test ( P = 0.01). Of all completed polypectomies, the competent polypectomy rate significantly improved from pretest to post-test (55 % vs. 71 %; P < 0.01). This improvement was significant for sessile polypectomy (37 % vs. 65 %; P < 0.01) but not for stalked polypectomy (82 % vs. 80 %; P = 0.70). Conclusions Simulation-based training improved polypectomy skills among practicing endoscopists. Further studies are needed to assess the translation of simulation-based education to clinical practice.
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Affiliation(s)
- Ronak V. Patel
- Division of Gastroenterology and Hepatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States
| | - Jeffrey H. Barsuk
- Division of Hospital Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States,Department of Medical Education, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States
| | - Elaine R. Cohen
- Division of Hospital Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States
| | - Sachin B. Wani
- Division of Gastroenterology and Hepatology, University of Colorado, Aurora, Colorado, United States
| | - Amit Rastogi
- Division of Gastroenterology, Hepatology, and Motility, The University of Kansas, Kansas City, Kansas, United States
| | - William C. McGaghie
- Department of Medical Education, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States
| | - Diane B. Wayne
- Department of Medical Education, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States
| | - Rajesh N. Keswani
- Division of Gastroenterology and Hepatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States
| | - Srinadh Komanduri
- Division of Gastroenterology and Hepatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States
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Wayne DB, Cohen ER, McGaghie WC. Letter to the Editor in Response to: Early Skill Decay After Paracentesis Training. J Gen Intern Med 2021; 36:1794. [PMID: 33796982 PMCID: PMC8175526 DOI: 10.1007/s11606-021-06720-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 10/20/2020] [Accepted: 03/14/2021] [Indexed: 10/21/2022]
Affiliation(s)
- Diane B Wayne
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
- Department of Medical Education, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
| | - Elaine R Cohen
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - William C McGaghie
- Department of Medical Education, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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Mikhaeil-Demo Y, Holmboe E, Gerard EE, Wayne DB, Cohen ER, Yamazaki K, Templer JW, Bega D, Culler GW, Bhatt AB, Shafi N, Barsuk JH. Simulation-Based Assessments and Graduating Neurology Residents' Milestones: Status Epilepticus Milestones. J Grad Med Educ 2021; 13:223-230. [PMID: 33897956 PMCID: PMC8054597 DOI: 10.4300/jgme-d-20-00832.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 10/05/2020] [Accepted: 01/06/2021] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND The American Board of Psychiatry and Neurology and the Accreditation Council for Graduate Medical Education (ACGME) developed Milestones that provide a framework for residents' assessment. However, Milestones do not provide a description for how programs should perform assessments. OBJECTIVES We evaluated graduating residents' status epilepticus (SE) identification and management skills and how they correlate with ACGME Milestones reported for epilepsy and management/treatment by their program's clinical competency committee (CCC). METHODS We performed a cohort study of graduating neurology residents from 3 academic medical centers in Chicago in 2018. We evaluated residents' skills identifying and managing SE using a simulation-based assessment (26-item checklist). Simulation-based assessment scores were compared to experience (number of SE cases each resident reported identifying and managing during residency), self-confidence in identifying and managing these cases, and their end of residency Milestones assigned by a CCC based on end-of-rotation evaluations. RESULTS Sixteen of 21 (76%) eligible residents participated in the study. Average SE checklist score was 15.6 of 26 checklist items correct (60%, SD 12.2%). There were no significant correlations between resident checklist performance and experience or self-confidence. The average participant's level of Milestone for epilepsy and management/treatment was high at 4.3 of 5 (SD 0.4) and 4.4 of 5 (SD 0.4), respectively. There were no significant associations between checklist skills performance and level of Milestone assigned. CONCLUSIONS Simulated SE skills performance of graduating neurology residents was poor. Our study suggests that end-of-rotation evaluations alone are inadequate for assigning Milestones for high-stakes clinical skills such as identification and management of SE.
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Affiliation(s)
- Yara Mikhaeil-Demo
- Yara Mikhaeil-Demo, MD, is Assistant Professor, Department of Neurology, Northwestern University, Feinberg School of Medicine
| | - Eric Holmboe
- Eric Holmboe, MD, MACP, FRCP, is Chief Research, Milestone Development, and Evaluation Officer, Accreditation Council for Graduate Medical Education (ACGME)
| | - Elizabeth E. Gerard
- Elizabeth E. Gerard, MD, is Director, Clinical Neurophysiology Fellowship, and Associate Professor, Department of Neurology, Northwestern University, Feinberg School of Medicine
| | - Diane B. Wayne
- Diane B. Wayne, MD, is Vice Dean for Education, Chair, Department of Medical Education, and Professor of Medicine and Medical Education, Northwestern University, Feinberg School of Medicine
| | - Elaine R. Cohen
- Elaine R. Cohen, MEd, is Research Associate, Department of Medicine, Northwestern University, Feinberg School of Medicine
| | - Kenji Yamazaki
- Kenji Yamazaki, PhD, is Senior Analyst, Milestones Research and Evaluation, ACGME
| | - Jessica W. Templer
- Jessica W. Templer, MD, is Director, Epilepsy Fellowship, and Assistant Professor, Department of Neurology, Northwestern University, Feinberg School of Medicine
| | - Danny Bega
- Danny Bega, MD, is Director, Neurology Residency Program, and Assistant Professor, Department of Neurology, Northwestern University, Feinberg School of Medicine
| | - George W. Culler
- George W. Culler, MD, is Epilepsy Fellow, Department of Neurology, Northwestern University, Feinberg School of Medicine
| | - Amar B. Bhatt
- Amar B. Bhatt, MD, is Assistant Professor, Department of Neurological Sciences, Rush University
| | - Neelofer Shafi
- Neelofer Shafi, MD, is Director, Students and Faculty Development, and Assistant Professor, Department of Neurology and Rehabilitation, University of Illinois Chicago
| | - Jeffrey H. Barsuk
- Jeffrey H. Barsuk, MD, MS, is Director, Simulation and Patient Safety, and Professor of Medicine and Medical Education, Northwestern University, Feinberg School of Medicine
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Schroedl CJ, Frogameni A, Barsuk JH, Cohen ER, Sivarajan L, Wayne DB. Impact of Simulation-based Mastery Learning on Resident Skill Managing Mechanical Ventilators. ATS Sch 2020; 2:34-48. [PMID: 33870322 PMCID: PMC8043263 DOI: 10.34197/ats-scholar.2020-0023oc] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Accepted: 11/23/2020] [Indexed: 12/23/2022] Open
Abstract
Background: Caring for patients requiring mechanical ventilation is complex, and residents may lack adequate skill for managing these patients. Simulation-based mastery learning (SBML) is an educational model that trains clinicians to a high standard and can reduce complications. The mastery learning model has not been applied to ventilator management. Objective: The purpose of this study was to determine whether SBML, as compared with traditional training, is an effective strategy for teaching residents the skills necessary to manage patients requiring mechanical ventilation. Methods: We developed an SBML curriculum and a 47-item skills checklist to test ventilator management for patients with normal, restricted, and obstructed lung physiology. A minimum passing standard (MPS) on the checklist was set using the Mastery Angoff method. Residents rotating through the medical intensive care unit in Academic Year 2017-2018 were assigned to SBML or traditional training based on their medical intensive care unit team. The SBML group was pretested on a ventilator simulator using the skills checklist. They then received a 1.5-hour session (45 min didactic and 45 min deliberate practice on the simulator with feedback). At rotation completion, they were posttested on the simulator using the checklist until the MPS was met. Both SBML-trained and traditionally trained groups received teaching during daily bedside rounds and twice weekly didactic lectures. At rotation completion, traditionally trained residents were tested using the same skills checklist on the simulator. We compared pretest and posttest performance among SBML-trained residents and end of the rotation test performances between the SBML-trained and traditionally trained residents. Results: The MPS was set at 87% on the checklist. Fifty-seven residents were assigned to the SBML-trained group and 49 were assigned to the traditionally trained group. Mean checklist scores for SBML-trained residents improved from 51.4% (standard deviation [SD] = 17.5%) at pretest to 86.1% (SD = 7.6%) at initial posttest and 92.5% (SD = 3.7%) at final (mastery) posttest (both P < 0.001). Forty-two percent of residents required more than one attempt at the posttest to meet or exceed the MPS. At rotation completion, the traditionally trained residents had a mean test score of 60.9% (SD = 13.3%). Conclusion: SBML is an effective strategy to train residents on mechanical ventilator management. An SBML curriculum may augment traditional training methods to further equip residents to safely manage ventilated patients.
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Affiliation(s)
- Clara J. Schroedl
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Alexandra Frogameni
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Jeffrey H. Barsuk
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Elaine R. Cohen
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Lakshmi Sivarajan
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Diane B. Wayne
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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Green MM, Wayne DB, Garcia PM, Sanguino SM. Northwestern University Feinberg School of Medicine. Acad Med 2020; 95:S155-S158. [PMID: 33626670 DOI: 10.1097/acm.0000000000003307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
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Affiliation(s)
- Diane B Wayne
- Diane B. Wayne, Vice Dean for Education, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
- Marianne Green, Senior Associate Dean for Medical Education, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
- Eric G. Neilson, Vice President for Medical Affairs, Lewis Landsberg Dean, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
| | - Marianne Green
- Diane B. Wayne, Vice Dean for Education, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
- Marianne Green, Senior Associate Dean for Medical Education, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
- Eric G. Neilson, Vice President for Medical Affairs, Lewis Landsberg Dean, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
| | - Eric G Neilson
- Diane B. Wayne, Vice Dean for Education, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
- Marianne Green, Senior Associate Dean for Medical Education, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
- Eric G. Neilson, Vice President for Medical Affairs, Lewis Landsberg Dean, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
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Vermylen JH, Wayne DB, Cohen ER, McGaghie WC, Wood GJ. Promoting Readiness for Residency: Embedding Simulation-Based Mastery Learning for Breaking Bad News Into the Medicine Subinternship. Acad Med 2020; 95:1050-1056. [PMID: 32576763 DOI: 10.1097/acm.0000000000003210] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
PURPOSE It is challenging to add rigorous, competency-based communication skills training to existing clerkship structures. The authors embedded a simulation-based mastery learning (SBML) curriculum into a medicine subinternship to demonstrate feasibility and determine the impact on the foundational skill of breaking bad news (BBN). METHOD All fourth-year students enrolled in a medicine subinternship at Northwestern University Feinberg School of Medicine from September 2017 through August 2018 were expected to complete a BBN SBML curriculum. First, students completed a pretest with a standardized patient using a previously developed BBN assessment tool. Learners then participated in a 4-hour BBN skills workshop with didactic instruction, focused feedback, and deliberate practice with simulated patients. Students were required to meet or exceed a predetermined minimum passing standard (MPS) at posttest. The authors compared pretest and posttest scores to evaluate the effect of the intervention. Participant demographic characteristics and course evaluations were also collected. RESULTS Eighty-five students were eligible for the study, and 79 (93%) completed all components. Although 55/79 (70%) reported having personally delivered serious news to actual patients, baseline performance was poor. Students' overall checklist performance significantly improved from a mean of 65.0% (SD = 16.2%) items correct to 94.2% (SD = 5.9%; P < .001) correct. There was also statistically significant improvement in scaled items assessing quality of communication, and all students achieved the MPS at mastery posttest. All students stated they would recommend the workshop to colleagues. CONCLUSIONS It is feasible to embed SBML into a required clerkship. In the context of this study, rigorous SBML resulted in uniformly high levels of skill acquisition, documented competency, and was positively received by learners.
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Affiliation(s)
- Julia H Vermylen
- J.H. Vermylen is assistant professor, Department of Medicine and Department of Medical Education, Northwestern University Feinberg School of Medicine, Chicago, Illinois. D.B. Wayne is professor, Department of Medicine and Department of Medical Education, Northwestern University Feinberg School of Medicine, Chicago, Illinois. E.R. Cohen is research associate, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois. W.C. McGaghie is professor, Department of Medical Education and Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois. G.J. Wood is associate professor, Department of Medicine and Department of Medical Education, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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Davidson LJ, Chow KY, Jivan A, Prenner SB, Cohen ER, Schimmel DR, McGaghie WC, Barsuk JH, Wayne DB, Sweis RN. Improving cardiology fellow education of right heart catheterization using a simulation based curriculum. Catheter Cardiovasc Interv 2020; 97:503-508. [PMID: 32608175 DOI: 10.1002/ccd.29128] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 05/18/2020] [Accepted: 06/14/2020] [Indexed: 01/02/2023]
Abstract
BACKGROUND Medical procedures are traditionally taught informally at patients' bedside through observation and practice using the adage "see one, do one, teach one." This lack of formalized training can cause trainees to be unprepared to perform procedures independently. Simulation based education (SBE) increases competence, reduces complications, and decreases costs. We developed, implemented, and evaluated the efficacy of a right heart catheterization (RHC) SBE curriculum. METHODS The RHC curriculum consisted of a pretest, video didactics, deliberate practice, and a posttest. Pre-and posttest skills examinations consisted of a dichotomous 43-item checklist on RHC skills and a 14-item hemodynamic waveform quiz. We enrolled two groups of fellows: 6 first-year, novice cardiology fellows at Northwestern University in their first month of training, and 11 second- and third-year fellows who had completed traditional required, level I training in RHC. We trained the first-year fellows at the beginning of the 2018-2019 year using the SBE curriculum and compared them to the traditionally-trained cardiology fellows who did not complete SBE. RESULTS The SBE-trained fellows significantly improved RHC skills, hemodynamic knowledge, and confidence from pre- to posttesting. SBE-trained fellows performed similarly to traditionally-trained fellows on simulated RHC skills checklists (88.4% correct vs. 89.2%, p = .84), hemodynamic quizzes (94.0% correct vs. 86.4%, p = .12), and confidence (79.4 vs. 85.9 out of 100, p = .15) despite less clinical experience. CONCLUSIONS A SBE curriculum for RHC allowed novice cardiology fellows to achieve level I skills and knowledge at the beginning of fellowship and can train cardiology fellows before patient contact.
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Affiliation(s)
- Laura J Davidson
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Kimberly Y Chow
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Arif Jivan
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Stuart B Prenner
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Elaine R Cohen
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Daniel R Schimmel
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - William C McGaghie
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Jeffrey H Barsuk
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Diane B Wayne
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Ranya N Sweis
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
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21
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Henschen BL, Liss DT, Golden BP, Cameron KA, Bierman JA, Ryan ER, Gard LA, Neilson EG, Wayne DB, Evans DB. Continuity With Patients, Preceptors, and Peers Improves Primary Care Training: A Randomized Medical Education Trial. Acad Med 2020; 95:425-434. [PMID: 31626000 DOI: 10.1097/acm.0000000000003045] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
PURPOSE Infusing continuity of care into medical student clerkships may accelerate professional development, preserve patient-centered attitudes, and improve primary care training. However, prospective, randomized studies of longitudinal curricula are lacking. METHOD All entering Northwestern University Feinberg School of Medicine students in 2015 and 2016 were randomized to the Education Centered Medical Home (ECMH), a 4-year, team-based primary care clerkship; or a mentored individual preceptorship (IP) for 2 years followed by a traditional 4-week primary care clerkship. Students were surveyed 4 times (baseline, M1, M2, and M3 year [through 2018]); surveys included the Maslach Burnout Inventory (MBI); the Communication, Curriculum, and Culture (C3) survey assessing the hidden curriculum; and the Attitudes Toward Health Care Teams (ATHCT) scale. The authors analyzed results using an intent-to-treat approach. RESULTS Three hundred twenty-nine students were randomized; 316 (96%) participated in surveys. Seventy percent of all respondents would recommend the ECMH to incoming first-year students. ECMH students reported a more positive learning environment (overall quality, 4.4 ECMH vs 4.0 IP, P < .001), greater team-centered attitudes (ATHCT scale, 3.2 vs 3.0, P = .007), less exposure to negative aspects of the hidden curriculum (C3 scale, 4.6 vs 4.3, P < .001), and comparable medical knowledge acquisition. ECMH students established more continuity relationships with patients (2.2 vs 0.3, P < .001) and reported significantly higher professional efficacy (MBI-PE, 4.1 vs 3.9, P = .02). CONCLUSIONS In this randomized medical education trial, the ECMH provided superior primary care training across multiple outcomes compared with a traditional clerkship-based model, including improved professional efficacy.
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Affiliation(s)
- Bruce L Henschen
- B.L. Henschen is assistant professor, Division of General Internal Medicine and Geriatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois; ORCID: http://orcid.org/0000-0003-0994-9725. D.T. Liss is research assistant professor, Division of General Internal Medicine and Geriatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois; ORCID: https://orcid.org/0000-0001-5505-2922. B.P. Golden is instructor, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois; ORCID: https://orcid.org/0000-0003-0576-3894. K.A. Cameron is research professor, Division of General Internal Medicine and Geriatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois; ORCID: http://orcid.org/0000-0002-3535-6459. J.A. Bierman is associate professor, Division of General Internal Medicine and Geriatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois; ORCID: http://orcid.org/0000-0001-7534-8499. E.R. Ryan was associate professor, Department of Family and Community Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, at the time of this work. She is currently associate dean and campus director, Northwest Campus, and professor, Clinical Family Medicine, Indiana University School of Medicine-Northwest Campus, Gary, Indiana; ORCID: http://orcid.org/0000-0001-8680-3741. L.A. Gard is research project coordinator, Division of General Internal Medicine and Geriatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois. E.G. Neilson is professor and Lewis Landsberg Dean, Northwestern University Feinberg School of Medicine, Chicago, Illinois; ORCID: http://orcid.org/0000-0003-3723-8859. D.B. Wayne is Dr. John Sherman Professor of Medicine and Medical Education, Division of General Internal Medicine and Geriatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois; ORCID: http://orcid.org/0000-0001-6468-0744. D.B. Evans is assistant professor, Division of General Internal Medicine and Geriatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois; ORCID: https://orcid.org/0000-0003-0760-3034
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McGaghie WC, Wayne DB, Barsuk JH. Translational Science and Healthcare Quality and Safety Improvement from Mastery Learning. Comprehensive Healthcare Simulation: Mastery Learning in Health Professions Education 2020. [DOI: 10.1007/978-3-030-34811-3_16] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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McGaghie WC, Barsuk JH, Wayne DB. Clinical Education: Origins and Outcomes. Comprehensive Healthcare Simulation: Mastery Learning in Health Professions Education 2020. [DOI: 10.1007/978-3-030-34811-3_1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Barsuk JH, Cohen ER, Harap RS, Grady KL, Wilcox JE, Shanklin KB, Wayne DB, Cameron KA. Patient, Caregiver, and Clinician Perceptions of Ventricular Assist Device Self-care Education Inform the Development of a Simulation-based Mastery Learning Curriculum. J Cardiovasc Nurs 2020; 35:54-65. [PMID: 31738216 PMCID: PMC6895423 DOI: 10.1097/jcn.0000000000000621] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND Patients who undergo ventricular assist device (VAD) implantation and their caregivers must rapidly learn a significant amount of self-care skills and knowledge. OBJECTIVE The aim of this study was to explore patient, caregiver, VAD coordinator, and physician perspectives and perceptions of existing VAD self-care training to inform development of a simulation-based mastery learning (SBML) curriculum to teach patients and caregivers VAD self-care skills and knowledge. METHODS We conducted semistructured, in-person interviews with patients with a VAD, their caregivers, VAD coordinators, and physicians (cardiac surgeons, an infectious disease physician, and advanced heart failure cardiologists). We used a 2-cycle team-based iterative inductive approach to coding and analysis. RESULTS We interviewed 16 patients, 12 caregivers, 7 VAD coordinators, and 11 physicians. Seven major themes were derived from the interviews including (1) identification of critical curricular content, (2) need for standardization and assessment, (3) training modalities, (4) benefits of repetition, (5) piercing it all together, (6) need for refresher training, and (7) provision of training before implant. CONCLUSIONS Findings from this study suggest that SBML is a natural fit for the high-risk tasks needed to save VAD self-care. The 7 unique training-related themes derived from the qualitative data informed the design and development of a VAD SBML self-care curriculum.
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Affiliation(s)
- Jeffrey H. Barsuk
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
- Department of Medical Education, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Elaine R. Cohen
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Rebecca S. Harap
- Bluhm Cardiovascular Institute, Northwestern Memorial Hospital, Chicago, IL, United States
| | - Kathleen L. Grady
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
- Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Jane E. Wilcox
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
- Bluhm Cardiovascular Institute, Northwestern Memorial Hospital, Chicago, IL, United States
| | - Kerry B. Shanklin
- Bluhm Cardiovascular Institute, Northwestern Memorial Hospital, Chicago, IL, United States
| | - Diane B. Wayne
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
- Department of Medical Education, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Kenzie A. Cameron
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
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Barsuk JH, Wilcox JE, Cohen ER, Harap RS, Shanklin KB, Grady KL, Kim JS, Nonog GP, Schulze LE, Jirak AM, Wayne DB, Cameron KA. Simulation-Based Mastery Learning Improves Patient and Caregiver Ventricular Assist Device Self-Care Skills: A Randomized Pilot Trial. Circ Cardiovasc Qual Outcomes 2019; 12:e005794. [PMID: 31601111 PMCID: PMC7002015 DOI: 10.1161/circoutcomes.119.005794] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND No recognized standards exist for teaching patients and their caregivers ventricular assist device (VAD) self-care skills. We compared the effectiveness of a VAD simulation-based mastery learning (SBML) self-care training curriculum with usual VAD self-care training. METHODS AND RESULTS VAD patients and their caregivers were randomized to SBML or usual training during their implant hospitalization. The SBML group completed a pretest on 3 VAD self-care skills (controller, power source, and dressing change), then viewed videos and participated in deliberate practice on a simulator. SBML participants took a posttest and were required to meet or exceed a minimum passing standard for each of the skills. The usual training group completed the existing institutional VAD self-care teaching protocol. Before hospital discharge, the SBML and usual training groups took the same 3 VAD self-care skills tests. We compared demographic and clinical information, self-confidence, total participant training time, and skills performance between groups. Forty participants completed the study in each group. There were no differences in demographic and clinical information, self-confidence, or training time between groups. More participants in the SBML group met the minimum passing standard compared with the usual training group for controller (37/40 [93%] versus 25/40 [63%]; P=0.001), power source (36/40 [90%] versus 9/40 [23%]; P<0.001), and dressing change skills (19/20 [95%] versus 0/20; P<0.001). CONCLUSIONS SBML provided superior VAD self-care skills learning outcomes compared with usual training. This study has important implications for patients due to the morbidity and mortality associated with improper VAD self-care. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT03073005.
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Affiliation(s)
- Jeffrey H. Barsuk
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
- Department of Medical Education, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Jane E. Wilcox
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
- Bluhm Cardiovascular Institute, Northwestern Memorial Hospital, Chicago, IL, United States
| | - Elaine R. Cohen
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Rebecca S. Harap
- Bluhm Cardiovascular Institute, Northwestern Memorial Hospital, Chicago, IL, United States
| | - Kerry B. Shanklin
- Bluhm Cardiovascular Institute, Northwestern Memorial Hospital, Chicago, IL, United States
| | - Kathleen L. Grady
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
- Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Jane S. Kim
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Gretchen P. Nonog
- Bluhm Cardiovascular Institute, Northwestern Memorial Hospital, Chicago, IL, United States
| | - Lauren E. Schulze
- Bluhm Cardiovascular Institute, Northwestern Memorial Hospital, Chicago, IL, United States
| | - Alison M. Jirak
- Bluhm Cardiovascular Institute, Northwestern Memorial Hospital, Chicago, IL, United States
| | - Diane B. Wayne
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
- Department of Medical Education, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Kenzie A. Cameron
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
- Department of Medical Education, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
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Affiliation(s)
- Marianne Green
- Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Diane B Wayne
- Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Eric G Neilson
- Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
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Salzman DH, McGaghie WC, Caprio TW, Hufmeyer KK, Issa N, Cohen ER, Wayne DB. A Mastery Learning Capstone Course to Teach and Assess Components of Three Entrustable Professional Activities to Graduating Medical Students. Teach Learn Med 2019; 31:186-194. [PMID: 30596271 DOI: 10.1080/10401334.2018.1526689] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
PROBLEM Thirteen measurable Entrustable Professional Activities (EPAs) have been proposed by the Association of American Medical Colleges as a means to operationalize medical school graduates' patient care qualifications. Mastery learning is an effective method for boosting clinical skills, but its applicability to the EPAs remains to be studied. The authors designed this study to evaluate a mastery learning intervention to teach and assess components of 3 of the 13 EPAs in a 4th-year capstone course. INTERVENTION The course featured mastery learning principles and addressed three EPA-based skills: (a) obtain informed consent, (b) develop a differential diagnosis and write admission orders, and (c) write discharge prescriptions. All students underwent a baseline skills assessment, received feedback, engaged in deliberate practice with actionable feedback, and completed a similar skills-based posttest assessment. Students continued with practice and testing until the minimum passing standards (MPSs) were reached for each posttest. CONTEXT All medical students at a single medical school (Northwestern University, Feinberg School of Medicine) who matriculated in 2012 and graduated with the class of 2016 participated in a required transition to residency course immediately prior to graduation. OUTCOME There were 134 students eligible to participate, and 130 (97.0%) completed all curricular requirements and assessments. All 130 medical students who completed the course met or exceeded the MPS for each of the three EPA-based clinical skills. Reliability coefficients for outcome data were uniformly high. Measures for each of the three clinical skills showed statistically significant improvement. LESSONS LEARNED The capstone course was an effective approach to teach and assess components of three EPA-based clinical skills to mastery learning standards in a 4th-year capstone course. We learned that this approach for implementation is feasible and results in significant improvement in components of EPA skill performance. Next steps will include developing assessments incorporating the mastery model into components of additional EPAs, identifying the best location within the curriculum to insert this content, and expanding the number of assessments as part of a larger assessment system.
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Affiliation(s)
- David H Salzman
- a Department of Emergency, Medicine Northwestern University Feinberg School of Medicine , Chicago , Illinois , USA
- b Department of Medical Education , Northwestern University Feinberg School of Medicine , Chicago , Illinois , USA
| | - William C McGaghie
- b Department of Medical Education , Northwestern University Feinberg School of Medicine , Chicago , Illinois , USA
- c Department of Preventative Medicine , Northwestern University Feinberg School of Medicine , Chicago , Illinois , USA
| | - Timothy W Caprio
- d Department of Medicine , Northwestern University Feinberg School of Medicine , Chicago , Illinois , USA
| | - Kathryn K Hufmeyer
- d Department of Medicine , Northwestern University Feinberg School of Medicine , Chicago , Illinois , USA
| | - Nabil Issa
- e Department of Surgery , Northwestern University Feinberg School of Medicine , Chicago , Illinois , USA
| | - Elaine R Cohen
- d Department of Medicine , Northwestern University Feinberg School of Medicine , Chicago , Illinois , USA
| | - Diane B Wayne
- b Department of Medical Education , Northwestern University Feinberg School of Medicine , Chicago , Illinois , USA
- e Department of Surgery , Northwestern University Feinberg School of Medicine , Chicago , Illinois , USA
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Vermylen JH, Wood GJ, Cohen ER, Barsuk JH, McGaghie WC, Wayne DB. Development of a Simulation-Based Mastery Learning Curriculum for Breaking Bad News. J Pain Symptom Manage 2019; 57:682-687. [PMID: 30472316 DOI: 10.1016/j.jpainsymman.2018.11.012] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Revised: 11/15/2018] [Accepted: 11/15/2018] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Physician communication impacts patient outcomes. However, communication skills, especially around difficult conversations, remain suboptimal, and there is no clear way to determine the validity of entrustment decisions. The aims of this study were to 1) describe the development of a simulation-based mastery learning (SBML) curriculum for breaking bad news (BBN) conversation skills and 2) set a defensible minimum passing standard (MPS) to ensure uniform skill acquisition among learners. INNOVATION An SBML BBN curriculum was developed for fourth-year medical students. An assessment tool was created to evaluate the acquisition of skills involved in a BBN conversation. Pilot testing was completed to confirm improvement in skill acquisition and set the MPS. OUTCOMES A BBN assessment tool containing a 15-item checklist and six scaled items was developed. Students' checklist performance improved significantly at post-test compared to baseline (mean 65.33%, SD = 12.09% vs mean 88.67%, SD = 9.45%, P < 0.001). Students were also significantly more likely to have at least a score of 4 (on a five-point scale) for the six scaled questions at post-test. The MPS was set at 80%, requiring a score of 12 items on the checklist and at least 4 of 5 for each scaled item. Using the MPS, 30% of students would require additional training after post-testing. COMMENTS We developed a SBML curriculum with a comprehensive assessment of BBN skills and a defensible competency standard. Future efforts will expand the mastery model to larger cohorts and assess the impact of rigorous education on patient care outcomes.
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Affiliation(s)
- Julia H Vermylen
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
| | - Gordon J Wood
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Elaine R Cohen
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Jeffrey H Barsuk
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA; Department of Medical Education, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - William C McGaghie
- Department of Medical Education, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Diane B Wayne
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA; Department of Medical Education, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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Henschen BL, Ryan ER, Evans DB, Truong A, Wayne DB, Bierman JA, Cameron KA. Perceptions of Patient-Centered Care among First-Year Medical Students. Teach Learn Med 2019; 31:26-33. [PMID: 29847155 DOI: 10.1080/10401334.2018.1468260] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Phenomenon: Teaching patient-centered care (PCC) is a key component of undergraduate medical curricula. Prior frameworks of PCC describe multiple domains of patient-centeredness, ranging from interpersonal encounters to systems-level issues. Medical students' perceptions of PCC are thought to erode as they progress through school, but little is known about how students view PCC toward the beginning of training. This study explores the perceptions of PCC among 1st-year medical students to inform curricular development and evaluation. Approach: Medical students participated in semistructured, in-person interviews within 4 months of starting medical school as part of a longitudinal study. Transcripts were analyzed using a grounded theory approach and the constant comparative method to describe responses and characterize emergent themes. Transcripts were reviewed to compare codes and compile a final codebook. Findings: Thirty-eight students completed interviews. Students provided heterogeneous definitions of PCC, including perceptions that PCC is implicit and obvious. Many students were unable to provide a concrete definition of PCC, juxtaposing PCC with other priorities such as profit- or physician-centered care, whereas others thought the term was jargon. Some participants defined PCC as upholding patient values using hypothetical examples centered around physician behavior. Insights: Although students appeared to enter medical school with a range of perceptions about PCC, many of their descriptions were limited and only scratch the surface of existing frameworks. Rather than their perceptions of PCC eroding during medical school, students may never fully develop a foundational understanding of PCC. Our findings reinforce the need for authentic, clinically experiential learning opportunities that promote PCC from the earliest stages of medical education.
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Affiliation(s)
- Bruce L Henschen
- a Division of General Internal Medicine and Geriatrics, Department of Medicine , Northwestern University Feinberg School of Medicine , Chicago , Illinois , USA
| | - Elizabeth R Ryan
- b Department of Family and Community Medicine , Northwestern University Feinberg School of Medicine , Chicago , Illinois , USA
| | - Daniel B Evans
- a Division of General Internal Medicine and Geriatrics, Department of Medicine , Northwestern University Feinberg School of Medicine , Chicago , Illinois , USA
| | - Ashley Truong
- a Division of General Internal Medicine and Geriatrics, Department of Medicine , Northwestern University Feinberg School of Medicine , Chicago , Illinois , USA
| | - Diane B Wayne
- a Division of General Internal Medicine and Geriatrics, Department of Medicine , Northwestern University Feinberg School of Medicine , Chicago , Illinois , USA
| | - Jennifer A Bierman
- a Division of General Internal Medicine and Geriatrics, Department of Medicine , Northwestern University Feinberg School of Medicine , Chicago , Illinois , USA
| | - Kenzie A Cameron
- a Division of General Internal Medicine and Geriatrics, Department of Medicine , Northwestern University Feinberg School of Medicine , Chicago , Illinois , USA
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Barsuk JH, Harap RS, Cohen ER, Cameron KA, Grady KL, Wilcox JE, Shanklin KB, Wayne DB. The Effect of Judge Selection on Standard Setting Using the Mastery Angoff Method during Development of a Ventricular Assist Device Self-Care Curriculum. Clin Simul Nurs 2018; 27:39-47.e4. [PMID: 32818046 DOI: 10.1016/j.ecns.2018.10.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Background Patients and caregivers need to perform ventricular assist device (VAD) self-care safely to help prevent complications (e.g., infection). We developed a VAD self-care simulation-based mastery learning (SBML) curriculum. We determined optimal minimum passing scores (MPSs) and evaluated effects of judge selection. Methods A multidisciplinary team created a VAD self-care SBML curriculum including simulated skills and knowledge examinations. Patients, caregivers, VAD coordinators, and physicians were expert judges who determined MPSs using the Mastery Angoff method. Results MPSs for the skills and knowledge examinations were high (range = 94-99% and 97% correct), respectively. Judges closely agreed on MPSs. Conclusions Stakeholders set stringent MPSs for high-stakes VAD self-care.
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Affiliation(s)
- Jeffrey H Barsuk
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States.,Department of Medical Education, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Rebecca S Harap
- Bluhm Cardiovascular Institute, Northwestern Memorial Hospital, Chicago, IL, United States
| | - Elaine R Cohen
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Kenzie A Cameron
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Kathleen L Grady
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States.,Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Jane E Wilcox
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States.,Bluhm Cardiovascular Institute, Northwestern Memorial Hospital, Chicago, IL, United States
| | - Kerry B Shanklin
- Bluhm Cardiovascular Institute, Northwestern Memorial Hospital, Chicago, IL, United States
| | - Diane B Wayne
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States.,Department of Medical Education, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
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Barsuk JH, Cohen ER, Wayne DB. In Reply to Kendall and Castro-Alves. Acad Med 2018; 93:1420-1421. [PMID: 30252733 DOI: 10.1097/acm.0000000000002361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Affiliation(s)
- Jeffrey H Barsuk
- Professor of medicine, directory simulation and patient safety, Departments of Medicine and Medical Education, Northwestern University Feinberg School of Medicine, Chicago, Illinois; . Research associate, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois. Vice dean for education and Dr. John Sherman Appleman Professor of Medicine, Departments of Medicine and Medical Education, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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Abstract
PURPOSE Defensible minimum passing standards (MPSs) must be used to evaluate learner performance outcomes in health professions education. In this study, the authors compared the results of traditional Angoff and Hofstee standard-setting exercises with the Mastery Angoff and Patient-Safety approaches for central venous catheter (CVC) insertion skills examinations. The authors also evaluated how these standards affected the historical performance of residents who participated in a simulation-based mastery learning (SBML) curriculum for CVC insertion skills. METHOD In April and May 2015, 12 physicians with expertise in CVC insertion set MPSs for previously published internal jugular (IJ) and subclavian (SC) CVC insertion checklists using Angoff, Hofstee, Mastery Angoff, and Patient-Safety approaches. The resulting MPSs were compared using historical performance of internal medicine and emergency medicine residents who participated in CVC insertion SBML. RESULTS The MPSs were set as follows: Angoff: IJ 91% checklist items correct, SC 90%. Hofstee: IJ 88%, SC 90%. Mastery Angoff: IJ 98%, SC 98%. Patient-Safety: IJ 98%, SC 98%. Based on the historical performance of 143 residents assessed on IJ and SC insertion, applying the 98% MPS would result in additional practice and retesting of 55/123 residents (45%) who had previously passed the IJ examination and 36/130 residents (28%) who had passed the SC examination using the Angoff and Hofstee MPSs. CONCLUSIONS The Mastery Angoff and Patient-Safety standard-setting approaches resulted in higher CVC insertion SBML MPSs compared with traditional standard-setting methods. Further study should assess the impact of these more rigorous standards on patient outcomes.
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Affiliation(s)
- Jeffrey H Barsuk
- J.H. Barsuk is professor, Departments of Medicine and Medical Education, Northwestern University Feinberg School of Medicine, Chicago, Illinois. E.R. Cohen is research associate, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois. D.B. Wayne is vice dean for education and Dr. John Sherman Appleman Professor, Departments of Medicine and Medical Education, Northwestern University Feinberg School of Medicine, Chicago, Illinois. W.C. McGaghie is professor, Department of Medical Education, Northwestern University Feinberg School of Medicine, Chicago, Illinois. R. Yudkowsky is professor, Department of Medical Education, University of Illinois at Chicago College of Medicine, Chicago, Illinois
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Barsuk JH, Cohen ER, Williams MV, Scher J, Jones SF, Feinglass J, McGaghie WC, O'Hara K, Wayne DB. Simulation-Based Mastery Learning for Thoracentesis Skills Improves Patient Outcomes: A Randomized Trial. Acad Med 2018; 93:729-735. [PMID: 29068818 DOI: 10.1097/acm.0000000000001965] [Citation(s) in RCA: 74] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
PURPOSE Physicians-in-training often perform bedside thoracenteses in academic medical centers, and complications are more common among less experienced clinicians. Simulation-based mastery learning (SBML) is one potential solution to this problem. This study evaluated the effects of a randomized trial of thoracentesis SBML on patient complications: iatrogenic pneumothorax (IP), hemothorax, and reexpansion pulmonary edema (REPE). METHOD The authors randomized internal medicine residents to undergo thoracentesis SBML at a tertiary care academic center from December 2012 to May 2016. They subsequently compared thoracentesis complications from procedures performed by SBML-trained residents, traditionally trained residents (no simulation training), and those referred to pulmonary medicine or interventional radiology (IR). RESULTS During the study period, 917 thoracenteses were performed on 709 patients. IP occurred in 60 (6.5%) procedures, of which 7 (11.6%) were clinically meaningful. SBML-trained residents performed procedures with a trend toward lower combined clinically meaningful complications (IP, hemothorax, REPE) compared with traditionally trained residents (7.9% vs. 0%; P = .06). SBML-trained residents caused fewer clinically meaningful IPs compared with traditionally trained residents, pulmonary, and IR referrals (P = .02). Hemothorax occurred after 4 (0.4%) thoracenteses, and SBML-trained residents had a trend toward lower hemothorax (0) compared with other groups (P = .07). REPE occurred after 3 (0.3%) procedures, with no differences between groups. SBML-trained residents performed procedures with lower combined clinically meaningful complications compared with other groups (P = .008). CONCLUSIONS Residents randomized to an SBML intervention performed thoracenteses with low rates of clinically meaningful complications. Rigorous education represents a successful quality improvement strategy.
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Affiliation(s)
- Jeffrey H Barsuk
- J.H. Barsuk is professor of medicine, Departments of Medicine and Medical Education, Northwestern University Feinberg School of Medicine, Chicago, Illinois. E.R. Cohen is a research associate, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois. M.V. Williams is professor of medicine, director, Center for Health Services Research, and vice chair, Department of Internal Medicine, University of Kentucky College of Medicine, Lexington, Kentucky. J. Scher is research coordinator, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois. S.F. Jones is research coordinator, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois. J. Feinglass is research professor of medicine, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois. W.C. McGaghie is professor of medical education, Department of Medical Education, Northwestern University Feinberg School of Medicine, Chicago, Illinois. K. O'Hara is instructor, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois. D.B. Wayne is vice dean for education and Dr. John Sherman Appleman Professor of Medicine, Departments of Medicine and Medical Education, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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McGaghie WC, Barsuk JH, Wayne DB. Building Partnerships to Improve Learning From Health Care Simulation. Acad Med 2018; 93:672-673. [PMID: 29688973 DOI: 10.1097/acm.0000000000002166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Affiliation(s)
- William C McGaghie
- Professor of medical education, Northwestern University Feinberg School of Medicine, Chicago, Illinois; ; ORCID: http://orcid.org/0000-0003-1672-0398. Professor of medicine and professor of medical education, Northwestern University Feinberg School of Medicine, Chicago, Illinois; ORCID: http://orcid.org/0000-0001-6584-9943. Vice dean for education and Dr. John Sherman Appleman Professor of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois; ORCID: http://orcid.org/0000-0001-6468-0744
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Cohen ER, Barsuk JH, Hertz JR, Wayne DB, Okuda Y, Mitra D, McGaghie WC, Cameron KA. Healthcare Providers' Awareness and Perceptions of Competency Requirements in Central Venous Catheter Insertion. MedEdPublish (2016) 2018; 7:12. [PMID: 38074552 PMCID: PMC10699405 DOI: 10.15694/mep.2018.0000012.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2024] Open
Abstract
This article was migrated. The article was marked as recommended. Background Studies show that medical residents do not feel comfortable and lack the skills and confidence to perform common bedside procedures. Regulatory bodies often require a set number of procedures to determine resident competence, yet medical providers' knowledge of competency guidelines are less well known. This study aimed to qualitatively assess existing practices relevant to documentation of competency in central venous catheter (CVC) insertion and explore healthcare providers' awareness and perceptions of those practices at their institutions. Methods The authors performed a qualitative study at Veterans Affairs Medical Centers (VAMCs) from February to December 2014 as part of a larger project related to the dissemination of a simulation-based CVC insertion curriculum. Two authors conducted interviews with hospital staff (including attending physicians, nurses, and residents) at selected VAMCs. Recordings of interviews were transcribed, coded, and analyzed using a grounded theory approach and constant comparative techniques. Results Twenty-six participants were interviewed at six VAMCs. Participants reported varying perspectives regarding their institutions' policies about CVC insertion. Four major themes emerged: (1) knowledge of institutional policy; (2) competency by numbers; (3) documentation of competency; and (4) perceptions of competency measures. Participants reported concern about the reliability of these policies and measures of competence. Conclusions This study demonstrates that healthcare providers' knowledge and perceptions about institutional requirements for procedural competency vary widely. Our findings suggest the need for establishment of consistent competency policies based on evidence-based practices, and highlight the need for increased communication regarding individual institutional policies. Integration of rigorous simulation-based education, implemented consistently across institutions, can provide a reliable mechanism to train and assess procedural competence and ensure patient safety.
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Affiliation(s)
| | | | | | | | | | - Debi Mitra
- Northwestern University Feinberg School of Medicine
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Prenner SB, Wayne DB, Sweis RN, Cohen ER, Feinglass JM, Schimmel DR. Simulation-based education leads to decreased use of fluoroscopy in diagnostic coronary angiography. Catheter Cardiovasc Interv 2017; 91:1054-1059. [DOI: 10.1002/ccd.27203] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Accepted: 06/15/2017] [Indexed: 12/23/2022]
Affiliation(s)
- Stuart B. Prenner
- Division of Cardiology; Bluhm Cardiovascular Institute, Northwestern Memorial Hospital; Chicago Illinois
| | - Diane B. Wayne
- Department of Medicine; Northwestern University Feinberg School of Medicine; Chicago Illinois
| | - Ranya N. Sweis
- Division of Cardiology; Bluhm Cardiovascular Institute, Northwestern Memorial Hospital; Chicago Illinois
| | - Elaine R. Cohen
- Department of Medicine; Northwestern University Feinberg School of Medicine; Chicago Illinois
| | - Joe M. Feinglass
- Department of Medicine; Northwestern University Feinberg School of Medicine; Chicago Illinois
| | - Daniel R. Schimmel
- Division of Cardiology; Bluhm Cardiovascular Institute, Northwestern Memorial Hospital; Chicago Illinois
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Affiliation(s)
- Jeffrey H Barsuk
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.,Department of Medical Education, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - William C McGaghie
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Diane B Wayne
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.,Department of Medical Education, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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Gacita A, Gargus E, Uchida T, Garcia P, Macken M, Seul L, Brucker J, Wayne DB. Introduction to Safe Space Training: Interactive Module for Promoting a Safe Space Learning Environment for LGBT Medical Students. MedEdPORTAL 2017; 13:10597. [PMID: 30800799 PMCID: PMC6338189 DOI: 10.15766/mep_2374-8265.10597] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
INTRODUCTION Lesbian, gay, bisexual, and transgender (LGBT) students face challenges in achieving their educational goals. By understanding concepts surrounding sexual orientation and gender identity, faculty, staff, and students can support LGBT community members and provide a safe educational space. In order to address this we created a condensed training resource that focused on skill building and is easily implemented institution-wide for students, residents, fellows, faculty, and staff. METHODS This module serves as an introduction to concepts integral to the LGBT community. It is structured into two sections and takes approximately 30 minutes to complete, including pre-/postevaluations. The first section of the module focuses on presenting basic information about the LGBT world experience and basic terminology. The second section contains two real-world scenarios aimed at demonstrating skills used to create a safe educational learning space. Each scenario contains interactive questions that allow participants to practice applying their new skills. RESULTS To date, 89 institutional community members at the Northwestern University Feinberg School of Medicine have completed the module. Survey results demonstrate that the module was well-received and effective at improving attitudes towards creating a safe space. DISCUSSION While this module provides a foundation in terminology and phenomena relevant to the LGBT experience, it is just one part of creating a positive institutional climate for LGBT community members. Additional in-person skills-based training should also be considered to complement and enhance this module's contents.
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Affiliation(s)
- Anthony Gacita
- MD/PhD Student, Northwestern University Feinberg School of Medicine
- Corresponding author:
| | - Emma Gargus
- MD/PhD Student, Northwestern University Feinberg School of Medicine
| | - Toshiko Uchida
- Associate Professor, Departments of Medicine and Medical Education, Northwestern University Feinberg School of Medicine
| | - Patricia Garcia
- Professor, Departments of Obstetrics and Gynecology and Medical Education, Northwestern University Feinberg School of Medicine
| | - Micheal Macken
- Assistant Professor, Department of Neurology, Northwestern University Feinberg School of Medicine
| | - Laura Seul
- Instructional Designer, Department of Medical Education, Northwestern University Feinberg School of Medicine
| | - James Brucker
- Instructor, Department of Medical Education, Northwestern University Feinberg School of Medicine
| | - Diane B. Wayne
- Vice Dean of Education, Northwestern University The Feinberg School of Medicine
- Professor, Departments of Medicine and Medical Education, Northwestern University Feinberg School of Medicine
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Affiliation(s)
- William C McGaghie
- Department of Medical Education, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Jeffrey H Barsuk
- Department of Medical Education, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Diane B Wayne
- Department of Medical Education, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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Salzman DH, Wayne DB, Eppich WJ, Hungness ES, Adler MD, Park CS, Barsness KA, McGaghie WC, Barsuk JH. An institution-wide approach to submission, review, and funding of simulation-based curricula. Adv Simul (Lond) 2017; 2:9. [PMID: 29450010 PMCID: PMC5806460 DOI: 10.1186/s41077-017-0042-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Accepted: 05/15/2017] [Indexed: 11/18/2022] Open
Abstract
This article describes the development, implementation, and modification of an institutional process to evaluate and fund graduate medical education simulation curricula. The goals of this activity were to (a) establish a standardized mechanism for proposal submission and evaluation, (b) identify simulation-based medical education (SBME) curricula that would benefit from mentored improvement before implementation, and (c) ensure that funding decisions were fair and defensible. Our intent was to develop a process that was grounded in sound educational principles, allowed for efficient administrative oversight, ensured approved courses were high quality, encouraged simulation education research and scholarship, and provided opportunities for medical specialties that had not previously used SBME to receive mentoring and faculty development.
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Affiliation(s)
- David H. Salzman
- Department of Emergency Medicine and Medical Education, Northwestern University Feinberg School of Medicine, 211 East Ontario Street, Suite 200, Chicago, IL 60611 USA
| | - Diane B. Wayne
- Department of Medicine and Medical Education, Northwestern University Feinberg School of Medicine, 420 E. Superior St, 12th floor, Chicago, IL 60611 USA
| | - Walter J. Eppich
- Ann & Robert H. Lurie Children’s Hospital of Chicago and Department of Medical Education, Northwestern University Feinberg School of Medicine, 240 East Huron St, McGaw 1-214, Chicago, IL 60611 USA
| | - Eric S. Hungness
- Department of Surgery and Medical Education, Northwestern University Feinberg School of Medicine, 240 East Huron St, Chicago, IL 60611 USA
| | - Mark D. Adler
- Ann & Robert H. Lurie Children’s Hospital of Chicago and Department of Medical Education, Northwestern University Feinberg School of Medicine, 240 East Huron, McGaw 1-245, Chicago, IL 60611 USA
| | - Christine S. Park
- Department of Anesthesiology, Northwestern University Feinberg School of Medicine, 251 E Huron St, Suite 5-704, Feinberg Pavilion, Chicago, IL 60611 USA
| | - Katherine A. Barsness
- Ann & Robert H. Lurie Children’s Hospital of Chicago and Department of Surgery, Northwestern University Feinberg School of Medicine, 225 East Chicago Ave, Chicago, IL 60611 USA
| | - William C. McGaghie
- Department of Medical Education, Northwestern University Feinberg School of Medicine, 240 East Huron St, McGaw 1-211, Chicago, IL 60611 USA
| | - Jeffrey H. Barsuk
- Department of Medicine and Medical Education, Northwestern University Feinberg School of Medicine, 240 East Huron St, McGaw 1-236, Chicago, IL 60611 USA
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Sharma RK, Szmuilowicz E, Ogunseitan A, Jones SF, Montalvo JA, O'Leary KJ, Wayne DB. Evaluation of a Mastery Learning Intervention on Hospitalists' Code Status Discussion Skills. J Pain Symptom Manage 2017; 53:1066-1070. [PMID: 28063865 DOI: 10.1016/j.jpainsymman.2016.12.341] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2016] [Revised: 11/29/2016] [Accepted: 12/27/2016] [Indexed: 10/20/2022]
Abstract
CONTEXT Although code status discussions (CSD) occur frequently in the hospital setting, discussions often lack content necessary for informed decision making. Simulation-based mastery learning (SBML) has been used to improve clinical skills among resident physicians and may provide a novel way to improve hospitalists' CSD skills. OBJECTIVES The objective of this pilot randomized controlled trial was to develop and evaluate a CSD SBML intervention for hospitalists. METHODS Twenty hospitalists were randomized to control vs. a CSD SBML intervention. Hospitalists conducted a baseline standardized patient encounter (pretest) that was scored using a 19-item CSD checklist and controls completed a repeat standardized patient encounter six months later (post-test). Intervention group hospitalists received at least one two-hour training session featuring deliberate practice and feedback and were expected to meet a minimum passing score (MPS) on the post-test of 84% set by an expert panel. RESULTS Only two of the 20 hospitalists met the MPS at pretest. Seventy percentage of intervention hospitalists achieved the MPS after a single training session. Post-test median checklist scores were higher for intervention hospitalists compared with controls (16.5 vs. 12.0, P = 0.0001). Intervention hospitalists were significantly more likely to ask about previous experiences with end-of-life decision making (70% vs. 20%, P = 0.03), explore values/goals (100% vs. 50%, P = 0.01), ask permission to make a recommendation regarding code status (60% vs. 0%, P = 0.003), and align recommendations with patient values/goals (90% vs. 40%, P = 0.02) than controls. CONCLUSION Few hospitalists demonstrated mastery of CSD skills at baseline; SBML was an effective way to improve these skills.
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Affiliation(s)
- Rashmi K Sharma
- Division of General Internal Medicine, University of Washington, Seattle, Washington, USA.
| | - Eytan Szmuilowicz
- Division of Hospital Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA; Section of Palliative Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Adeboye Ogunseitan
- Division of Hospital Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA; Section of Palliative Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Sasha F Jones
- Division of Hospital Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Jessica A Montalvo
- Division of Hospital Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA; Section of Palliative Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Kevin J O'Leary
- Division of Hospital Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Diane B Wayne
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA; Department of Medical Education, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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Affiliation(s)
- Diane B Wayne
- Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois2Department of Medical Education, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Marianne Green
- Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois2Department of Medical Education, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Eric G Neilson
- Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
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Barsuk JH, Cohen ER, Feinglass J, McGaghie WC, Wayne DB. Residents' Procedural Experience Does Not Ensure Competence: A Research Synthesis. J Grad Med Educ 2017; 9:201-208. [PMID: 28439354 PMCID: PMC5398145 DOI: 10.4300/jgme-d-16-00426.1] [Citation(s) in RCA: 79] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Revised: 09/14/2016] [Accepted: 12/05/2016] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Many medical certifying bodies require that a minimum number of clinical procedures be completed during residency training to obtain board eligibility. However, little is known about the relationship between the number of procedures residents perform and their clinical competence. OBJECTIVE This study evaluated associations between residents' medical procedure skills measured in a simulation laboratory and self-reported procedure experience and year of training. METHODS This research synthesis extracted and summarized data from multiple cohorts of internal medicine, emergency medicine, anesthesiology, and neurology resident physicians who performed simulated clinical procedures. The procedures were central venous catheter insertion, lumbar puncture, paracentesis, and thoracentesis. We compared residents' baseline simulated performance to their self-reported procedure experience using data from 7 research reports written by Northwestern University investigators between 2006 and 2016. We also evaluated how performance differed by postgraduate year (PGY). RESULTS A total of 588 simulated procedures were performed during the study period. We found significant associations between passing the skills examinations and higher number of self-reported procedures performed (P = .011) and higher PGY (P < .001). However, performance for all procedures was poor, as only 10% of residents passed the assessments with a mean of 48% of checklist items correct (SD = 24.2). The association between passing the skills examination and year of training was mostly due to differences between PGY-1 and subsequent years of training. CONCLUSIONS Despite positive associations between self-reported experience and simulated procedure performance, overall performance was poor. Residents' clinical experience is not a proxy for skill.
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Didwania A, Farnan JM, Icayan L, O'Leary KJ, Saathoff M, Bellam S, Humphrey HJ, Wayne DB, Arora VM. Impact of a Video-Based Interactive Workshop on Unprofessional Behaviors Among Internal Medicine Residents. J Grad Med Educ 2017; 9:241-244. [PMID: 28439361 PMCID: PMC5398139 DOI: 10.4300/jgme-d-16-00289.1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Revised: 08/24/2016] [Accepted: 11/13/2016] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Unprofessional behaviors undermine the hospital learning environment and the quality of patient care. OBJECTIVE To assess the impact of an interactive workshop on the perceptions of and self-reported participation in unprofessional behaviors. METHODS We conducted a pre-post survey study at 3 internal medicine residency programs. For the workshop we identified unprofessional behaviors related to on-call etiquette: "blocking" an admission, disparaging a colleague, and misrepresenting a test as urgent. Formal debriefing tools were utilized to guide the discussion. We fielded an internally developed 20-item survey on perception and participation in unprofessional behaviors prior to the workshop. An online "booster" quiz was delivered at 4 months postworkshop, and the 20-item survey was repeated at 9 months postworkshop. Results were compared to a previously published control from the same institutions, which showed that perceptions of unprofessional behavior did not change and participation in the behaviors worsened over the internship. RESULTS Of 237 eligible residents, 181 (76%) completed both pre- and postsurvey. Residents perceived blocking an admission and the misrepresentation of a test as urgent to be more unprofessional at a 9-month follow-up (2.0 versus 1.74 and 2.63 versus 2.28, respectively; P < .05), with no change in perception for disparaging a colleague. Participation in unprofessional behaviors did not decrease after the workshop, with the exception of misrepresenting a test as urgent (61% versus 50%, P = .019). CONCLUSIONS The results of this multi-site study indicate that an interactive workshop can change perception and may lower participation in some unprofessional behaviors.
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Barsuk JH, Cohen ER, Williams MV, Scher J, Feinglass J, McGaghie WC, O'Hara K, Wayne DB. The effect of simulation-based mastery learning on thoracentesis referral patterns. J Hosp Med 2016; 11:792-795. [PMID: 27273066 DOI: 10.1002/jhm.2623] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Revised: 04/28/2016] [Accepted: 05/08/2016] [Indexed: 11/10/2022]
Abstract
Internal medicine (IM) residents and hospitalist physicians commonly perform thoracenteses. National data show that thoracenteses are also frequently referred to other services such as interventional radiology (IR), increasing healthcare costs. Simulation-based mastery learning (SBML) is an effective method to boost physicians' procedural skills and self-confidence. This study aimed to (1) assess the effect of SBML on IM residents' simulated thoracentesis skills and (2) compare thoracentesis referral patterns, self-confidence, and reasons for referral between traditionally trained residents (non-SBML-trained), SBML-trained residents, and hospitalist physicians. A random sample of 112 IM residents at an academic medical center completed thoracentesis SBML from December 2012 to May 2015. We surveyed physicians caring for hospitalized patients with thoracenteses during the same time period and compared referral patterns, self-confidence, and reasons for referral. SBML-trained resident thoracentesis skills improved from a median of 57.6% (interquartile range [IQR] 43.3-76.9) at pretest to 96.2% (IQR 96.2-100.0) at post-test (P < 0.001). Surveys demonstrated that traditionally trained residents were more likely to refer to IR and cited lower confidence as reasons. SBML-trained residents were more likely to perform bedside thoracenteses. Hospitalist physicians were most likely to refer to pulmonary medicine and cited lack of time to perform the procedure as the main reason. SBML-trained residents were most confident about their thoracentesis skills, despite hospitalist physicians having more experience. This study identifies confidence and time as reasons physicians refer thoracenteses rather than perform them at the bedside. Thoracentesis SBML boosts skills and promotes bedside procedures that are safe and less expensive than referrals. Journal of Hospital Medicine 2016;11:792-795. © 2016 Society of Hospital Medicine.
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Affiliation(s)
- Jeffrey H Barsuk
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
- Department of Medical Education, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
| | - Elaine R Cohen
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Mark V Williams
- Department of Medicine, University of Kentucky School of Medicine, Lexington, Kentucky
| | - Jordan Scher
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Joe Feinglass
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - William C McGaghie
- Department of Medical Education, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Kelly O'Hara
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Diane B Wayne
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
- Department of Medical Education, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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Cohen ER, Barsuk JH, McGaghie WC, Wayne DB. In Reply to Udani et al. Acad Med 2016; 91:752-753. [PMID: 27218904 DOI: 10.1097/acm.0000000000001198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
- Elaine R Cohen
- Research associate, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois; . Associate professor, Department of Medicine, Department of Medical Education, Northwestern University Feinberg School of Medicine, Chicago, Illinois. Professor of medical education and preventive medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois. Vice dean for education and Dr. John Sherman Appleman Professor of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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Kozmic SE, Wayne DB, Feinglass J, Hohmann SF, Barsuk JH. Factors Associated with Inpatient Thoracentesis Procedure Quality at University Hospitals. Jt Comm J Qual Patient Saf 2016; 42:34-40. [PMID: 26685932 DOI: 10.1016/s1553-7250(16)42004-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Physicians increasingly refer thoracentesis procedures to interventional radiology (IR) rather than performing them at the bedside. Factors associated with thoracentesis procedures at university hospitals were studied to determine clinical outcomes by provider specialty. METHODS An administrative database review was performed of patients who underwent an inpatient thoracentesis procedure in hospitals participating in the University HealthSystem Consortium (UHC) Database from January 2010 through September 2013. The incidence of iatrogenic pneumothorax, mean total hospital costs, and mean length of stay (LOS) were compared by clinical specialty. RESULTS There were 113,860 admissions with 132,472 thoracentesis procedures performed on 99,509 patients at 234 UHC hospitals. IR performed 43,783 (33%) thoracentesis procedures; medicine, 22,243 (17%); and pulmonary, 26,887 (20%). The incidence of iatrogenic pneumothorax was 2.8% for IR, 2.9% for medicine, and 3.1% for pulmonary. Medicine and pulmonary had equivalent risk of iatrogenic pneumothorax compared to IR after controlling for clinical covariates. Admissions with medicine and pulmonary procedures were associated with significantly lower costs compared to IR admissions (p < 0.001) after controlling for clinical covariates. Admissions with IR procedures had a mean LOS of 14.1 days; medicine, 13.2 days; and pulmonary, 15.9 days. Admissions with medicine and pulmonary procedures were associated with fewer hospital days when compared to IR in the controlled model (p < 0.001). CONCLUSION Admissions with medicine and pulmonary bedside thoracentesis procedures are as safe and less costly than IR procedures. Shifting IR thoracentesis procedures to the bedside might be a potential way to reduce hospital costs while still ensuring high-quality patient care, provided that portable ultrasound is used.
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Affiliation(s)
- Sarah E Kozmic
- Northwestern University Feinberg School of Medicine, Chicago, USA
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O’Brien EK, Wayne DB, Barsness KA, McGaghie WC, Barsuk JH. Use of 3D Printing for Medical Education Models in Transplantation Medicine: a Critical Review. Curr Transpl Rep 2016. [DOI: 10.1007/s40472-016-0088-7] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Affiliation(s)
- William C McGaghie
- professor of medical education, associate professor of medicine, and vice dean of education and professor of medicine, Northwestern University Feinberg School of Medicine
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McGaghie WC, Barsuk JH, Cohen ER, Kristopaitis T, Wayne DB. Dissemination of an innovative mastery learning curriculum grounded in implementation science principles: a case study. Acad Med 2015; 90:1487-1494. [PMID: 26352761 DOI: 10.1097/acm.0000000000000907] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Dissemination of a medical education innovation, such as mastery learning, from a setting where it has been used successfully to a new and different medical education environment is not easy. This article describes the uneven yet successful dissemination of a simulation-based mastery learning (SBML) curriculum on central venous catheter (CVC) insertion for internal medicine and emergency medicine residents across medical education settings. The dissemination program was grounded in implementation science principles. The article begins by describing implementation science which addresses the mechanisms of medical education and health care delivery. The authors then present a mastery learning case study in two phases: (1) the development, implementation, and evaluation of the SBML CVC curriculum at a tertiary care academic medical center; and (2) the dissemination of the SBML CVC curriculum to an academic community hospital setting. Contextual information about the drivers and barriers that affected the SBML CVC curriculum dissemination is presented. This work demonstrates that dissemination of mastery learning curricula, like all other medical education innovations, will fail without active educational leadership, personal contacts, dedication, hard work, rigorous measurement, and attention to implementation science principles. The article concludes by presenting a set of lessons learned about disseminating an SBML CVC curriculum across different medical education settings.
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Affiliation(s)
- William C McGaghie
- W.C. McGaghie is professor of medical education, Northwestern University Feinberg School of Medicine, Chicago, Illinois. J.H. Barsuk is associate professor of medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois. E.R. Cohen is a research associate, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois. T. Kristopaitis is associate professor of medicine and pathology, Loyola University Chicago Stritch School of Medicine, Maywood, Illinois. D.B. Wayne is vice dean of education and Dr. John Sherman Appleman Professor of Medical Education, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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