Purpose This article presents a comparison of the effectiveness of traditional clinical education toward skill acquisition goals versus simulation-based medical education (SBME) with deliberate practice (DP). Method This is a quantitative meta-analysis that spans twenty years, 1990 to 2010. A search strategy involving three literature databases, 12 search terms, and four inclusion criteria was used. Four authors independently retrieved and reviewed articles. Main outcome measures were extracted to calculate effect sizes. Results Of 3,742 articles identified, 14 met inclusion criteria. The overall effect size for the 14 studies evaluating the comparative effectiveness of SBME compared to traditional clinical medical education was 0.71 (95% confidence interval, 0.65–0.76; P < .001). Conclusions Although the number of reports analyzed in this meta analysis is small, these results show that SBME with DP is superior to traditional clinical medical education in achieving specific clinical skill acquisition goals. SBME is a complex educational intervention that should be introduced thoughtfully and evaluated rigorously at training sites. Further research on incorporating SBME with DP into medical education is needed to amplify its power, utility, and cost-effectiveness.

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An educational intervention in CVC insertion significantly improved patient outcomes. Simulation-based education is a valuable adjunct in residency education.

A simulation-based mastery learning program increased residents' skills in simulated central venous catheter insertion and decreased complications related to central venous catheter insertions in actual patient care.

Disclosure: The authors have no financial or other potential conflicts of interest.BACKGROUND: Central venous catheter (CVC) insertions are performed frequently by internal medicine residents.Complications, including arterial puncture and pneumothorax, decrease when operators use fewer needle passes to insert the CVC. In this study, we evaluated the effect of simulation-based mastery learning on CVC insertion skill. DESIGN:This was a cohort study of internal jugular (IJ) and subclavian (SC) CVC insertions by 41 internal medicine residents rotating through the medical intensive care unit (MICU) over a five-month period. Thirteen traditionallytrained residents were surveyed about the number of needle passes, complications, and procedural self-confidence on CVCs inserted in the MICU. Concurrently, 28 residents completed simulation-based training in IJ and SC CVC insertions. Simulator-trained residents were expected to perform CVC insertions to mastery standards on a central line simulator. Simulator-trained residents then rotated through the MICU and were surveyed regarding CVC placement. The impact of simulation training was assessed by comparing group survey results. Central venous catheter (CVC) insertions are commonly performed at the bedside in medical intensive care unit (MICU) settings. Internal medicine residents are required to demonstrate knowledge regarding CVC indications, complications, and sterile technique, 1 and often perform the procedure during training. Education in CVC insertion is needed because many internal medicine residents are uncomfortable performing this procedure. 2 CVC insertion also carries the risk of potentially life-threatening complications including infection, pneumothorax, arterial puncture, deep vein thrombosis, and bleeding. Education and training may also contribute to improved patient care because increased physician experience with CVC insertion reduces complication risk. 3,4 Similarly, a higher number of needle passes or attempts during CVC insertion correlates with mechanical complications such as pneumothorax or arterial punctures. 4-8 Pneumothorax rates for internal jugular (IJ) CVCs have been reported to range from 0% to 0.2% and for subclavian (SC) CVCs from 1.5% to 3.1%. 4,5 The arterial puncture rate for IJ CVCs ranges from 5.0% to 9.4% and for SC CVCs from 3.1% to 4.9%. 4,5 Proper use of ultrasound to assist with IJ CVC insertion has been shown to decrease these mechanical complications. 4,5 However, studies of ultrasound use with SC CVC insertion have mixed results. 4 Simulation-based training has been used in medical education to increase knowledge, provide opportunities for deliberate and safe practice, and shape the development of RESULTS: Journal of Hospital Medicine Vol 4 No 7 September 2009 397clinical skills. 9,10 We previously used simulation-based mastery learning to improve the thoracentesis and advanced cardiac life support (ACLS) skills of internal medicine residents. 11,12 Although a few small studies have linked simulation-based interventions to imp...

A simulation-based educational intervention in CVC insertion was highly cost-effective. These results suggest that investment in simulation training can produce significant medical care cost savings.

Objective:To evaluate the effect of simulation-based mastery learning (SBML) on internal medicine residents' lumbar puncture (LP) skills, assess neurology residents' acquired LP skills from traditional clinical education, and compare the results of SBML to traditional clinical education. Methods:This study was a pretest-posttest design with a comparison group. Fifty-eight postgraduate year (PGY) 1 internal medicine residents received an SBML intervention in LP. Residents completed a baseline skill assessment (pretest) using a 21-item LP checklist. After a 3-hour session featuring deliberate practice and feedback, residents completed a posttest and were expected to meet or exceed a minimum passing score (MPS) set by an expert panel. Simulatortrained residents' pretest and posttest scores were compared to assess the impact of the intervention. Thirty-six PGY2, 3, and 4 neurology residents from 3 medical centers completed the same simulated LP assessment without SBML. SBML posttest scores were compared to neurology residents' baseline scores.Results: PGY1 internal medicine residents improved from a mean of 46.3% to 95.7% after SBML (p Ͻ 0.001) and all met the MPS at final posttest. The performance of traditionally trained neurology residents was significantly lower than simulator-trained residents (mean 65.4%, p Ͻ 0.001) and only 6% met the MPS. Conclusions:Residents who completed SBML showed significant improvement in LP procedural skills. Few neurology residents were competent to perform a simulated LP despite clinical experience with the procedure. Neurology Lumbar puncture (LP) is commonly performed by physicians-in-training who often learn vicariously by observing procedures performed by peers. This method leads to uneven skill acquisition and trainee discomfort. 1The American Board of Psychiatry and Neurology, 2 the American Association of Neurology, 3 and the Accreditation Council for Graduate Medical Education 4 have no formal policies to ensure the competence of neurology residents at performing LP. The American Board of Internal Medicine does not require procedural competence in LP, but advises use of simulation training before procedures are performed on patients.5 Despite this, many residents will ultimately practice in a setting where competence in LP is required.Simulation technology increases procedural skill by providing the opportunity for deliberate practice in a safe environment. 6 Researchers at Northwestern University use simulation-based education to train medical residents to mastery skill levels in procedures such as central venous catheter insertion, 7-9 thoracentesis, 10 and advanced cardiac life support. 11 Mastery learning is a stringent form of competency-based education that requires trainees to acquire clinical skill mea-