Background Musculoskeletal problems are the reason for one-quarter of primary care visits. Opportunities for internal medicine residents to perform joint aspirations and injections have declined. Simulation has been shown to improve procedure skills post completion of simulation courses, yet controversy exists about the durability of simulation-acquired skills. Objective To investigate whether web-based review preserves residents' joint procedure skills 6 to 30 months after a simulation course. Methods Postgraduate year–1 internal medicine residents participated in a simulation-based Joint Aspiration Injection Course consisting of web-based instructional material, guided practice on joint models, and a multiple-choice test. Procedure proficiency was scored by using a 3-component skills checklist. Six to 30 months later, residents who had participated in the simulation were randomly assigned to review or not to review the original web-based instructional material before retesting. The groups were compared by using Wilcoxon rank sum and matched pairs signed rank tests. Results Compared to the performance at the end of the simulation course, scores of all 3 procedure components declined (informed consent, 64.7–43.0 versus 30.6–23.8, P < .001; procedure proficiency, 63.4–61.7 versus 46.4–44.3, P < .001; and postprocedure instructions, 58.0–54.1 versus 29.9–29.4, P < .001). However, the review group outperformed the nonreview group on informed consent (shoulder: 37.1 versus 24.6, P = .01) and postprocedure instructions (shoulder: 34.0 versus 25.2, P = .01; knee: 35.5 versus 24.8, P < .001). Residents who reported doing actual procedures maintained a higher confidence level, compared with those reporting none (6.8–5.1 versus 4.1–3.6, P < .001). Conclusion Shoulder and knee simulation-acquired skills declined 6 to 30 months after a simulation course. However, rereview of web-based instructional material improved proficiency in informed consent, shoulder, and postprocedure instructions, shoulder and knee.
Background Several studies have examined the effects of simulation and live training experiences on abdominal paracentesis skills, but no study has examined the durability of such training or compared skills retention between the simulation-only and hybrid training approaches. Methods A subset of internal medicine residents who participated in simulation-based training in abdominal paracentesis were assigned to an additional, live training experience. Procedural knowledge and skill were assessed following initial training and at six months, and compared between groups. Results Complete data was available for 29 out of 37 residents who received simulation-only training and 18 out of 23 who received simulation plus live training. There were no statistical differences in procedural skills scores at either point in time. The simulation plus live training group achieved a higher mean score on the knowledge test at six months (p=0.006). Conclusions Simulation-based training is sufficient for achieving initial mastery in abdominal paracentesis, but not for maintaining paracentesis skills at six months in the absence of structured, maintenance training. The addition of a live training experience to complement the simulation training was not sufficient to prevent skills decline.
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