title: A blended approach to invasive bedside procedural instruction.
abstract: OBJECTIVE
  This study assessed the impact of a blended, standardized curriculum for invasive bedside procedural training on medical knowledge and technical skills for Internal Medicine residents.
  
  
  METHODS
  The investigators developed a curriculum in procedural instruction and performance for Internal Medicine house staff, and implemented the program at a tertiary care academic medical center with a primary affiliation with a US medical school. The investigators chose procedures recommended for technical competence by the American Board of Internal Medicine: lumbar puncture, thoracentesis, paracentesis, central venous catheter insertion, and knee arthrocentesis. The program included: (1) assessment of baseline medical knowledge and technical proficiency on mannequins, (2) video instruction of procedure, (3) faculty-led discussion of critical concepts, (4) faculty demonstration of the procedure on mannequin, (5) individual practice on simulators, (6) post-intervention knowledge evaluation, and (7) post-intervention skills evaluation. The performance achieved during the initial skills evaluation on a mannequin was compared to the performance achieved on the first patient subsequent to the instructional portion.
  
  
  RESULTS
  All participants with complete data demonstrated a statistically significant pre-intervention to post-intervention improvement (p < 0.05) in comprehensive medical knowledge and procedural skills.
  
  
  CONCLUSIONS
  A blended, standardized curriculum in invasive bedside procedural instruction can significantly improve performance in participants' medical knowledge and technical skills.
authors.affiliation: University of Miami – Jackson Hospital Center for Patient Safety, 1611 NW 12 Avenue, Institute building, 4th floor, Miami, FL 33136, USA. jlenchus@med.miami.edu
authors.forename: Joshua
authors.initials: J
authors.lastname: Lenchus
authors.forename: S Barry
authors.initials: SB
authors.lastname: Issenberg
authors.forename: Daniel
authors.initials: D
authors.lastname: Murphy
authors.forename: Ruth
authors.initials: R
authors.lastname: Everett-Thomas
authors.forename: Laura
authors.initials: L
authors.lastname: Erben
authors.forename: Kristopher
authors.initials: K
authors.lastname: Arheart
authors.forename: David J
authors.initials: DJ
authors.lastname: Birnbach
mesh_terms: D000046:Academic Medical Centers / Q000379:methods*; D000328:Adult; D002405:Catheterization, Central Venous / Q000379:methods; D002983:Clinical Competence; D002985:Clinical Protocols; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007396:Internship and Residency / Q000379:methods*; D008297:Male; D019152:Paracentesis / Q000193:education / Q000379:methods; D019095:Point-of-Care Systems; D011677:Punctures / Q000379:methods*; D013129:Spinal Puncture / Q000379:methods