title: Hybrid simulation for knee arthrocentesis: improving fidelity in procedures training.
abstract: BACKGROUND
  Procedures form a core competency for internists, yet many do not master these skills during residency. Simulation can help fill this gap, but many curricula focus on technical skills, and overlook communication skills necessary to perform procedures proficiently. Hybrid simulation (HS) is a novel way to teach and assess procedural skills in an integrated, contextually-based way.
  
  
  OBJECTIVE
  To create a HS model for teaching arthrocentesis to internal medicine residents.
  
  
  METHODS
  Internal medicine residency program at the University of Toronto.
  
  
  METHODS
  Twenty four second-year internal medicine residents.
  
  
  METHODS
  Residents were introduced to HS, given practice time with feedback from standardized patients (SPs) and faculty, and assessed individually using a different scenario and SP. Physicians scored overall performance using a 6-point procedural skills measure, and both physicians and SPs scored communication using a 5-point communication skills measure.
  
  
  RESULTS
  Realism was highly rated by residents (4.13/5.00), SPs (4.00) and physicians (4.33), and was perceived to enhance learning. Residents' procedural skills were rated as 4.21/6.00 (3.00 - 5.00; ICC = 0.77, [0.53 - 0.92]), comparable to an experienced post-graduate year (PGY) 2-3; and all but one resident was considered competent.
  
  
  CONCLUSIONS
  HS facilitates simultaneous acquisition of technical and communication skills. Future research should examine whether HS improves transfer of skills to the clinical setting.
authors: Department of Medicine, University of Toronto, Toronto, Canada. lynfa.stroud@sunnybrook.ca
authors: Lynfa
authors: L
authors: Stroud
authors: Rodrigo B
authors: RB
authors: Cavalcanti
mesh_terms: D002983:Clinical Competence; D003142:Communication; D004503:Education, Medical, Graduate / Q000379:methods*; D004521:Educational Measurement / Q000379:methods; D006801:Humans; D007396:Internship and Residency; D007719:Knee Joint; D019152:Paracentesis / Q000193:education* / Q000592:standards; D016544:Patient Simulation; D010817:Physician-Patient Relations; D015397:Program Evaluation