Procedural instruction in invasive bedside procedures: a systematic review and meta-analysis of effective teaching approaches

Abstract

This systematic review of bedside procedural skills demonstrates that the current literature is heterogeneous and of varying quality and rigour. Evidence is strongest for the use of simulation and competency-based paradigms in teaching procedures, and these approaches should be the mainstay of programmes that train physicians to perform procedures. Further research should clarify differences among instructional methods (eg, forms of hands-on training) rather than among educational modes (eg, lecture vs simulation).

Randomised controlled trial to assess the effect of a Just-in-Time training on procedural performance: a proof-of-concept study to address procedural skill decay

“…A systematic review of procedural interventions was consulted to estimate the effect size for procedural training on task performance 24. Based on seven studies with a total sample size of 326, a standard mean difference of 1.25 was found for procedural training and checklist-based outcome criteria.…”

E‐PREP: A competency‐based emergency department procedural training programme

“…The literature surrounding procedural medical education is widely varied and often suffers from significant methodology issues, making interpretation difficult. However, there is a substantial body of evidence supporting the observation that specialised educational methods are superior to the apprentice model and that simulation‐ and competency‐based methods are the most likely to succeed . E ‐PREP was attempting to expand on the traditional ‘see one, do one, teach one’ model, which has recently been elaborated into the ‘learn, see, practice, do, maintain’ framework…”

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

“…7,8 In response to the need for more life-like simulation models, cadaver-based labs are becoming increasingly favored by medical educators. [9][10][11][12][13][14] This model provides more realistic tissue handling, haptic feedback, preserved tissue planes, and anatomic variation. 9,12 In addition, confidence in performing procedures is heightened as a result of creating more life-like situations, as one would see in clinical practice.…”

“…Huang et al recently published a systematic review and metaanalysis of effective teaching approaches for invasive bedside procedures (including arthrocentesis), and concluded that the use of high-quality simulation that includes repetitive practice and mastery learning, supplemented by visual aids, appears to be the most effective approach. 11 We believe that the fresh cadaver represents the high quality simulation that Huang references. Unique to our approach was providing an additional visual aid by using the opposite limb to display relevant anatomy.…”

“…Huang, et al recommended using the competency-based education model, in which 'mastery' of a skill is required by the student in order to complete their training. 11 In practice, this means that a trainee would only be allowed to perform procedures on patients once they have reached predefined simulation-based skill thresholds. This instructional design should be further explored in the teaching of arthrocenteses.…”