Learning and Retention Rates after Training in Posterior Epistaxis Management

Abstract

Objectives: 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.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.Results: 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. Conclusions: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.

Technology‐enhanced Simulation in Emergency Medicine: A Systematic Review and Meta‐Analysis

“…23 This study found that those trained using the mastery model completed the test task faster (effect size = 0.59, p = 0.003) and with better technique (effect size = 0.40, p < 0.001) compared with the nonmastery group. As above, these positive effects were not seen when subjects were tested 3 months later.…”

“…23,24 Lammers 23 used a "pause and perfect" model for teaching posterior epistaxis management, with faculty supervising participants during each step of a procedure, and pausing to correct mistakes when they were evident. When compared with trainees who received traditional observation, intervention subjects were more efficient and had better technique; this effect, however, was not sustained when subjects were retested at 3 months.…”

“…There were 19 studies that used designs in which one approach to simulation-based education was compared with another (see Table 3). [23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41] Twelve of the 19 studies included prehospital providers as participants, and nine of these studies focused on airway management training. Because the research questions in these 19 studies varied substantially, we were unable to provide a quantitative synthesis of results.…”

Progress Toward Improving the Quality of Cardiac Arrest Medical Team Responses at an Academic Teaching Hospital

“…9,22 However, other studies of simulator-based training interventions have demonstrated significant skill decay over time. 23,24 Our intervention includes a standardized curriculum with intense deliberate practice, which we believe is responsible for the substantial skill retention as seen in other similarly successful interventions. 25 Our finding is made more evident by comparing results for the 2008 cohorts with those for similarly studied resident cohorts in 2004, where simulator-trained PGY-2 residents performed significantly better than traditionally trained (non-SBME trained) PGY-3 residents.…”

Human Factors and Simulation in Emergency Medicine

“…60 More recently, educators are using HF more overtly in addressing procedures 61 and also indirectly through the measurement of learner cognitive load during the training process. 29,30 Investigators have utilized HFA to approach simulation-based training and assessment of procedures, including intraosseous line insertion, 62 epistaxis management, 63 bag-valve-mask ventilation, 64 intravenous catheter insertion, 65 emergency ultrasound technique, 66 and central venous catheter placement.…”