American Society of Regional Anesthesia and Pain Medicine August 2018 - 17
RESIDENTS' PROCEDURAL EXPERIENCE DOES NOT ENSURE
COMPETENCE: A RESEARCH SYNTHESIS
Barsuk JH, Cohen ER, Feinglass J, et al. J Grad Med Ed. 2017;
9(2):201-208.
The commonly held belief that increased clinical experience
invariably results in improved performance, especially with
procedures, is not well supported by available evidence.
Performance deficiencies may be better addressed with simulation,
in which learners demonstrate mastery of techniques by achieving a
required passing score, based on optimally performing standardized
tasks, regardless of the actual number of attempts made.
Authors sought to compare resident clinical experience (that is,
number of prior procedures performed) with the ability to achieve
a minimum passing score on four different procedures performed
in a simulation setting. Residents from several different specialty
training programs, representing a cross section of different
hospitals, provided the number of prior procedures of each type
that they had performed,
based on their resident case
logs.
Final thought: Although performance of invasive procedures did
improve with more clinical experience, the rate of attainment of
passing scores compared to an established baseline of required
behaviors was low before deliberate practice in a simulation
setting.
CHALLENGES IN HEALTH CARE SIMULATION: ARE WE LEARNING
ANYTHING NEW?
Henriksen K, Rodrick D, Grace EN, et al. Acad Med.
2018;93(5):705-708.
Health care simulation in medical training institutions has established
methodology for skills improvement and practicing clinical
management, yet educators debate whether we are actually learning
anything new about optimal use of health care simulation, particularly
with respect to improving patient safety and quality of care. Many
studies simply re-evaluate already demonstrated knowledge.
The authors posited that to learn something new, the question
needs to shift from "Is
simulation effective?"
to "How can it be more
effective?" The answer
involves different tasks,
targets, and fields.
Identifying relevant
educational issues is more
useful, such as outcome
measurement and the best
ways to structure deliberate
practice and assess performance.
"The flipped classroom 'active learnercentered' model of learning may hold
some benefit for anesthesia resident
education compared to the 'passive
teacher-centered' approach."
During the simulation
training, residents
performed central venous
catheter insertion, lumbar
puncture, paracentesis, and
thoracentesis (based on the
type of training program).
A baseline score was collected before the training was initiated,
followed by didactics and deliberate practice until a learner
attained the minimum passing score (MPS). Only 10% of residents
achieved the MPS at baseline, and the number of prior procedures
performed in the clinical setting was significantly associated with
achieving a passing score in the simulation exercises.
The authors cited literature demonstrating that neither prior
numbers of procedures or time-in-training correlates well with
Accreditation Council for Graduate Medical Education definitions of
competence. Conversely, simulation-based training with deliberate
practice offers standardization, feedback from trained educators,
translation of outcomes to improvements in actual clinical care,
and ongoing, formative evaluation so that learners demonstrate a
required degree of mastery of a particular skill.
Limitations included self-reporting by the residents, the limited
number of hospitals/trainees involved in the study (all from one
city), and the potential discrepancy between what local experts
determined as minimal standards for success in the study and the
requirements of educators for learning the same procedures at the
residents' actual training sites.
More must be learned about how simulation training skills transfer
to the clinical setting as well as improved quality and safety for
patients. Research in this area will also need to be diversified,
depending on the questions asked. As the authors suggested, an
open and purposeful pursuit of questions in patient safety and
nontechnical skills such as teamwork, situation awareness, and
decision-making are important. As we learn how to optimize the
use of simulation, patient safety will improve.
Final thought: In our complex health care system, patient safety
remains a multifaceted challenge that requires multifaceted
approaches.
ASSOCIATION BETWEEN TEACHING STATUS AND MORTALITY IN US
HOSPITALS
Burke LG, Frakt AB, Khullar D, et al. JAMA. 2017;317(20):2105-
2113.
Does admission to a teaching hospital versus a nonteaching
hospital impact overall mortality rate? Study authors found that
American Society of Regional Anesthesia and Pain Medicine
2018
17
Table of Contents for the Digital Edition of American Society of Regional Anesthesia and Pain Medicine August 2018
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