Simulation-Based Education with Mastery Learning Improves Paracentesis Skills

Abstract

Background Paracentesis is a commonly performed bedside procedure that has the potential for serious complications. Therefore, simulation-based education for paracentesis is valuable for clinicians. Objective To assess internal medicine residents' procedural skills before and after simulation-based mastery learning on a paracentesis simulator. Methods A team with expertise in simulation and procedural skills developed and created a high fidelity, ultrasound-compatible paracentesis simulator. Fifty-eight first-year internal medicine residents completed a mastery learning-based intervention using the paracentesis simulator. Residents underwent baseline skill assessment (pretest) using a 25-item checklist. Residents completed a posttest after a 3-hour education session featuring a demonstration of the procedure, deliberate practice, ultrasound training, and feedback. All residents were expected to meet or exceed a minimum passing score (MPS) at posttest, the key feature of mastery learning. We compared pretest and posttest checklist scores to evaluate the effect of the educational intervention. Residents rated the training sessions. Results Residents' paracentesis skills improved from an average pretest score of 33.0% (SD = 15.2%) to 92.7% (SD = 5.4%) at posttest (P < .001). After the training intervention, all residents met or exceeded the MPS. The training sessions and realism of the simulation were rated highly by learners. Conclusion This study demonstrates the ability of a paracentesis simulator to significantly improve procedural competence.

Performance of Temporary Hemodialysis Catheter Insertion by Nephrology Fellows and Attending Nephrologists

“…Fellows reported very high satisfaction with the SBML intervention, and their THDC skills improved dramatically at post-test. This is similar to the results of earlier studies (6,12,13,18,19,21) and consistent with others showing that SBML improves patient care outcomes and reduces associated health care costs (10)(11)(12)(13)(22)(23)(24)(25).…”

“…Practice sessions using models are hard work work, higher procedural self-confidence was associated with higher simulated THDC insertion skills in this study (6,7,12,(18)(19)(20)(21). Nevertheless, the vast majority of attending nephrologists and all fellows failed to meet the MPS at baseline, indicating poor overall ability to self-assess procedural skill.…”

State-of-the-art usage of simulation in anesthesia

“…Similar results were found for other skills such as lumbar puncture [28,29], fiberoptic intubation [30], paracentesis [31], thoracocentesis [32], and procedures such as advanced cardiac life support [33].…”

Cost Savings of Performing Paracentesis Procedures at the Bedside After Simulation-based Education

“…9 Bedside paracentesis procedures are performed on the hepatology service by internal medicine residents who have completed simulation-based education to mastery standards. 11,12 Each resident completes a 4-hour simulationbased mastery learning (SBML) paracentesis training program and must meet or exceed a minimum passing score on a clinical skills examination before performing the procedure on a patient. 11,12 Residents who do not initially meet the minimum passing score return to the simulation laboratory for additional deliberate skills practice.…”