Identifying the optimal thoracentesis training strategy: a randomized non-inferiority study
Sandra Thun Langsted1, Søren Helbo Skaarup2, Jesper Bo Weile3
1Department of Emergency Medicine, Randers Regional Hospital, Randers, Denmark; Research Center for Emergency Medicine, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.
Background:
Thoracentesis is a common clinical procedure, but the optimal training method remains unclear.
Objective:
To investigate whether a novel teaching program combining e-learning and simulation-based self-directed, spaced learning (intervention) is non-inferior to a traditional instructor-led massed training approach (control).
Methods:
In this multicenter randomized, non-inferiority study, emergency physicians unable to perform thoracentesis were randomized to either the intervention group (e-learning and three self-directed simulation sessions over two weeks) or a control group (single three-hour instructor-led simulation course). Skill acquisition and retention were evaluated at two weeks and three months by blinded assessors. The primary outcome was passing rate at two weeks post training, with a non-inferiority margin of 10 %. Secondary outcome was passing rate at three months.
Results:
A total of 63 participants (intervention group: 29, control group: 34) were included. The majority were female (72 % in the intervention group vs. 50 % in the control group). At two weeks, passing rates were 66 % (19/29) in intervention group and 65 % (18/26) control, with a risk difference of 0.8 %, CI-95 %: -30 %;30 %, p = 0.96. At three months, skill retention was significantly higher in the intervention group (92 %) compared to the control group (73 %), with a risk difference of 19 % CI-95 %: 10 %;30 %, p < 0.001.
Conclusions:
A novel training approach with self-directed spaced learning for thoracentesis resulted in comparable skill acquisition when comparing to traditional instructor-led massed training although the study was underpowered to demonstrate non-inferiority. Self-directed spaced learning was associated with superior for skill retention compared to instructor-led massed training after three months.
