Design, implementation, and outcome of a hands-on arthrocentesis workshop.
BACKGROUND
During a 4-week rheumatology elective at our institution, opportunities for internal medicine residents to perform arthrocentesis were limited, particularly for sites other than the knee. Consequently, residents were inadequately prepared and had less self-confidence to perform such procedures. To overcome these educational deficiencies, an arthrocentesis workshop was developed. We report our quality improvement data that was collected during the first year of workshop implementation.


METHODS
We devised a structured half-day arthrocentesis workshop for rheumatology fellows as well as rotating internal medicine residents. This program consisted of a one hour lecture immediately followed by a hands-on workshop that used mannequin models for 5 anatomic sites. A self-assessment questionnaire and medical knowledge test were administered before and after each session. The accuracy of the self-assessment questionnaire was analyzed by comparing responses to an external objective measure of knowledge in the same content area. Finally, an optional postworkshop survey addressed resident satisfaction.


RESULTS
Thirty-eight trainees participated in the workshop between July 2006 and June 2007. There were statistically significant improvements in self-confidence in 9 content areas (P < 0.0002), cognitive testing (P < 0.0001) and in self-assurance of procedural skill at all anatomic sites. A high degree of discordance was found between the perceived level of competence and the actual performance on the medical knowledge test during the preworkshop analysis. In contrast, the postworkshop analysis displayed modestly higher concordance. All residents completing a postworkshop survey believed that it was a useful exercise, and 96% stated that they would change their practice habits.


CONCLUSIONS
The arthrocentesis workshop provided a solid foundation from which trainees can learn key concepts of joint injection, increase their self-confidence and refine their motor skills. The accuracy of resident self-reported confidence is poor and should therefore be used only to complement other means of competency assessment and medical knowledge acquisition.
Barilla-Labarca
Maria-Louise
ML
Division of Rheumatology and Allergy-Clinical Immunology, North Shore Long Island Jewish Health System, Lake Success, NY, USA. mbarilla@lij.edu
Tsang
James C
JC
Goldsmith
Melissa
M
Furie
Richard
R
D000305:Adrenal Cortex Hormones / Q000008:administration & dosage; D044963:Biopsy, Fine-Needle / Q000379:methods*; D002983:Clinical Competence; D003479:Curriculum; D004493:Education / Q000379:methods / Q000458:organization & administration*; D006801:Humans; D007270:Injections, Intra-Articular; D007388:Internal Medicine / Q000193:education*; D007396:Internship and Residency; D016730:Program Development; D011795:Surveys and Questionnaires
D000305:Adrenal Cortex Hormones