Competency-based instruction in critical invasive skills improves both resident performance and patient safety

Martín, Marcel; Vashisht, Bhupesh; Frezza, Eldo E.; Ferone, Terri; López, Bárbara Miladys Placencia; Pahuja, Murlidhar; Spence, Ríchard K.

doi:10.1016/s0039-6060(98)70136-9

Cited by 97 publications

(66 citation statements)

References 3 publications

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“…It has been shown that the skills thus acquired transfer quite well to the patients’ bedside, and physicians that were trained using simulated curricula performed significantly better than controls in their clinical encounters [39,40,41]. The use of simulated models to train the novice prior to patient contact has also been proven to promote patient comfort and safety [42, 43]. In addition, simulated training with objective assessment and feedback identifies and reduces errors and poorly acquired habits, and provides opportunities for learning from mistakes and remedial intervention [44,45,46].…”

Section: Resultsmentioning

confidence: 99%

Validation of Two Instruments to Assess Technical Bronchoscopic Skill Using Virtual Reality Simulation

2008

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Background: In an era of increased emphasis on patient safety and competency-based education, demonstration of significant variability in the teaching of flexible bronchoscopy has led to initiatives for new standardized curricula and assessment tools. Objectives: To evaluate the efficacy of such curricula and to assess bronchoscopic skill, 2 measuring instruments have been developed: the Bronchoscopy Skills and Tasks Assessment Tool (BSTAT) and the Bronchoscopy Step-by-Step Evaluation Tool (BSET). We studied the validity and reliability of these 2 instruments. Methods: Two independent testers simultaneously scored 22 volunteer participants at 3 levels [novice (n = 7), fellow (n = 8) and attending (n = 7)] on a virtual reality bronchoscopy simulator using the 2 instruments; each participant was tested twice, in 2 separate sessions. Intertester and test-retest reliability were analyzed with intraclass correlations (ICC); ANOVA was used to assess concurrent validity based on the subjects’ expected skill level. Results: The ICCs between the testers were 0.98 for both the BSTAT and BSET. Comparison of the scores between the sessions showed high test-retest reliability by ICC (0.86 and 0.85 for BSTAT and BSET respectively), with a small yet statistically significant learning effect. The novice group’s scores were lower than the fellows’ and attendings’ (p < 0.001) for both the BSTAT and BSET; the fellows’ scores were consistently lower than the attendings’ on both tests, yet the differences were not statistically significant. Conclusion: This validation study of 2 objective tests of bronchoscopic skill demonstrated high reliability and concurrent validity. These instruments can now be used to evaluate the effectiveness of new competency-based bronchoscopy curricula.

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Section: Resultsmentioning

confidence: 99%

Validation of Two Instruments to Assess Technical Bronchoscopic Skill Using Virtual Reality Simulation

2008

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“…The use of simulation-based training for medical and surgical procedures has been demonstrated to be effective, cost-effective, and to increase patients’ comfort and safety [10,11,12,13,14]. Procedural simulators have been validated for assessing a variety of medical and surgical procedural skills including colonoscopy and laparoscopy [15,16].…”

Section: Introductionmentioning

confidence: 99%

Validation of an Endobronchial Ultrasound Simulator: Differentiating Operator Skill Level

et al. 2011

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Background: Endobronchial ultrasound (EBUS) is a revolutionary diagnostic procedure. There is currently no accepted method of assessing EBUS technical skill or competency. Objectives: This study aimed to validate a computer EBUS simulator in differentiating between operators of varying clinical EBUS experience. Methods: A convenience sample (n = 22) of bronchoscopists was separated into four cohorts based on previous bronchoscopy experience: group A = novice bronchoscopists, no EBUS experience (n = 4), group B = expert bronchoscopists, no EBUS experience (n = 5), group C = basic clinical EBUS training (n = 9), group D = EBUS experts (n = 4). After a standardized introduction session on the EBUS simulator, participants performed 2 simulated cases on an EBUS simulator with performance metrics measured by the simulator. Results: Significant differences between groups were noted for total procedure time, percentage of lymph nodes identified and percentage of successful biopsies (p < 0.05, ANOVA). Group D performed significantly better than all other groups for total procedure time and percentage of lymph nodes identified (p < 0.05). Group C performed significantly better than groups A and B for total procedure time, percentage of lymph nodes identified and percentage of successful biopsies (p < 0.05, ANOVA). Conclusions: An EBUS simulator can accurately discriminate between operators with different levels of clinical EBUS experience. EBUS simulators show promise as a tool for assessing training and evaluating competency.

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“…Both low- and high-fidelity simulation have been shown to enhance physician competence in procedural skills [4,5,6,7], including bronchoscopy [8], while saving time and improving the learning curve [9,10]. Skills thus acquired transfer effectively to the patients’ bedside [11,12,13,14], and physicians who are trained using simulators perform significantly better than controls in their clinical encounters [15,16,17]. Simulator training with objective assessment and feedback identifies and reduces errors, and provides opportunities for remedial intervention [18,19,20,21].…”

Section: Background and Purposementioning

confidence: 99%

“…Simulator training with objective assessment and feedback identifies and reduces errors, and provides opportunities for remedial intervention [18,19,20,21]. In addition, the use of simulator platforms and inanimate models to train novices prior to patient contact has been proven to promote patient comfort and safety [17,22]. …”

Section: Background and Purposementioning

confidence: 99%

Comparative Effectiveness of Low- and High-Fidelity Bronchoscopy Simulation for Training in Conventional Transbronchial Needle Aspiration and User Preferences

et al. 2010

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Background: Conventional transbronchial needle aspiration (TBNA) can be learned using high-fidelity virtual-reality platforms and low-fidelity models comprised of molded silicone or excised animal airways. Objectives: The purpose of this study was to determine perceptions and preferences of learners and instructors regarding the comparative effectiveness of low-fidelity and high-fidelity bronchoscopy simulation for training in TBNA. Methods: During the 2008 annual CHEST conference, a prospective randomized crossover design was used to train study participants in three methods of conventional TBNA using low- and high-fidelity models. Likert style questions were administered to learners and instructors in order to elicit preferences and opinions regarding educational effectiveness of the models. Results were tabulated and depicted in graphic format, with medians calculated. Results: Learners felt that the models were equally enjoyable (13–13) and enthusiasm generating (low 17-high 15). There was preference for low-fidelity in terms of realism (23–17), ease of learning (20–6), and learning all three TBNA methods (31–7 for hub-against-wall, 31–6 for jabbing, 29–6 for piggyback). Low-fidelity was preferred as an ideal model overall (19–11). Instructors thought that low-fidelity was more useful in teaching TBNA (9–0 for all three methods). Instructors perceived the low-fidelity model overall as an ideal tool for learning TBNA (8–0) and a more effective teaching instrument (8–0). Conclusion: Based on learner and instructor perceptions, a low-fidelity model is superior to a high-fidelity platform for training in three methods of conventional TBNA.

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Competency-based instruction in critical invasive skills improves both resident performance and patient safety

Cited by 97 publications

References 3 publications

Validation of Two Instruments to Assess Technical Bronchoscopic Skill Using Virtual Reality Simulation

Validation of Two Instruments to Assess Technical Bronchoscopic Skill Using Virtual Reality Simulation

Validation of an Endobronchial Ultrasound Simulator: Differentiating Operator Skill Level

Comparative Effectiveness of Low- and High-Fidelity Bronchoscopy Simulation for Training in Conventional Transbronchial Needle Aspiration and User Preferences

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