title: First-year residents outperform third-year residents after simulation-based education in critical care medicine.
abstract: BACKGROUND
  Previous research shows that gaps exist in internal medicine residents' critical care knowledge and skills. The purpose of this study was to compare the bedside critical care competency of first-year residents who received a simulation-based educational intervention plus clinical training with third-year residents who received clinical training alone.
  
  
  METHODS
  During their first 3 months of residency, a group of first-year residents completed a simulation-based educational intervention. A group of traditionally trained third-year residents who did not receive simulation-based training served as a comparison group. Both groups were evaluated using a 20-item clinical skills assessment at the bedside of a patient receiving mechanical ventilation at the end of their medical intensive care unit rotation. Scores on the skills assessment were compared between groups.
  
  
  RESULTS
  Simulator-trained first-year residents (n = 40) scored significantly higher compared with traditionally trained third-year residents (n = 27) on the bedside assessment (91.3% [95% confidence interval, 88.2%-94.3%] vs. 80.9% [95% confidence interval, 76.8%-85.0%]; P < 0.001).
  
  
  CONCLUSIONS
  First-year residents who completed a simulation-based educational intervention demonstrated higher clinical competency compared with third-year residents who did not undergo simulation training. Critical care competency cannot be assumed after clinical intensive care unit rotations; simulation-based curricula can help ensure residents are proficient to care for critically ill patients.
authors.affiliation: Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA. bsinger007@fsm.northwestern.edu
authors.forename: Benjamin D
authors.initials: BD
authors.lastname: Singer
authors.forename: Thomas C
authors.initials: TC
authors.lastname: Corbridge
authors.forename: Clara J
authors.initials: CJ
authors.lastname: Schroedl
authors.forename: Jane E
authors.initials: JE
authors.lastname: Wilcox
authors.forename: Elaine R
authors.initials: ER
authors.lastname: Cohen
authors.forename: William C
authors.initials: WC
authors.lastname: McGaghie
authors.forename: Diane B
authors.initials: DB
authors.lastname: Wayne
mesh_terms: D002983:Clinical Competence; D003198:Computer Simulation; D003422:Critical Care; D006801:Humans; D007362:Intensive Care Units; D007396:Internship and Residency / Q000379:methods*; D012121:Respiration, Artificial / Q000379:methods