Use of Simulation-Based Mastery Learning for Thoracentesis to Improve Outcomes

描述（由申请人提供）：基于模拟的掌握学习（SBML）减少了中心静脉导管插入的严重医源性并发症。鉴于医疗程序是困扰3%住院患者的并发症的第二大常见原因，SBML应适用于所有医疗中心的程序。在学术医院，床边程序，如胸腔穿刺术（清除胸腔中的液体），往往是由无人监督的医疗实习生。传统上，医学实习生学习程序依赖于历史上的“看一个，做一个，教一个”的心态。不幸的是，这种方法使病人在受训者能够胜任之前接受手术。通过使用医疗模拟，医学教育工作者可以增加受训者的基本知识和技能，同时确保程序能力和减少患者暴露于不必要的风险。使用掌握学习模型的医学模拟训练提高了临床技能并降低了手术相关损伤的风险。我们的研究小组率先使用这种以证据为基础的方法来教授医学实习生。掌握学习要求所有受训者在培训结束前都表现出统一的高水平技能。这确保了在实际遇到病人之前在医疗模拟器上的能力。拟议的研究的目标是调查使用SBML课程，以提高内科住院医师的技能时，对病人进行胸腔穿刺术。此外，我们将评估这些技能如何影响病人的结果，通过比较模拟训练的居民进行胸腔穿刺术，那些谁有“传统”的培训。该项目将评估这些总体假设：1）使用掌握学习方法的基于模拟的培训提高了胸腔穿刺术的技能和知识; 2）这种方法将促进学习技能的保留; 3）改善患者的预后，缩短住院时间和医疗费用。具体目标是：1）基于掌握学习模型，使用模拟器、超声和基于网络的教学指导来培训内科住院医师，重新设计胸腔穿刺术程序课程; 2）测量内科住院医师在接受课程时技能的变化，3）评估受训者在正式模拟培训和掌握学习后一年内胸腔穿刺术程序技能的稳定性，以及; 4）证明与传统学习方法相比，使用掌握学习程序课程是否减少了胸腔穿刺术的医源性并发症，并通过缩短住院时间和降低成本来提高医疗保健利用率。拟议的研究将证明，SBML显着降低医源性并发症和医疗保健成本从胸腔穿刺术进行的医生在培训。这项研究的结果可能会通知政策，要求正式的能力为基础的培训，使用模拟技术的所有床边程序。

DESCRIPTION (provided by applicant): Simulation-based mastery learning (SBML) decreases serious iatrogenic complications from central venous catheter insertion. Given medical procedures are the second most common cause of the complications that afflict 3% of hospitalized patients, SBML should be applied to procedures done in all medical centers. In academic hospitals, bedside procedures such as thoracentesis (removal of fluid in the chest) are often performed by unsupervised medical trainees. Traditionally, medical trainees learn procedures relying on the historic "see one, do one, teach one" mentality. Unfortunately, this approach subjects patients to procedures before trainees are competent. Through the use of medical simulation, medical educators can increase the essential knowledge and skills of trainees while assuring procedural competence and reducing patient exposure to undue risk. Medical simulation training using the mastery learning model improves clinical skills and reduces the risk of procedure- associated injury. Our research group pioneered the use of this evidence-based approach for teaching medical trainees. Mastery learning requires that all trainees demonstrate a uniformly high level of skill before training completion. This ensures competence on a medical simulator before actual patient encounters. The goal of the proposed research is to investigate the use of an SBML curriculum to improve internal medicine residents' skills when performing thoracenteses on patients. Additionally, we will evaluate how these skills affect patient outcomes by comparing thoracenteses performed by simulator-trained residents to those who have "traditional" training. This project will evaluate these overall hypotheses: 1) simulation-based training using the mastery learning approach improves thoracentesis skills and knowledge; 2) this methodology will promote retention of the learned skills, and; 3) result in improved patient outcomes, reduced length of stay, and medical costs. Specific aims are: 1) redesign a thoracentesis procedure curriculum, based on the mastery learning model, using simulators, ultrasound, and web-based didactic instruction to train medical residents; 2) measure changes in medical resident skills as they undergo the curriculum, 3) assess the stability of trainees' thoracentesis procedure skills over a one year period following formal simulation training with mastery learning, and; 4) demonstrate whether using the mastery learning procedure curriculum compared to a traditional learning approach decreases iatrogenic complications from thoracentesis and improves healthcare utilization through reductions in length of hospital stay and decreased cost. The proposed study will demonstrate that SBML significantly decreases iatrogenic complications and healthcare costs from thoracenteses performed by physicians in training. Results from this study may inform policy to require formal competency-based training using simulation technology for all bedside procedures.