Developing Technical Expertise in Emergency Medicine—The Role of Simulation in Procedural Skill Acquisition

Wang, Ernest E.; Quinones, Joshua; Fitch, Michael T.; Dooley-Hash, Suzanne; Griswold-Theodorson, Sharon; Medzon, Ron; Korley, Frederick K.; Laack, Torrey A.; Robinett, Adam; Clay, Lamont

doi:10.1111/j.1553-2712.2008.00218.x

Cited by 125 publications

(82 citation statements)

References 133 publications

(122 reference statements)

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“…The clinical implications of simulation-based training in sterile technique for EM residents are important because, we believe, the ED environment is fundamentally different from the MICU environment owing to the patient volume and pace of workflow. In keeping with the recommendations from the Academic Emergency Medicine consensus conference, 24 our study provides data to support the use of simulation-based training for achieving a high degree of proficiency in sterile technique performance in EM residents.…”

Section: Discussionsupporting

confidence: 65%

Simulation‐based Training for Emergency Medicine Residents in Sterile Technique During Central Venous Catheterization: Impact on Performance, Policy, and Outcomes

Hoskote

Khouli

Lanoix

et al. 2014

Academic Emergency Medicine

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Objectives: Central line-associated bloodstream infection (CLABSI) is a preventable nosocomial infection. Simulation-based training in sterile technique during central venous catheter (CVC) placement for emergency medicine (EM) residents, and its effect on changing the medical intensive care unit (MICU) practice of routine replacement of CVCs placed under sterile technique in the emergency department (ED), has not been evaluated. Methods:Emergency medicine residents received simulation-based sterile technique training during CVC placement between May 2008 and September 2010. Between June 2008 and January 2011, the authors reviewed records of patients who had CVCs placed in the ED under sterile technique by EM residents and were admitted to the MICU (group 1) and CVCs placed in the MICU under sterile technique by internal medicine (IM) residents (group 2). IM residents completed similar simulation-based training before May 2008. Changes in EM residents' sterile technique performance scores were compared, as well as CLABSI rates in both groups. EM residents' CVC procedural skills were not assessed.Results: Seventy-six EM residents completed simulation-based training with significant improvement in performance (median scores 13 out of 24 before training, 24 out of 24 after training; p < 0.001). CLABSI rates per 1,000 catheter-days were 1.02 in group 1 and 1.02 in group 2 (p = 0.99). Both groups had similar demographics, acuity, and mortality (p > 0.5).Conclusions: Routine replacement of CVCs placed in the ED under sterile technique after simulationbased training would appear to be unnecessary. These findings demonstrate patient-centered outcomes that are comparable for CVCs in ED-admitted MICU patients, regardless of whether the CVC was placed in the ED or MICU.ACADEMIC EMERGENCY MEDICINE 2015;22:81-87

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Section: Discussionsupporting

confidence: 65%

Simulation‐based Training for Emergency Medicine Residents in Sterile Technique During Central Venous Catheterization: Impact on Performance, Policy, and Outcomes

Hoskote

Khouli

Lanoix

et al. 2014

Academic Emergency Medicine

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“…14 Although current research suggests that they are most useful in developing critical management skills and teamwork, 14 further research is needed to determine the best use of this expensive technology.…”

Section: High-fidelity Manikinsmentioning

confidence: 99%

Teaching procedures: improving “see one, do one, teach one”

Birnbaumer

2011

CJEM

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“…23 Simulation-based skills training, whose dominant instructional strategy is deliberate practice, has penetrated EM residency curricula to a great extent. 2,[24][25][26] Working out the most effective simulation training curricula and schedules is one of the most important education tasks of this generation of EM educators. 27 Experience curves make clear that the development of skills during a training program can set the context for the use of simulation-based instruction and assessment for maintenance of competence during professional practice.…”

Section: Implications For Em Educationmentioning

confidence: 99%

Experience Curves as an Organizing Framework for Deliberate Practice in Emergency Medicine Learning

Pusic

Kessler

Szyld

et al. 2012

Academic Emergency Medicine

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Deliberate practice is an important skill-training strategy in emergency medicine (EM) education. Learning curves display the relationship between practice and proficiency. Forgetting curves show the opposite, and demonstrate how skill decays over time when it is not reinforced. Using examples of published studies of deliberate practice in EM we list the properties of learning and forgetting curves and suggest how they can be combined to create experience curves: a longitudinal representation of the relationship between practice, skill acquisition, and decay over time. This framework makes explicit the need to avoid a piecemeal, episodic approach to skill practice and assessment in favor of more emphasis on what can be done to improve durability of competence over time. The authors highlight the implications for both educators and education researchers.ACADEMIC EMERGENCY MEDICINE 2012; 19:1476-1480 by the Society for Academic Emergency Medicine E mergency physicians (EPs) intervene cognitively or physically to ameliorate any of a number of health conditions ranging from simple laceration repairs to managing massive multitrauma disaster situations. One of the fundamental tasks in medical education is the teaching and learning of these cognitive and kinesthetic skills. To gain these skills, novices use a number of instructional strategies, ranging from mental imagery to practicing on high-fidelity simulators. Some of these skills are amenable to deliberate practice, in which the learner repeats the given skill with informative feedback, in the hopes of progressive improvement to a recognized level of mastery.1,2 Once mastery is achieved, issues of skill retention supervene.3 Skills not practiced can degrade at a startling rate.In this article, we present experience curves, which are combinations of learning and forgetting curves that can demonstrate a single, longitudinal representation of knowledge and skill acquisition and decay over time. We will focus on discrete skills that are amenable to deliberate practice as defined by Ericsson.1 Deliberate practice consists of repetition with tailored feedback, is effortful, and is best done over an extended period. Examples could be cognitive (interpreting a radiograph, doing a calculation, applying knowledge to a medical decision, etc.), kinesthetic (performing a cricothyroidotomy), or mixed (leading a resuscitation).Informed by selected research in the medical and general education literatures, we first describe the educational properties of learning curves and forgetting curves. [4][5][6] We then show how these concepts can be united to make up experience curves.7 Our goal in writing this concept article is to promote a longitudinal approach to how these sorts of skills could be practiced in emergency medicine (EM) simulation environments. This framework makes explicit the need to avoid a piecemeal, episodic approach to skill practice and

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Developing Technical Expertise in Emergency Medicine—The Role of Simulation in Procedural Skill Acquisition

Cited by 125 publications

References 133 publications

Simulation‐based Training for Emergency Medicine Residents in Sterile Technique During Central Venous Catheterization: Impact on Performance, Policy, and Outcomes

Simulation‐based Training for Emergency Medicine Residents in Sterile Technique During Central Venous Catheterization: Impact on Performance, Policy, and Outcomes

Teaching procedures: improving “see one, do one, teach one”

Experience Curves as an Organizing Framework for Deliberate Practice in Emergency Medicine Learning

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