Procedural Curriculum to Verify Intern Competence Prior to Patient Care

Abstract

Introduction: Emergency medicine (EM) programs train residents to perform clinical procedures with known iatrogenic risks. Currently, there is no established framework for graduating medical students to demonstrate procedural competency prior to matriculating into residency. Mastery-based learning has demonstrated improved patient-safety outcomes. Incorporation of this framework allows learners to demonstrate procedural competency to a predetermined standard in the simulation laboratory prior to performing invasive procedures on patients in the clinical setting. This study describes the creation and implementation of a competency-based procedural curriculum for first-year EM residents using simulation to prepare learners for supervised participation in procedures during patient care. Methods: Checklists were developed internally for five high-risk procedures (central venous line placement, endotracheal intubation, lumbar puncture, paracentesis, chest tube placement). Performance standards were developed using Mastery-Angoff methods. Minimum passing scores were determined for each procedure. Over a two-year period, 38 residents underwent baseline assessment, deliberate practice, and post-testing against the passing standard score to demonstrate procedural competency in the simulation laboratory during intern orientation. Results: We found that 37% of residents required more than one attempt to achieve the minimum passing score on some procedures, however, all residents ultimately met the competency standard on all five high-risk procedures in simulation. One critical incident of central venous catheter guideline retention was identified in the simulation laboratory during the second year of implementation. Conclusion: All incoming first-year EM residents demonstrated procedural competence on five different procedures using a mastery-based educational framework. A competency-based EM curriculum allowed for demonstration of procedural competence prior to resident participation in supervised clinical patient care.

National survey on management of spontaneous pneumothorax from emergency department to specialised treatment: room for improvement

“…It is worrying that only a small number of departments mandated the staff to complete a training program for chest tube insertion. Data suggest that procedural training programs including simulation and validated assessment tests are not only available but also have proven efficacy and shown to improve success rate and safety of invasive thoracic procedures [ 22 , 23 ].…”

Preparing interns for clinical practice through an institution-wide simulation-based mastery learning program for teaching central venous catheter placement

“…[11] Before the intervention, faculty stakeholders from anesthesiology, emergency medicine (EM), internal medicine (IM), interventional radiology, and surgery developed a de novo CVC checklist (see Checklist Instrument, Supplemental Digital Content 1, http://links.lww.com/MD/M727) based on our own institutional safety protocols with consideration of published guidelines for best practice. [12,13] Faculty established the MPS using the Mastery-Angoff method. [14] Each checklist item was scored dichotomously (correct or incorrect) and all items were given equal weight for scoring.…”