By examining multiple sources of validity evidence, this study suggests that the mini-CEX provides a reliable and valid assessment of clinical competence for PGY-4 trainees in internal medicine.

BACKGROUND:Efficacy of simulators in teaching central venous catheterization (CVC) in an internal medicine residency program is unknown.OBJECTIVE:To determine whether or not learning CVC on simulators is associated with improvement in performance of CVC, knowledge about the procedure, and self‐reported confidence.METHODS:All consenting first‐year internal medicine residents who completed training in CVC on simulators were included. Participants were evaluated pre‐ and post‐training by video‐recorded CVC insertion and multiple‐choice knowledge assessments. Procedural technique was rated in a blinded fashion by two independent adjudicators. Knowledge retention and self‐reported confidence were reassessed at 18 months.MEASUREMENTS:Primary outcome of CVC performance was assessed based on global rating score (minimum 1, maximum 5). Secondary measures include checklist score (out of ten), knowledge score and self‐reported confidence (6‐point Likert scale ranging from “none” to “complete”).RESULTS:Median global rating scores in 30 participants increased from 3.5 (IQR = 3‐4) to 4.5 (IQR = 4‐4.5) (P < 0.001). Checklist score increased from 9 (IQR = 6‐9.5) to 9.5 (IQR = 9‐9.5) (P < 0.001). Knowledge score increased from 65.7 ± 11.9% to 81.2 ± 10.7% (P < 0.001). Confidence increased from 3 (“moderate”, IQR = 2‐3) to 4 (“good”, IQR=3‐4) (P < 0.001). Sixteen participants completed the retention tests. Improvement in knowledge score and confidence at 18 months was retained compared with baseline (P = 0.002 and P < 0.0001 respectively).CONCLUSIONS:Use of simulators in teaching CVC in an internal medicine residency program results in improved procedural performance, knowledge, and self‐reported confidence. Improvement in knowledge and confidence was retained at 18 months. Journal of Hospital Medicine 2009;4:410–416. © 2009 Society of Hospital Medicine.

BackgroundSimulation is increasingly used for teaching medical procedures. The goal of this study was to assess learner preferences for how simulators should be used in a procedural curriculum.MethodsA 26-item survey was constructed to assess the optimal use of simulators for the teaching of medical procedures in an internal medicine residency curriculum. Survey domains were generated independently by two investigators and validated by an expert panel (n = 7). Final survey items were revised based on pilot survey and distributed to 128 internal medicine residents.ResultsOf the 128 residents surveyed, 106 (83%) responded. Most responders felt that simulators should be used to learn technical skills (94%), refine technical skills (84%), and acquire procedural teaching skills (87%).Respondents felt that procedures most effectively taught by simulators include: central venous catheterization, thoracentesis, intubation, lumbar puncture, and paracentesis. The majority of learners felt that teaching should be done early in residency (97%).With regards to course format, 62% of respondents felt that no more than 3-4 learners per simulator and an instructor to learner ratio of 1:3-4 would be acceptable.The majority felt that the role of instructors should include demonstration of technique (92%), observe learner techniques (92%), teach evidence behind procedural steps (84%) and provide feedback (89%). Commonly cited barriers to procedural teaching were limitations in time, number of instructors and simulators, and lack of realism of some simulators.ConclusionsOur results suggest that residents value simulator-based procedural teaching in the form of small-group sessions. Simulators should be an integral part of medical procedural education.

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