Unexpected collateral effects of simulation-based medical education.
OBJECTIVE
Internal medicine residents who complete simulation-based education (SBE) in central venous catheter (CVC) insertion acquire improved skills that yield better patient care outcomes. The collateral effects of SBE on the skills of residents who have not yet experienced SBE are unknown.


METHODS
In this retrospective, observational study, the authors used a checklist to test the internal jugular and subclavian CVC insertion skills of 102 Northwestern University second- and third-year internal medicine residents before they received simulation training. The authors compared, across consecutive academic years (2007-2008, 2008-2009, 2009-2010), mean pretraining scores and the percent of trainees who met or surpassed a minimum passing score (MPS).


RESULTS
Mean internal jugular pretest scores improved from 46.7% (standard deviation = 20.8%) in 2007 to 55.7% (±22.5%) in 2008 and 70.8% (±22.4%) in 2009 (P < .001). Mean subclavian pretest scores changed from 48.3% (±25.5%) in 2007 to 45.6% (±31.0%) in 2008 and 63.6% (±27.3%) in 2009 (P = .04). The percentage of residents who met or surpassed the MPS before training for internal jugular insertion was 7% in 2007, 16% in 2008, and 38% in 2009 (P = .004); for subclavian insertion, the percentage was 11% in 2007, 19% in 2008, and 38% in 2009 (P = .028).


CONCLUSIONS
SBE for senior residents had an effect on junior trainees, as evidenced by pretraining CVC insertion skill improvement across three consecutive years. SBE for a targeted group of residents has implications for skill acquisition among other trainees.
Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA. jbarsuk@nmh.org
Jeffrey H
JH
Barsuk
Elaine R
ER
Cohen
Joe
J
Feinglass
William C
WC
McGaghie
Diane B
DB
Wayne
D000328:Adult; D000704:Analysis of Variance; D002405:Catheterization, Central Venous; D002983:Clinical Competence; D015331:Cohort Studies; D003162:Competency-Based Education / Q000379:methods*; D003198:Computer Simulation; D004503:Education, Medical, Graduate / Q000379:methods*; D005260:Female; D006784:Hospitals, Teaching; D006801:Humans; D007388:Internal Medicine / Q000193:education; D007396:Internship and Residency / Q000379:methods; D059032:Learning Curve; D016014:Linear Models; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D012189:Retrospective Studies; D013647:Task Performance and Analysis; D013997:Time Factors; D014481:United States