Learning and retention rates after training in posterior epistaxis management

The objective of the study was to compare the learning and retention rates of resident physicians trained in posterior epistaxis management with nasal gauze packing on a simulation model following two training methods.

This was a prospective, repeated-measures study. An objective, criterion-referenced performance standard, consisting of the number of major steps completed in the proper sequence, and the number of minor steps completed within a specified time, was used by an evaluator to assess performances. Subjects underwent two pretraining assessments 1 week prior to and the day of training and then were randomized to one of two training methods: the traditional "observation" method or a "pause-and-perfect" method. After training, both groups repeated the procedure until meeting the performance standard. Subjects were retested 1 and 3 months after training.

Twenty-eight subjects participated. Baseline performance measures were similar between groups and did not change prior to training. During performance testing, experimental subjects completed a greater percentage of major steps (84%) and minor steps (86%) in less time (25 minutes) than the controls (65 and 68%, in 35 minutes) during the first attempt. All subjects met the standard within three attempts. There were no differences in major and minor steps completed between the two groups at either 1 week or 3 months after training, but performance times were shorter in the experimental group. After 3 months, 13% of control and none of experimental subjects met the performance standard.

The pause-and-perfect training method produced more rapid progress toward a performance standard during the initial attempt and better performance times after 3 months than the traditional, observational training method. Without further practice, this skill deteriorated after 3 months with both methods of training.