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Simulation-Based Mastery Learning for Thoracentesis Skills Improves Patient Outcomes: A Randomized Trial.
Jeffrey H Barsuk1, Elaine R Cohen, Mark V Williams
1J.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.
Simulation-based mastery learning (SBML) for thoracentesis reduced patient complications among internal medicine residents. This rigorous education strategy improved procedural safety and represents a successful quality improvement initiative.
Area of Science:
- Medical Education
- Surgical Simulation
- Pulmonary Medicine
Background:
- Physicians-in-training performing bedside thoracentesis can have higher complication rates.
- Simulation-based mastery learning (SBML) offers a potential solution to improve procedural safety.
- Key complications include iatrogenic pneumothorax (IP), hemothorax, and reexpansion pulmonary edema (REPE).
Purpose of the Study:
- To evaluate the impact of thoracentesis SBML on patient complications.
- To compare complication rates between SBML-trained residents, traditionally trained residents, and referrals.
Main Methods:
- Internal medicine residents were randomized to SBML or traditional training.
- A tertiary care academic center conducted the study from December 2012 to May 2016.
- 917 thoracenteses were analyzed, comparing complication rates across groups.
Main Results:
- SBML-trained residents showed a trend toward lower combined clinically meaningful complications (7.9% vs. 0%; P = .06).
- SBML residents had significantly fewer clinically meaningful iatrogenic pneumothoraces (IP) compared to other groups (P = .02).
- SBML-trained residents performed procedures with significantly lower overall clinically meaningful complications (P = .008).
Conclusions:
- Thoracentesis performed by SBML-trained residents resulted in low rates of clinically meaningful complications.
- Rigorous simulation-based education is an effective quality improvement strategy for procedural training.
- SBML enhances patient safety in invasive procedures performed by trainees.
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