An instructional program to facilitate teaching joint/soft-tissue injection and aspiration

Abstract

OBJECTIVE:We developed an instructional program to teach aspiration and injection techniques of the knee and shoulder to medical students and residents. METHODS:Residents and fourth-year medical students participating in a rheumatology elective were assigned by deterministic allocation into 3 groups: the Traditional group received no specific instruction in arthrocentesis but simply rotated through rheumatology, learning injection techniques only if they saw patients who required them; the Lecture-only group received only the didactic lecture and did not have the opportunity to practice on the models; the Program group participated in the newly developed program of instruction that combined a didactic lecture and a hands-on workshop using the anatomic models to practice arthrocentesis techniques. RESULTS:The scores on the written examination for those in the Program group (mean score 37.46 out of 40 possible) and the Lecture-only group (mean 37.75) were significantly higher than those of the Traditional group (mean 33.15) (P < .05). The scores on the practical examination for those in the Program group (mean score 24.08 out of 26 possible) were significantly higher than those of the Lecture-only (mean 20.50) and Traditional (mean 17.33) (P < .05) CONCLUSION:The addition of this type of instruction to supplement a traditional internal medicine rotation can enhance a learner's ability to perform joint/soft-tissue injection and aspiration. J oint/soft-tissue injection and aspiration (JSIA) are procedures frequently performed by both specialists and primary care providers. Seventy-two percent of general internists and 87% of family physicians use these procedures in their practice. 1,2 Instruction in injection techniques should be a part of residency training. When queried however, only 36% of internal medicine residency program directors reported that all of their residents master JSIA compared to 87% for blood gas analysis and 83% for ECG interpretation. 3 Traditionally, JSIA is taught without the benefit of an organized approach. Experience in JSIA depends on whether a patient is seen who requires JSIA, and whether the staff physician feels comfortable supervising a learner. It is possible under such a system for a learner to complete his/her training without adequate instruction or experience in JSIA. Elnicki et al. have noted that, unfortunately, only a minority of office-level procedures are taught by faculty in medical training settings. 4 How then should teaching JSIA be approached? Instruction in core procedural skills is an essential component of almost all residencies. Since the didactic lecture format is not well suited for the acquisition of complex manual operations, these skills have been primarily taught through demonstration, followed by supervised performance on patients. However, concerns regarding the safety of patients and the lack of readily available faculty and patient populations limit the utility of such an approach. For this reason, there is a need for an instructional alternative that all...

A novel fresh cadaver model for education and assessment of joint aspiration

“…13,17 Traditionally, medical students and residents have learned to perform technical skills via the apprenticeship format of ''see one, do one, teach one,'' in which demonstration by a skilled physician is followed by performance on a patient. 18 Concerns regarding patient safety have led to a variety of alternative teaching approaches including simulations, animal workshops, and cadaver-based labs. 18 These alternative approaches aim to provide the student with technical experience in a risk-free environment, prior to performing the procedure on a patient.…”

“…18 Concerns regarding patient safety have led to a variety of alternative teaching approaches including simulations, animal workshops, and cadaver-based labs. 18 These alternative approaches aim to provide the student with technical experience in a risk-free environment, prior to performing the procedure on a patient. A growing body of literature suggests that there is significant benefit to receiving formal, documented, procedural instruction compared to the traditional apprenticeship model.…”

“…Vogelgesang et al supplemented their teaching of arthrocentesis with a didactic lecture and a hands-on workshop using a synthetic model. 18 In their study, students and residents on a rheumatology rotation that participated in the technical skills workshop performed better on a postrotation practical examination than those who only received the lecture, while those that learned solely via the traditional approach had the worst performance. 18 There have been numerous reports of institutions utilizing cadaver-based models to teach arthrocentesis.…”

A structured course teaching junior doctors invasive medical procedures results in sustained improvements in self-reported confidence

“…10 The use of models has been shown in various settings to improve competency and confidence. [11][12][13] Models are available for the teaching of a number of procedures and while even the best of these have limitations in terms of realism, they can provide a useful platform on which to base procedure skills training prior to their application on patients. Many hospitals have skills laboratories equipped to varying degrees with these resources.…”

Impact of Web-Based Review on Long-Term Retention of Simulation-Acquired Knee and Shoulder Aspiration and Injection Skills

“…3 Owing to the decreasing length of office visits, resident work hour restrictions, and concern for patient safety, residents learn and perform fewer office procedures. 4 Simulation-based learning provides a low risk, predictable, and reproducible environment that has been embraced as a solution to teach learners new procedures without compromising patient safety. 5,6 Many studies, [7][8][9][10][11] including a few that specifically examined teaching arthrocentesis and intra-articular injection techniques, report preintervention to postintervention increases in…”