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Klein MR, Loke DE, Barsuk JH, Adler MD, McGaghie WC, Salzman DH. Twelve tips for developing simulation-based mastery learning clinical skills checklists. Med Teach 2024:1-6. [PMID: 38670308 DOI: 10.1080/0142159x.2024.2345270] [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] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Accepted: 04/16/2024] [Indexed: 04/28/2024]
Abstract
Simulation-based mastery learning is a powerful educational paradigm that leads to high levels of performance through a combination of strict standards, deliberate practice, formative feedback, and rigorous assessment. Successful mastery learning curricula often require well-designed checklists that produce reliable data that contribute to valid decisions. The following twelve tips are intended to help educators create defensible and effective clinical skills checklists for use in mastery learning curricula. These tips focus on defining the scope of a checklist using established principles of curriculum development, crafting the checklist based on a literature review and expert input, revising and testing the checklist, and recruiting judges to set a minimum passing standard. While this article has a particular focus on mastery learning, with the exception of the tips related to standard setting, the general principles discussed apply to the development of any clinical skills checklist.
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Affiliation(s)
- Matthew R Klein
- Department of Emergency Medicine, Brown University Warren Alpert Medical School, Providence, Rhode Island, USA
| | - Dana E Loke
- Department of Emergency Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Jeffrey H Barsuk
- Department of Medicine (Hospital Medicine) and Department of Medical Education, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Mark D Adler
- Department of Pediatrics (Emergency Medicine) and Department of Medical Education, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - William C McGaghie
- Department of Medical Education and Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - David H Salzman
- Department of Emergency Medicine and Department of Medical Education, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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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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Phillips ML, Tsao M, Davis-Sandfoss A, Benzon H, Mitchell JD, Barsuk JH, Ballard HA. Use of Simulation-Based Mastery Learning Curriculum to Improve Difficult Conversation Skills Among Anesthesiologists: A Pilot Study. J Educ Perioper Med 2023; 25:E710. [PMID: 37720371 PMCID: PMC10502581 DOI: 10.46374/volxxv_issue3_phillips] [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] [Subscribe] [Scholar Register] [Indexed: 09/19/2023]
Abstract
Background Breaking bad news (BBN) is an important clinical task for physicians. Unfortunately, there is no standard method to teach and assess these skills of anesthesiologists. Although anesthesiology has become a relatively safe medical specialty, complications still occur that require disclosure to patients and their families. Disclosure of bad news can be a significant source of stress for clinicians, especially for those who have low confidence in their BBN skills. Anesthesiologists' skills in BBN can be improved with simulation-based mastery learning (SBML), an intense form of competency-based learning. Methods An SBML curriculum was developed using the SPIKES (Situation, Perception, Invitation, Knowledge, Emotion, Summarize) framework for BBN and the NURSE (Naming, Understanding, Respecting, Supporting, Exploring) statements for expressing empathy. A pretest-posttest study was conducted from March 2020 to June 2022 to evaluate anesthesiologists' performance in BBN. Participants completed a 2-hour curriculum consisting of a pretest, didactic session, deliberate practice with feedback, and a posttest. Anesthesiologists were assessed using a 16-item skills checklist. Results Six anesthesiology attendings and 14 anesthesiology fellows were enrolled in the study. Three of 20 participants met the minimum passing score (MPS) at the time of their pretest. All study participants met the MPS on their first posttest (P < .001). The median participant confidence in BBN significantly increased (3 to 4, P < .001). Overall course satisfaction in the curriculum was high, with a median score of 5. Conclusions Our study demonstrates that a BBN SBML curriculum for anesthesiologists significantly improved communication skills and confidence in a simulated environment. Because only 3 participants met the MPS before training, our results suggest that anesthesiologists could benefit from further education to gain effective communication skills and that SBML training may be effective to achieve this result.
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Affiliation(s)
- Mitchell L. Phillips
- The following authors are in the Department of Pediatric Anesthesiology at Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL; Mitchell L. Phillips, Michelle Tsao, and Heather A. Ballard are Assistant Professors; Andrew Davis-Sandfoss is a Fellow; and Hubert Benzon is an Associate Professor. John D. Mitchell is a Professor of Anesthesiology and Vice Chair for Academic Affairs in the Department of Anesthesiology, Perioperative Medicine & Pain Management at Henry Ford Health, Detroit, MI. Jeffrey H. Barsuk is a Professor in the Department of Medicine at Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Michelle Tsao
- The following authors are in the Department of Pediatric Anesthesiology at Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL; Mitchell L. Phillips, Michelle Tsao, and Heather A. Ballard are Assistant Professors; Andrew Davis-Sandfoss is a Fellow; and Hubert Benzon is an Associate Professor. John D. Mitchell is a Professor of Anesthesiology and Vice Chair for Academic Affairs in the Department of Anesthesiology, Perioperative Medicine & Pain Management at Henry Ford Health, Detroit, MI. Jeffrey H. Barsuk is a Professor in the Department of Medicine at Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Andrew Davis-Sandfoss
- The following authors are in the Department of Pediatric Anesthesiology at Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL; Mitchell L. Phillips, Michelle Tsao, and Heather A. Ballard are Assistant Professors; Andrew Davis-Sandfoss is a Fellow; and Hubert Benzon is an Associate Professor. John D. Mitchell is a Professor of Anesthesiology and Vice Chair for Academic Affairs in the Department of Anesthesiology, Perioperative Medicine & Pain Management at Henry Ford Health, Detroit, MI. Jeffrey H. Barsuk is a Professor in the Department of Medicine at Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Hubert Benzon
- The following authors are in the Department of Pediatric Anesthesiology at Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL; Mitchell L. Phillips, Michelle Tsao, and Heather A. Ballard are Assistant Professors; Andrew Davis-Sandfoss is a Fellow; and Hubert Benzon is an Associate Professor. John D. Mitchell is a Professor of Anesthesiology and Vice Chair for Academic Affairs in the Department of Anesthesiology, Perioperative Medicine & Pain Management at Henry Ford Health, Detroit, MI. Jeffrey H. Barsuk is a Professor in the Department of Medicine at Northwestern University Feinberg School of Medicine, Chicago, IL
| | - John D. Mitchell
- The following authors are in the Department of Pediatric Anesthesiology at Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL; Mitchell L. Phillips, Michelle Tsao, and Heather A. Ballard are Assistant Professors; Andrew Davis-Sandfoss is a Fellow; and Hubert Benzon is an Associate Professor. John D. Mitchell is a Professor of Anesthesiology and Vice Chair for Academic Affairs in the Department of Anesthesiology, Perioperative Medicine & Pain Management at Henry Ford Health, Detroit, MI. Jeffrey H. Barsuk is a Professor in the Department of Medicine at Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Jeffrey H. Barsuk
- The following authors are in the Department of Pediatric Anesthesiology at Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL; Mitchell L. Phillips, Michelle Tsao, and Heather A. Ballard are Assistant Professors; Andrew Davis-Sandfoss is a Fellow; and Hubert Benzon is an Associate Professor. John D. Mitchell is a Professor of Anesthesiology and Vice Chair for Academic Affairs in the Department of Anesthesiology, Perioperative Medicine & Pain Management at Henry Ford Health, Detroit, MI. Jeffrey H. Barsuk is a Professor in the Department of Medicine at Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Heather A. Ballard
- The following authors are in the Department of Pediatric Anesthesiology at Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL; Mitchell L. Phillips, Michelle Tsao, and Heather A. Ballard are Assistant Professors; Andrew Davis-Sandfoss is a Fellow; and Hubert Benzon is an Associate Professor. John D. Mitchell is a Professor of Anesthesiology and Vice Chair for Academic Affairs in the Department of Anesthesiology, Perioperative Medicine & Pain Management at Henry Ford Health, Detroit, MI. Jeffrey H. Barsuk is a Professor in the Department of Medicine at Northwestern University Feinberg School of Medicine, Chicago, IL
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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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Ballard HA, Rivera A, Tsao M, Phillips M, Robles A, Hajduk J, Feinglass J, Barsuk JH. Use of an ultrasound-guided intravenous catheter insertion simulation-based mastery learning curriculum to improve paediatric anaesthesia care. BJA Open 2022; 4:100101. [PMID: 37588791 PMCID: PMC10430828 DOI: 10.1016/j.bjao.2022.100101] [Citation(s) in RCA: 1] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 10/06/2022] [Indexed: 08/18/2023]
Abstract
Background We previously showed that an ultrasound-guided i.v. catheter insertion (USGIV) simulation-based mastery learning (SBML) curriculum improves the simulated USGIV skills of paediatric anaesthesiologists. It remains unclear if improvements in simulated USGIV skills translate to improved patient care. Methods A cohort study was conducted from August 2018 to August 2020 to evaluate paediatric anaesthesiologists' USGIV performance in the operating theatre before and after they participated in the USGIV SBML curriculum. Paediatric anaesthesiologists' use of ultrasound for successful i.v. insertion and first-attempt i.v. insertion success rate with ultrasound were compared before and after training. Results Twenty-nine paediatric anaesthesiologists completed training. Unadjusted analysis showed a significant increase in the percentage of i.v. catheters inserted with ultrasound for successful i.v. catheter insertion (9.5-14.5%; P<0.001) and first i.v. catheter insertion attempt success with ultrasound (5.5-8.9%; P<0.001) from before to after training. Multivariable regression analysis showed higher odds of ultrasound use for a successful i.v. catheter attempt (1.79; 95% confidence interval [CI]: 1.11-2.90; P=0.018) and first-attempt success with ultrasound (4.11; 95% CI: 2.02-8.37; P<0.001) after training. Conclusions After completing the USGIV SBML curriculum, paediatric anaesthesiologists increased their ultrasound use for successful i.v. catheter insertion and first-attempt success rate with ultrasound for patients in the operating theatre.
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Affiliation(s)
- Heather A. Ballard
- Department of Pediatric Anesthesiology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Adovich Rivera
- Institute of Public Health, Division of Health Services Outcomes Research, USA
| | - Michelle Tsao
- Department of Pediatric Anesthesiology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Mitch Phillips
- Department of Pediatric Anesthesiology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Alison Robles
- Department of Pediatric Anesthesiology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - John Hajduk
- Department of Pediatric Anesthesiology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Joe Feinglass
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Jeffrey H. Barsuk
- Department of Medicine, Northwestern 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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Ballard HA, Hajduk J, Cheon EC, King MR, Barsuk JH. Clinical and demographic factors associated with pediatric difficult intravenous access in the operating room. Paediatr Anaesth 2022; 32:792-800. [PMID: 35293066 PMCID: PMC9310763 DOI: 10.1111/pan.14438] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 03/08/2022] [Accepted: 03/10/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Pediatric intravenous catheter insertion can be difficult in the operating room due to the technical challenges of small diameter vessels and the need to rapidly gain intravenous access in anesthetized children. Few studies have examined factors associated with difficult vascular access in the operating room, especially accounting for the increased possibility to use ultrasound guidance. AIMS The primary aim of the study was to identify factors associated with pediatric difficult vascular access in the operating room. Our primary hypothesis was that Black race, Hispanic ethnicity, and ultrasound use would be associated with pediatric difficult vascular access. METHODS We performed a retrospective analysis of prospectively collected data from a cohort of pediatric patients who had intravenous catheters inserted in the operating room at an academic tertiary care children's hospital from March 2020 to February 2021. We measured associations among patients who were labeled as having difficult vascular access (>2 attempts at access) with demographic, clinical, and hospital factors. RESULTS 12 728 intravenous catheter insertions were analyzed. Multivariable analysis showed significantly higher odds of difficult vascular access with Black non-Hispanic race (1.43, 95% CI: 1.06-1.93, p = .018), younger age (0.93, 95% CI: 0.89-0.98, p = .005), overweight (1.41, 95% CI: 1.04-1.90, p = .025) and obese body mass index (1.56, 95% 95% CI: 1.12-2.17, p = .008), and American Society of Anesthesiologists physical status III (1.54, 95% CI:1.11-2.13, p = .01). The attending anesthesiologist compared to all other practitioners (certified registered nurse anesthetist: (0.41, 95% CI: 0.31-0.56, p < .001, registered nurse: 0.25, 95% CI: 0.13-0.48, p < .001, trainee: 0.21, 95% CI: 0.17-0.28, p-value <.001 with attending as reference variable) and ultrasound use (2.61, 95% CI: 1.85-3.69, p < .001) were associated with successful intravenous catheter placement. CONCLUSIONS Black non-Hispanic race/ethnicity, younger age, obese/overweight body mass index, American Society of Anesthesiologists physical status III, and ultrasound were all associated with pediatric difficult vascular access in the operating room.
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Affiliation(s)
- Heather A. Ballard
- Department of Pediatric AnesthesiologyAnn & Robert H. Lurie Children's Hospital of ChicagoChicagoIllinoisUSA
| | - John Hajduk
- Department of Pediatric AnesthesiologyAnn & Robert H. Lurie Children's Hospital of ChicagoChicagoIllinoisUSA
| | - Eric C. Cheon
- Department of Pediatric AnesthesiologyAnn & Robert H. Lurie Children's Hospital of ChicagoChicagoIllinoisUSA
| | - Michael R. King
- Department of Pediatric AnesthesiologyAnn & Robert H. Lurie Children's Hospital of ChicagoChicagoIllinoisUSA
| | - Jeffrey H. Barsuk
- Department of MedicineNorthwestern University Feinberg School of MedicineChicagoIllinoisUSA
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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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Amick AE, Feinsmith SE, Davis EM, Sell J, Macdonald V, Trinquero P, Moore AG, Gappmeier V, Colton K, Cunningham A, Ford W, Feinglass J, Barsuk JH. Simulation-Based Mastery Learning Improves Ultrasound-Guided Peripheral Intravenous Catheter Insertion Skills of Practicing Nurses. Simul Healthc 2022; 17:7-14. [PMID: 33428356 DOI: 10.1097/sih.0000000000000545] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [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: 10/22/2022]
Abstract
INTRODUCTION Difficult intravenous (IV) access (DIVA) is frequently encountered in the hospital setting. Ultrasound-guided peripheral IV catheter (USGPIV) insertion has emerged as an effective procedure to establish access in patients with DIVA. Despite the increased use of USGPIV, little is known about the optimal training paradigms for bedside nurses. Therefore, we developed and evaluated a novel, sustainable, USGPIV simulation-based mastery learning (SBML) curriculum for nurses. METHODS This is a prospective cohort study of an USGPIV SBML training program for bedside nurses over a 12-month period. We evaluated skills and self-confidence before and after training and measured the proportion of the nurses achieving independent, proctor, and instructor status. Procedure logs and surveys were used to explore the nurse experience and utilization of USGPIV on real patients with DIVA 3 months after the intervention. RESULTS Two hundred thirty-eight nurses enrolled in the study. The USGPIV skill checklist scores increased from median of 6.0 [interquartile range = 4.0-9.0 (pretest) to 29.0, interquartile range = 28-30 (posttest), P < 0.001]. The USGPIV confidence improved from before (mean = 2.32, SD = 1.17) to after (mean = 3.85, SD = 0.73, P < 0.001) training (5-point Likert scale). Sixty-two percent of the nurses enrolled achieved independent status, 47.5% became proctors, and 11.3% course trainers. At 3-month posttraining, the nurses had attempted a mean of 35.6 USGPIV insertions with an 89.5% success rate. CONCLUSIONS This novel USGPIV SBML curriculum improves nurses' insertion skills, self-confidence, and progresses patient care through USGPIV insertions on hospitalized patients with DIVA.
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Affiliation(s)
- Ashley Elizabeth Amick
- From the University of Washington (A.E.A.), Seattle, WA; Loyola University (S.E.F.), Chicago, IL; University of Michigan Medical School (E.M.D.), Ann Arbor, MI; Northwestern University (J.S., P.T., A.G.M., V.G., K.C., A.C., W.F., J.F., J.H.B.), Evanston; and Northwestern Memorial Hospital (V.M.), Chicago, IL
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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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15
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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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Issa N, Liddy WE, Samant S, Conley DB, Kern RC, Hungness ES, Cohen ER, Barsuk JH. Effectiveness of a simulation-based mastery learning to train clinicians on a novel cricothyrotomy procedure at an academic medical centre during a pandemic: a quasi-experimental cohort study. BMJ Open 2021; 11:e054746. [PMID: 34799364 PMCID: PMC8606759 DOI: 10.1136/bmjopen-2021-054746] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES To develop and evaluate a simulation-based mastery learning (SBML) curriculum for cricothyrotomy using wet towels to suppress aerosolisation during a pandemic. DESIGN Quasi-experimental, pre-post study. SETTING Tertiary care, academic medical centre in Chicago. PARTICIPANTS Ear, nose and throat and general surgery residents, fellows and attendings. INTERVENTION Cricothyroidotomy simulation-based mastery learning curriculum. OUTCOMES MEASURE Pretest to posttest simulated cricothyrotomy skills checklist performance. RESULTS 37 of 41 eligible surgeons participated in the curriculum. Median pretest score was 72.5 (IQR 55.0-80.0) and 100.0 (IQR 98.8-100.0) for the posttest p<0.001. All participants scored at or above a minimum passing standard (93% checklist items correct) at posttest. CONCLUSIONS Using SBML is effective to quickly train clinicians to competently perform simulated cricothyrotomy during a pandemic.
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Affiliation(s)
- Nabil Issa
- Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Whitney E Liddy
- Department of Otolaryngology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Sandeep Samant
- Department of Otolaryngology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - David B Conley
- Department of Otolaryngology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Robert C Kern
- Department of Otolaryngology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Eric S Hungness
- Department of Surgery, 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
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17
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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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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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19
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Patel NG, Bhasin A, Feinglass JM, Angarone MP, Cohen ER, Barsuk JH. Mortality, critical illness, and mechanical ventilation among hospitalized patients with COVID-19 on therapeutic anticoagulants. Thromb Update 2021; 2:100027. [PMID: 38620459 PMCID: PMC7732225 DOI: 10.1016/j.tru.2020.100027] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Revised: 12/06/2020] [Accepted: 12/08/2020] [Indexed: 12/22/2022] Open
Abstract
Background COVID-19 is associated with hypercoagulability and increased incidence of thrombosis. We compared the clinical outcomes of adults hospitalized with COVID-19 who were on therapeutic anticoagulants to those on prophylactic anticoagulation. Materials and methods We performed an observational study of adult inpatients' with COVID-19 from March 9 to June 26, 2020. We compared patients who were continued on their outpatient prescribed therapeutic anticoagulation and those who were newly started on therapeutic anticoagulation for COVID-19 (without other indication) to those who were on prophylactic doses. The primary outcome was overall death while secondary outcomes were critical illness (World Health Organization Ordinal Scale for Clinical Improvement score ≥5), mechanical ventilation, and death among patients who first had critical illness. We adjusted for age, sex, race, body mass index (BMI), Charlson score, glucose on admission, and use of antiplatelet agents. Results Of 1716 inpatients with COVID-19, 171 patients were continued on their therapeutic anticoagulation and 78 were started on new therapeutic anticoagulation for COVID-19. In patients continued on home therapeutic anticoagulation, there were no differences in overall death, critical illness, mechanical ventilation, or death among patients with critical illness compared to patients on prophylactic anticoagulation. In patients receiving new therapeutic anticoagulation for COVID-19, there was increased death (OR 5.93; 95% CI 3.71-9.47), critical illness (OR 14.51; 95% CI 7.43-28.31), need mechanical ventilation (OR 11.22; 95% CI 6.67-18.86), and death after first having critical illness (OR 5.51; 95% CI 2.80-10.87). Conclusions Therapeutic anticoagulation for inpatients with COVID-19 was not associated with improved outcomes.
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Affiliation(s)
- Niti G Patel
- Northwestern University Feinberg School of Medicine, Department of Medicine, Chicago, IL, USA
| | - Ajay Bhasin
- Northwestern University Feinberg School of Medicine, Department of Medicine, Chicago, IL, USA
| | - Joseph M Feinglass
- Northwestern University Feinberg School of Medicine, Division of General Internal Medicine and Geriatrics, Chicago, IL, USA
| | - Michael P Angarone
- Northwestern University Feinberg School of Medicine, Division of Infectious Diseases, Department of Medicine, Chicago, IL, USA
| | - Elaine R Cohen
- Northwestern University Feinberg School of Medicine, Department of Medicine, Chicago, IL, USA
| | - Jeffrey H Barsuk
- Northwestern University Feinberg School of Medicine, Department of Medicine, Chicago, IL, USA
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20
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Griswold S, Uchida T, Issenberg SB, Motola I, McGaghie WC, Gisondi MA, Lorenz A, Barsuk JH. Ethical imperative of psychological safety in healthcare: in response to the Manifesto for healthcare simulation practice. BMJ Simul Technol Enhanc Learn 2021; 7:457-458. [PMID: 35515745 PMCID: PMC8936733 DOI: 10.1136/bmjstel-2021-000889] [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] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 04/07/2021] [Indexed: 11/04/2022]
Abstract
Psychological safety is valued in other high-risk industries as an essential element to ensure safety. Yet, in healthcare, psychological safety is not mandatorily measured, quantified, or reported as an independent measure of safety. All members of the healthcare team's voice and safety are important. Calls for personal, physical or patient safety should never be disregarded or met with retaliation.
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Affiliation(s)
- Sharon Griswold
- Department of Emergency Medicine, Penn State Health Milton S Hershey Medical Center, Hershey, Pennsylvania, USA
| | - Toshiko Uchida
- Departments of Medical Education and Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - S Barry Issenberg
- Departments of Medical Education and Medicine, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Ivette Motola
- Departments of Medical Education and Emergency Medicine of Miami Miller School of Medicine, Miami, Florida, USA
| | - William C McGaghie
- Department of Medical Education, Northwestern University Feinberg School of Medicine, Miami, Florida, USA
| | - Michael A Gisondi
- Department of Emergency Medicine and The Precision Education and Assessment Research Lab, Stanford University School of Medicine, Stanford, California, USA
| | - Amelia Lorenz
- Northwestern University Clinical Education Center, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Jeffrey H Barsuk
- Departments of Medical Education and Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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21
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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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Davis EM, Feinsmith S, Amick AE, Sell J, McDonald V, Trinquero P, Moore A, Gappmaier V, Colton K, Cunningham A, Ford W, Feinglass J, Barsuk JH. Difficult intravenous access in the emergency department: Performance and impact of ultrasound-guided IV insertion performed by nurses. Am J Emerg Med 2020; 46:539-544. [PMID: 33191044 DOI: 10.1016/j.ajem.2020.11.013] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 11/02/2020] [Accepted: 11/05/2020] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Difficult intravenous access (DIVA) is a common problem in Emergency Departments (EDs), yet the prevalence and clinical impact of this condition is poorly understood. Ultrasound-guided peripheral intravenous catheter (USGPIV) insertion is a successful modality for obtaining intravenous (IV) access in patients with DIVA. OBJECTIVES We aimed to describe the prevalence of DIVA, explore how DIVA affects delivery of care, and determine if nurse insertion of USGPIV improves care delays among patients with DIVA. METHODS We retrospectively queried the electronic medical record for all ED patients who had a peripheral IV (PIV) inserted at a tertiary academic medical center from 2015 to 2017. We categorized patients as having DIVA if they required ≥3 PIV attempts or an USGPIV. We compared metrics for care delivery including time-to-IV-access, time-to-laboratory-results, time-to-IV-analgesia, and ED length of stay (LOS) between patients with and without DIVA. We also compared these metrics in patients with DIVA with a physician-inserted USGPIV versus those with a nurse-inserted USGPIV. RESULTS A total of 147,260 patients were evaluated during the study period. Of these, 13,192 (8.9%) met criteria for DIVA. Patients with DIVA encountered statistically significant delays in time-to-IV-access, time-to-laboratory-results, time-to-IV-analgesia, and ED LOS compared to patients without DIVA (all p < 0.001). Patients with nurse-inserted USGPIVs also had statistically significant improvements in time-to-IV-access, time-to-laboratory-results, time-to-IV-analgesia, and ED LOS compared to patients with physician-inserted USGPIVs (all p < 0.001). CONCLUSION DIVA affects many ED patients and leads to delays in PIV access-related care. Nurse insertion of USGPIVs improves care in patients with DIVA.
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Affiliation(s)
- Evan M Davis
- Department of Emergency Medicine, University of Michigan Medical School, Ann Arbor, MI, USA.
| | - Sarah Feinsmith
- Department of Emergency Medicine, Northwestern Memorial Hospital, Chicago, IL, USA
| | - Ashley E Amick
- Department of Emergency Medicine, Department of Internal Medicine, University of Washington School of Medicine, Seattle, WA, USA.
| | - Jordan Sell
- Department of Emergency Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
| | - Valerie McDonald
- Department of Emergency Medicine, Northwestern Memorial Hospital, Chicago, IL, USA
| | - Paul Trinquero
- Department of Emergency Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Arthur Moore
- Department of Emergency Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Victor Gappmaier
- Department of Emergency Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Katharine Colton
- Department of Emergency Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Andrew Cunningham
- Department of Emergency Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - William Ford
- Department of Emergency Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Joseph Feinglass
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
| | - Jeffrey H Barsuk
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
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Ballard HA, Tsao M, Robles A, Phillips M, Hajduk J, Feinglass J, Barsuk JH. Use of a simulation-based mastery learning curriculum to improve ultrasound-guided vascular access skills of pediatric anesthesiologists. Paediatr Anaesth 2020; 30:1204-1210. [PMID: 32594590 DOI: 10.1111/pan.13953] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [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: 04/07/2020] [Revised: 06/14/2020] [Accepted: 06/17/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Pediatric vascular access is inherently challenging due to the small caliber of children's vessels. Ultrasound-guided intravenous catheter insertion has been shown to increase success rates and decrease time to cannulation in patients with difficult intravenous access. Although proficiency in ultrasound-guided intravenous catheter insertion is a critical skill in pediatric anesthesia, there are no published competency-based training curricula. AIMS The objective of this study was to evaluate the performance of pediatric anesthesiologists who participated in a novel ultrasound-guided intravenous catheter insertion simulation-based mastery learning curriculum. METHODS Pediatric anesthesia attendings, fellows, and rotating residents participated in the ultrasound-guided intravenous catheter insertion simulation-based mastery learning curriculum from August 2019 to February 2020. The 2-hour curriculum consisted of participants first undergoing a simulated skills pretest followed by watching a video on ultrasound-guided intravenous catheter insertion and deliberate practice on a simulator. Subsequently, all participants took a post-test and were required to meet or exceed a minimum passing standard. Those who were unable to meet the minimum passing standard participated in further practice until they could be retested and met this standard. We compared pre to post-test ultrasound-guided intravenous catheter insertion skills and self-confidence before and after participation in the curriculum. RESULTS Twenty-six pediatric anesthesia attendings, 12 fellows, and 38 residents participated in the curriculum. At pretest, 16/76 (21%) participants were able to meet or exceed the minimum passing standard. The median score on the pretest was 21/25 skills checklist items correct and improved to 24/25 at post-test (95% CI 3.0-4.0, P < .01). Self-confidence significantly improved after the course from an average of 3.2 before the course to a postcourse score of 3.9 (95% CI 0.5-0.9, P < .01; 1 = Not all confident, 5 = Very confident). CONCLUSIONS Simulation-based mastery learning significantly improved anesthesiologists' ultrasound-guided intravenous catheter insertion performance in a simulated setting.
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Affiliation(s)
- Heather A Ballard
- Department of Pediatric Anesthesiology, Ann & Robert H. Lurie Children's Hospital of Chicago, IL, USA.,Northwestern University, Feinberg School of Medicine, Chicago, IL, USA
| | - Michelle Tsao
- Department of Pediatric Anesthesiology, Ann & Robert H. Lurie Children's Hospital of Chicago, IL, USA.,Northwestern University, Feinberg School of Medicine, Chicago, IL, USA
| | - Alison Robles
- Department of Pediatric Anesthesiology, Ann & Robert H. Lurie Children's Hospital of Chicago, IL, USA.,Northwestern University, Feinberg School of Medicine, Chicago, IL, USA
| | - Mitch Phillips
- Department of Pediatric Anesthesiology, Ann & Robert H. Lurie Children's Hospital of Chicago, IL, USA.,Northwestern University, Feinberg School of Medicine, Chicago, IL, USA
| | - John Hajduk
- Department of Pediatric Anesthesiology, Ann & Robert H. Lurie Children's Hospital of Chicago, IL, USA.,Northwestern University, Feinberg School of Medicine, Chicago, IL, USA
| | - Joseph Feinglass
- Northwestern University, Feinberg School of Medicine, Chicago, IL, USA.,Department of Medicine, Northwestern Memorial Hospital, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA
| | - Jeffrey H Barsuk
- Northwestern University, Feinberg School of Medicine, Chicago, IL, USA.,Department of Medicine, Northwestern Memorial Hospital, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA
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24
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Mikhaeil-Demo Y, Barsuk JH, Culler GW, Bega D, Salzman DH, Cohen ER, Templer JW, Gerard EE. Use of a simulation-based mastery learning curriculum for neurology residents to improve the identification and management of status epilepticus. Epilepsy Behav 2020; 111:107247. [PMID: 32603805 DOI: 10.1016/j.yebeh.2020.107247] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [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: 03/14/2020] [Revised: 06/06/2020] [Accepted: 06/06/2020] [Indexed: 12/29/2022]
Abstract
BACKGROUND Appropriate and timely treatment of status epilepticus (SE) decreases morbidity and mortality. Therefore, skill-based training in the identification and management of SE is crucial for clinicians. OBJECTIVE The objective of the study was to develop and evaluate the impact of a simulation-based mastery learning (SBML) curriculum to train neurology residents on the identification and management of SE. METHODS We used pretest-posttest design with a retention test on SE skills for this study. Neurology residents in the second postgraduate year (PGY-2) were eligible to participate in the SE SBML curriculum. Learners completed a baseline-simulated SE skills assessment (pretest) using a 26-item dichotomous skills checklist. Next, they participated in a didactic session about the identification and management of SE, followed by deliberate skills practice. Subsequently, participants completed another skills assessment (posttest) using the same 26-item checklist. All participants were required to meet or exceed a minimum passing standard (MPS) determined by a panel of 14 SE experts using the Mastery Angoff standard setting method. After meeting the MPS at posttest, participants were reassessed during an unannounced in situ simulation session on the medical wards. We compared pretest with posttest simulated SE skills performance and posttest with reassessment in situ performance. RESULTS The MPS was set at 88% (23/26) checklist items correct. Sixteen neurology residents participated in the intervention. Participant performance improved from a median of 44.23% (Interquartile range (IQR): 34.62-55.77) at pretest to 94.23% (IQR: 92.13-100) at the posttest after SBML (p < .001). There was no significant difference in scores between the posttest and in situ test up to 8 months later (94.23%; IQR: 92.31-100 vs. 92.31%; IQR: 88.46-96.15; p = .13). CONCLUSIONS Our SBML curriculum significantly improved residents' SE identification and management skills that were largely retained during an unannounced simulated encounter in the hospital setting.
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Affiliation(s)
- Yara Mikhaeil-Demo
- Department of Neurology, University of Illinois, Chicago, IL; Department of Medical Education, Northwestern University, Feinberg School of Medicine, Chicago, IL..
| | - Jeffrey H Barsuk
- Department of Medical Education, Northwestern University, Feinberg School of Medicine, Chicago, IL.; Department of Medicine, Northwestern University, Feinberg School of Medicine, Chicago, IL
| | - George W Culler
- Department of Neurology, Northwestern University, Feinberg School of Medicine, Chicago, IL
| | - Danny Bega
- Department of Neurology, Northwestern University, Feinberg School of Medicine, Chicago, IL
| | - David H Salzman
- Department of Medical Education, Northwestern University, Feinberg School of Medicine, Chicago, IL.; Department of Emergency Medicine, Northwestern University, Feinberg School of Medicine, Chicago, IL
| | - Elaine R Cohen
- Department of Medicine, Northwestern University, Feinberg School of Medicine, Chicago, IL
| | - Jessica W Templer
- Department of Neurology, Northwestern University, Feinberg School of Medicine, Chicago, IL
| | - Elizabeth E Gerard
- Department of Neurology, Northwestern University, Feinberg School of Medicine, Chicago, IL
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Issa N, Liddy WE, Samant S, Conley DB, Kern RC, Hungness ES, Barsuk JH. Emergency cricothyrotomy during the COVID-19 pandemic: how to suppress aerosolization. Trauma Surg Acute Care Open 2020; 5:e000542. [PMID: 34192159 PMCID: PMC7411373 DOI: 10.1136/tsaco-2020-000542] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 07/03/2020] [Accepted: 07/27/2020] [Indexed: 12/14/2022] Open
Abstract
Background Cricothyrotomy is associated with significant aerosolization that increases the potential risk of infection among healthcare providers. It is important to identify simple yet effective methods to suppress aerosolization and improve the safety of healthcare providers. Methods 5 ear, nose and throat and general surgeons used a locally developed hybrid cricothyrotomy simulator with a porcine trachea to test three draping methods to suppress aerosolization during the procedure: an X-ray cassette drape, dry operating room (OR) towels and wet OR towels. The three methods were judged based on three categories: effectiveness of suppression, availability in all healthcare systems and ease of handling. Results All five surgeons performed the procedure independently using each of the three suppression methods. The wet OR towel drape was found to be an effective method to suppress aerosolization, and it did not hinder the surgeons from performing the procedure accurately. This finding was confirmed by using an atomized fluorescein dye injection into the porcine trachea, representing aerosolized material while performing the procedure. Conclusions We present a novel intervention using wet towels to suppress aerosolization during cricothyrotomy. Wet towels are cheap and readily available within any healthcare setting regardless of the financial resources available.
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Affiliation(s)
- Nabil Issa
- Departments of Surgery and Medical Education, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Whitney E Liddy
- Department of Ear, Nose and Throat, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Sandeep Samant
- Department of Ear, Nose and Throat, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - David B Conley
- Department of Ear, Nose and Throat, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Robert C Kern
- Department of Ear, Nose and Throat, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Eric S Hungness
- Departments of Surgery and Medical Education, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Jeffrey H Barsuk
- Departments of Medicine and Medical Education, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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26
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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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27
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Cheung EO, Barsuk JH, Mitra D, Gannotta RJ, Horowitz B, Didwania AK, Victorson D. Preliminary Efficacy of a Brief Mindfulness Intervention for Procedural Stress in Medical Intern Simulated Performance: A Randomized Controlled Pilot Trial. J Altern Complement Med 2020; 26:282-290. [DOI: 10.1089/acm.2019.0209] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Affiliation(s)
- Elaine O. Cheung
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Jeffrey H. Barsuk
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
- Department of Medical Education, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Debi Mitra
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | | | - Bruriah Horowitz
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Aashish K. Didwania
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
- Department of Medical Education, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - David Victorson
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL
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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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Shanklin KB, Harap RS, Barsuk JH, Cohen ER, Cameron KA, Grady KL, Pham DT, Yancy CW, Wilcox JE. Ventricular Assist Device Driveline Dressing Protocols: A Need for Standardization. J Card Fail 2019. [DOI: 10.1016/j.cardfail.2019.07.309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Wilcox JE, Cameron KA, Harap RS, Shanklin KL, Grady KL, Cohen ER, Abicht TO, Adler ED, Alexy T, Alonso W, Beckman J, Bjelkengren J, Cagliostro B, Cogswell R, Colombo PC, Cotts W, Haglund NA, Haverstick S, Kiernan MS, Lampert B, LeMond LM, Lee S, Lerg G, Lindenfeld J, Mahr C, Meehan K, Pagani FD, Pan S, Pavone J, Um J, Yancy CW, Thinh D, Barsuk JH. Ventricular Assist Device Driveline Dressing-Change Protocols: A Need for Standardization. A Report from the SimVAD Investigators. J Card Fail 2019; 25:695-697. [PMID: 31247286 DOI: 10.1016/j.cardfail.2019.06.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Revised: 06/05/2019] [Accepted: 06/20/2019] [Indexed: 10/26/2022]
Affiliation(s)
- Jane E Wilcox
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL; Bluhm Cardiovascular Institute, Northwestern Memorial Hospital, Chicago, IL.
| | - Kenzie A Cameron
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Rebecca S Harap
- Bluhm Cardiovascular Institute, Northwestern Memorial Hospital, Chicago, IL
| | - Kerry L Shanklin
- Bluhm Cardiovascular Institute, Northwestern Memorial Hospital, Chicago, IL
| | - Kathleen L Grady
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL; Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Elaine R Cohen
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | | | - Eric D Adler
- University of California San Diego, San Diego, CA
| | - Tamas Alexy
- University of Minnesota Health, Minneapolis, MN
| | - Windy Alonso
- University of Nebraska Medical Center, Omaha, NE
| | | | | | | | | | | | | | | | | | | | - Brent Lampert
- The Ohio State University Wexner Medical Center, Columbus, OH
| | | | | | | | | | - Claudius Mahr
- University of Washington Medical Center, Seattle, WA
| | | | | | - Stephen Pan
- New York University Langone Health, New York City, NY
| | | | - John Um
- University of Nebraska Medical Center, Omaha, NE
| | - Clyde W Yancy
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL; Bluhm Cardiovascular Institute, Northwestern Memorial Hospital, Chicago, IL
| | - Duc Thinh
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL; Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Jeffrey H Barsuk
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL; Department of Medical Education, Northwestern University Feinberg School of Medicine, Chicago, IL
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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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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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Harap RS, Cameron KA, Nonog G, Schulze L, Cohen E, Grady KL, Wilcox JE, Shanklin K, Yancy CW, Pham DT, Barsuk JH. A Simulation-Based Mastery Learning Approach to Ventricular Assist Device Self-Management: The SimVAD Study. J Card Fail 2018. [DOI: 10.1016/j.cardfail.2018.07.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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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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Abstract
Paracentesis is a core competency for hospitalists. Using ultrasound for fluid localization is standard practice and involves a low-frequency probe. Experts recommend a "2-probe technique, " which incorporates a high-frequency ultrasound probe in addition to the low-frequency probe to identify blood vessels within the intended needle path. Evidence is currently lacking to support this 2-probe technique, so we performed a pre- to postintervention study to evaluate its effect on paracentesis-related bleeding complications. From February 2010 to August 2011, procedures were performed using only low-frequency probes (preintervention group), while the 2-probe technique was used from September 2011 to February 2016 (postintervention group). A total of 5777 procedures were performed. Paracentesis-related minor bleeding was similar between groups. Major bleeding was lower in the postintervention group (3 [0.3%], n = 1000 vs 4 [0.08%], n = 4777; P = 0.07). This clinically meaningful trend suggests that using the 2-probe technique might prevent paracentesis-related major bleeding.
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Affiliation(s)
- Jeffrey H Barsuk
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
| | - Bradley T Rosen
- Division of General Internal Medicine, Cedars- Sinai Medical Center, Los Angeles, California, USA
| | - Elaine R Cohen
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Joe Feinglass
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Mark J Ault
- Division of General Internal Medicine, Cedars- Sinai Medical Center, Los Angeles, California, USA
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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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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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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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Abstract
BACKGROUND Physicians often care for patients with pleural effusion, a condition that requires thoracentesis for evaluation and treatment. We aim to identify the most recent advances related to safe and effective performance of thoracentesis. METHODS We performed a narrative review with a systematic search of the literature. Two authors independently reviewed search results and selected studies based on relevance to thoracentesis; disagreements were resolved by consensus. Articles were categorized as those related to the pre-, intra- and postprocedural aspects of thoracentesis. RESULTS Sixty relevant studies were identified and included. Pre-procedural topics included methods for physician training and maintenance of skills, such as simulation with direct observation. Additionally, pre-procedural topics included the finding that moderate coagulopathies (international normalized ratio less than 3 or a platelet count greater than 25,000/μL) and mechanical ventilation did not increase risk of postprocedural complications. Intraprocedurally, ultrasound use was associated with lower risk of pneumothorax, while pleural manometry can identify a nonexpanding lung and may help reduce risk of re-expansion pulmonary edema. Postprocedurally, studies indicate that routine chest X-ray is unwarranted, because bedside ultrasound can identify pneumothorax. CONCLUSIONS While the performance of thoracentesis is not without risk, clinicians can incorporate recent advances into practice to mitigate patient harm and improve effectiveness. Journal of Hospital Medicine 2017;12:266-276.
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Affiliation(s)
- Richard Schildhouse
- Division of General Medicine, Department of Internal Medicine, University of Michigan School of Medicine, Ann Arbor, MI, USA
- Division of General Medicine, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
| | - Andrew Lai
- Division of Hospital Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Jeffrey H Barsuk
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Michelle Mourad
- Division of Hospital Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Vineet Chopra
- Division of General Medicine, Department of Internal Medicine, University of Michigan School of Medicine, Ann Arbor, MI, USA
- Division of General Medicine, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
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Clark E, Barsuk JH, Karpinski J, McQuillan R. Achieving Procedural Competence during Nephrology Fellowship Training: Current Requirements and Educational Research. Clin J Am Soc Nephrol 2016; 11:2244-2249. [PMID: 27269612 PMCID: PMC5142073 DOI: 10.2215/cjn.08940815] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [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: 12/19/2022]
Abstract
Concerns have previously been raised as to whether training programs are ensuring that nephrology fellows achieve competence in the procedural skills required for independent practice. We sought to review the current requirements for procedural training as well as educational research pertaining to achieving competence in the core nephrology procedures of nontunneled (temporary) hemodialysis catheter insertion and percutaneous kidney biopsy. At this time, there is no universal approach to procedural training and assessment during nephrology fellowship. Nonetheless, simulation-based mastery learning programs have been shown to be effective in improving fellows' skills in nontunneled (temporary) hemodialysis catheter insertion and should be provided by all nephrology training programs. For percutaneous kidney biopsy, the development and evaluation of inexpensive simulators are a promising starting point for future study. Current practice with respect to procedural training during nephrology fellowship remains imperfect; however, the ongoing shift toward competency-based evaluation provides opportunities to refocus on improvement.
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Affiliation(s)
- Edward Clark
- Division of Nephrology, Department of Medicine and Kidney Research Centre, Ottawa Hospital Research Institute, The University of Ottawa, Ottawa, Ontario, Canada
| | - Jeffrey H. Barsuk
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois; and
| | - Jolanta Karpinski
- Division of Nephrology, Department of Medicine and Kidney Research Centre, Ottawa Hospital Research Institute, The University of Ottawa, Ottawa, Ontario, Canada
| | - Rory McQuillan
- Division of Nephrology, University Health Network and The University of Toronto, Toronto, Ontario, Canada
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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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