Cohort study of hospitalists’ procedural skills: baseline competence and durability after simulation-based training

Abstract

ObjectivesHospitalists are expected to be competent in performing bedside procedures, which are associated with significant morbidity and mortality. A national decline in procedures performed by hospitalists has prompted questions about their procedural competency. Additionally, though simulation-based mastery learning (SBML) has been shown to be effective among trainees whether this approach has enduring benefits for independent practitioners who already have experience is unknown. We aimed to assess the baseline procedural skill of hospitalists already credentialed to perform procedures. We hypothesised that simulation-based training of hospitalists would result in durable skill gains after several months.DesignProspective cohort study with pretraining and post-training measurements.SettingSingle, large, urban academic medical centre in the USA.ParticipantsTwenty-two out of 38 eligible participants defined as hospitalists working on teaching services where they would supervise trainees performing procedures.InterventionsOne-on-one, 60 min SBML of lumbar puncture (LP) and abdominal paracentesis (AP).Primary and secondary outcome measuresOur primary outcome was the percentage of hospitalists obtaining minimum passing scores (MPS) on LP and AP checklists; our secondary outcomes were average checklist scores and self-reported confidence.ResultsAt baseline, only 16% hospitalists met or exceeded the MPS for LP and 32% for AP. Immediately after SBML, 100% of hospitalists reached this threshold. Reassessment an average of 7 months later revealed that only 40% of hospitalists achieved the MPS. Confidence increased initially after training but declined over time.ConclusionsHospitalists may be performing invasive bedside procedures without demonstration of adequate skill. A single evidence-based training intervention was insufficient to sustain skills for the majority of hospitalists over a short period of time. More stringent practices for certifying hospitalists who perform risky procedures are warranted, as well as mechanisms to support skill maintenance, such as periodic simulation-based training and assessment.

Pre-clerkship procedural training in venipuncture: a prospective cohort study on skills acquisition and durability

“…It was deemed unethical to request students to perform venipuncture on actual patients with training limited to SBPT on venipuncture one year ago. Thus, we expected a skill decay in accordance with previous research [ 70 , 71 ]. Hence, to overcome the ethical issues arising from requesting students (who only had SBPT on venipuncture one year ago and thus, deemed not to have adequate exposure) to perform venipuncture on actual patients, we designed the study so that the students were given four weeks of clinical training where they would be able to perform venipuncture on actual patients.…”

“…They concluded that the students were able to retain the skills learned through simulation-based training for one year despite the lack of training in between. However, more recent studies have shown evidence of steep skills decay following SBPT [ 70 ], with recommendations for booster training at intervals to maintain procedural competency [ 65 , 71 ].…”

Clinical Simulation for Procedural Expertise: State of Education and Application

“…It utilizes "active" teaching techniques and ensures competency-based education (Issenberg et al, 2005). It has enhanced learner competence and expertise (Bamford et al, 2018;Greif et al, 2010;Hale et al, 2021;Hayden et al, 2014). Due to these findings, evidence supports the introduction of SBPT to students before clerkships (Battaglia et al, 2021;Omori et al, 2005) to better prepare them to learn in the clinical setting (Battaglia et al, 2021;Remmen et al, 2001).…”

“…Simulation-based research conducted over decades is ripe with evidence supporting improved educator and learner satisfaction (Bradley, 2006), learner knowledge and confidence (Battaglia et al, 2021;Laschinger et al, 2008), and competence when assessed on simulators (Hale et al, 2021;Morgan & Cleave-Hogg, 2000). Although most studies support the use of simulation for improved knowledge and skill, only a few studies have shown the effectiveness of transferring knowledge and skill gained in simulation training into clinical practice (Hill et al, 2011).…”