Purpose:To evaluate the effectiveness of a learner-centered, simulation-based training developed to help medical students improve their procedural skills in intubation, arterial line placement, lumbar puncture, and central line insertion.Method:The study participants were second and third year medical students. Anesthesiology residents provided the training and evaluated students’ procedural skills. Two residents were present at each station to train the medical students who rotated through all 4 stations. Pre/posttraining assessment of confidence, knowledge, and procedural skills was done using a survey, a multiple-choice test, and procedural checklists, respectively.Results:In total, 24 students were trained in six 4-hour sessions. Students reported feeling significantly more confident, after training, in performing all 4 procedures on a real patient (P < .001). Paired-samples t tests indicated statistically significant improvement in knowledge scores for intubation, t(23) = −2.92, P < .001, and arterial line placement, t(23) = −2.75, P < .001. Procedural performance scores for intubation (t(23) = −17.29, P < .001), arterial line placement (t(23) = −19.75, P < .001), lumbar puncture (t(23) = −16.27, P < .001), and central line placement (t(23) = −17.25, P < .001) showed significant improvement. Intraclass correlation coefficients indicated high reliability in checklist scores for all procedures.Conclusions:The simulation sessions allowed each medical student to receive individual attention from 2 residents for each procedure. Students’ written comments indicated that this training modality was well received. Results showed that medical students improved their self-confidence, knowledge, and skills in the aforementioned procedures.

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BACKGROUND This study compares outcomes at a hospital-linked, physician-led, birthing center to a traditional hospital labor and delivery service. METHODS Using de-identified electronic medical records, a retrospective cohort design was employed to evaluate 32,174 singleton births during 1998–2005. RESULTS Compared to hospital service, birth care center delivery was associated with a lower rate of cesarean sections (adjusted Relative Risk =0.73, 95 percent confidence interval 0.59–0.91; p<0.001) without an increased rate of operative vaginal delivery (adjusted Relative Risk=1.04, 95 percent confidence interval 0.97–1.13; p=0.25) and a higher initiation of breast feeding (adjusted Relative Risk = 1.28, 95 percent confidence interval 1.25–1.30 (p=<0.001). A maternal length of stay greater than 72 hours occurred less frequently in the birth care center (adjusted Relative Risk =0.60, 95 percent confidence interval 0.55–0.66; p<0.001). Comparing only women without major obstetrical risk factors, the differences in outcomes were reduced but not eliminated. Adverse maternal and infant outcomes were not increased at the birth care center. CONCLUSION A hospital-linked, physician-led, birth care center has the potential to lower rates of cesarean sections without increasing rates of operative vaginal delivery or other adverse maternal and infant outcomes.