An innovative longitudinal curriculum to increase emergency medicine residents’ exposure to rarely encountered and technically challenging procedures

Abstract

BackgroundProcedural skills have historically been taught at the bedside. In this study, we aimed to increase resident knowledge of uncommon emergency medical procedures to increase residents’ procedural skills in common and uncommon emergency medical procedures and to integrate cognitive training with hands-on procedural instruction using high- and low-fidelity simulation.MethodsWe developed 13 anatomically/physiologically-based procedure modules focusing on uncommon clinical procedures and/or those requiring higher levels of technical skills. A departmental expert directed each session with collaboration from colleagues in related subspecialties. Sessions were developed based on Manthey and Fitch’s stages of procedural competency including 1) knowledge acquisition, 2) experience/technical skill development, and 3) competency evaluation. We then distributed a brief, 10-question, online survey to our residents in order to solicit feedback regarding their perceptions of increased knowledge and ability in uncommon and common emergency medical procedures, and their perception of the effectiveness of integrated cognitive training with hands-on instruction through high- and low-fidelity simulation.ResultsFifty percent of our residents (11/22) responded to our survey. Responses indicated the procedure series helped with understanding of both uncommon (65% strongly agreed [SA], 35% agreed [A]) and common (55% SA, 45% A) emergency medicine procedures and increased residents’ ability to perform uncommon (55% SA, 45% A) and common (45% SA, 55% A) emergency medical procedures. In addition, survey results indicated that the residents were able to reach their goal numbers.ConclusionBased on survey results, the procedure series improved our residents’ perceived understanding of and perceived ability to perform uncommon and more technically challenging procedures. Further, results suggest that the use of a cognitive curriculum model as developed by Manthey and Fitch is adaptable and could be modified to fit the needs of other medical specialties.

Using simulation-based education to improve residents' clinical decision making skills in developing countries

“…[27][28][29]31,[37][38][39]41 Of these, six programs included task or procedural skills in the immersive clinical scenario, 28,29,[37][38][39]41 while five programs incorporated additional stand-alone task/procedural stations. 27,31,37,39,41 Six programs reported using debriefing in their curricula to support learning, while one program used a question and answer period to promote reflection. [28][29][30][31]34,37,38,41 Three programs discussed cost of implementing the curricula, 30,31,39 and reported cost ranged from $17,500 (US) to approximately $50,000.…”

“…41 Program evaluation methods were described in three articles. 27,30,41 The authors of two programs provided the program evaluation tools used. 27,38 The curricula, and the resources made available in the articles, are specific to the authors" clinical context, but they may be used to develop similar curricula, and the concepts extended to other clinical disclipines to develop other novel clinical decision-making skills.…”

“…27 Grall and colleagues combined cognitive training with hands-on procedural instruction using high-and low-fidelity simulation. The advantages of this application were: 1) strongly founded in education theory, 2) Assessment aligned with ACGME competencies, 2) concurrently providing theoretical, technical, and instructional experience to the residents.…”

“…Emergency Medicine faculty of the University of Arizona (Tucson, US) used a progressive, four-stage, multimodule, simulation-based mastery curriculum to increase residents" knowledge and procedural skills in 13 difficult or uncommon emergency medical procedures. 27 Grall and colleagues combined cognitive training with hands-on procedural instruction using high-and low-fidelity simulation. The advantages of this application were: 1) strongly founded in education theory, 2) Assessment aligned with ACGME competencies, 2) concurrently providing theoretical, technical, and instructional experience to the residents.…”

52 Procedures in 52 Weeks: An Innovative Curriculum for Emergency Medicine Residents

“…All are infrequently encountered, within the scope of an EP’s practice, and yet not required by the ACGME. This creates a challenge for EM educators, who remain charged with graduating competent physicians who have the mental and technical expertise to perform such procedures 4,5. Another challenge faced when teaching and, more importantly, performing rare procedures is logistics.…”