Simulation training was associated with improved in-hospital performance of CVC insertion. Procedural simulation was associated with improved residents' skills and was more effective than traditional training.

Simulation allows educators to develop learner-focused training and outcomes-based assessments. However, the effectiveness and validity of simulation-based training in emergency medicine (EM) requires further investigation. Teaching and testing technical skills require methods and assessment instruments that are somewhat different than those used for cognitive or team skills. Drawing from work published by other medical disciplines as well as educational, behavioral, and human factors research, the authors developed six research themes: measurement of procedural skills; development of performance standards; assessment and validation of training methods, simulator models, and assessment tools; optimization of training methods; transfer of skills learned on simulator models to patients; and prevention of skill decay over time. The article reviews relevant and established educational research methodologies and identifies gaps in our knowledge of how physicians learn procedures. The authors present questions requiring further research that, once answered, will advance understanding of simulation-based procedural training and assessment in EM.

Recent innovations in procedural training with partial task simulation trainers necessitate developing methods to measure skills transfer from the simulator to the clinical setting. This description of a nonphysician IR direct observation system for CVC insertion offers a feasible tool that may be generalized to monitoring other invasive procedures.

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Purpose We critically reviewed recent parent-directed teen driving interventions in order to summarize their success in meeting stated goals; identify promising intervention components and knowledge gaps; aid in the selection, adaptation, and dissemination of effective interventions; and guide future research efforts. Methods We focused on interventions that included a direct parent component, explicitly stated outcomes related to the teen and/or their parents, were evaluated for parent or teen outcomes, targeted drivers under age 21, and had at least one evaluation study published since 1990 and in English. We conducted a comprehensive systematic search of 26 online databases between November 2013 and January 2014 and identified 34 papers representing 18 interventions. Results Several interventions—in particular those that had an active engagement component, incorporated an in-vehicle data recorder system, and had a strong conceptual approach—show promise in improving parental supervisory behaviors during the learner and early independent phases, increasing teen driver skill acquisition, and reducing teens' risky driving behaviors. Conclusions We identify essential characteristics of effective parent-involved teen driving interventions and their evaluation studies, propose a comprehensive and multi-tiered approach to intervention, and discuss several research areas and overarching issues for consideration.

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Epidemiologic study, level III.

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