title: An innovative longitudinal curriculum to increase emergency medicine residents' exposure to rarely encountered and technically challenging procedures.
abstract: BACKGROUND
  Procedural skills have historically been taught at the bedside. In this study, we aimed to increase resident knowledge of uncommon emergency medical procedures to increase residents' procedural skills in common and uncommon emergency medical procedures and to integrate cognitive training with hands-on procedural instruction using high- and low-fidelity simulation.
  
  
  METHODS
  We developed 13 anatomically/physiologically-based procedure modules focusing on uncommon clinical procedures and/or those requiring higher levels of technical skills. A departmental expert directed each session with collaboration from colleagues in related subspecialties. Sessions were developed based on Manthey and Fitch's stages of procedural competency including 1) knowledge acquisition, 2) experience/technical skill development, and 3) competency evaluation. We then distributed a brief, 10-question, online survey to our residents in order to solicit feedback regarding their perceptions of increased knowledge and ability in uncommon and common emergency medical procedures, and their perception of the effectiveness of integrated cognitive training with hands-on instruction through high- and low-fidelity simulation.
  
  
  RESULTS
  Fifty percent of our residents (11/22) responded to our survey. Responses indicated the procedure series helped with understanding of both uncommon (65% strongly agreed [SA], 35% agreed [A]) and common (55% SA, 45% A) emergency medicine procedures and increased residents' ability to perform uncommon (55% SA, 45% A) and common (45% SA, 55% A) emergency medical procedures. In addition, survey results indicated that the residents were able to reach their goal numbers.
  
  
  CONCLUSIONS
  Based on survey results, the procedure series improved our residents' perceived understanding of and perceived ability to perform uncommon and more technically challenging procedures. Further, results suggest that the use of a cognitive curriculum model as developed by Manthey and Fitch is adaptable and could be modified to fit the needs of other medical specialties.
authors.affiliation: Department of Emergency Medicine, The College of Medicine, The University of Arizona, Tucson, AZ, USA.
authors.forename: Kristi H
authors.initials: KH
authors.lastname: Grall
authors.affiliation: Department of Emergency Medicine, The College of Medicine, The University of Arizona, Tucson, AZ, USA.
authors.forename: Lisa R
authors.initials: LR
authors.lastname: Stoneking
authors.affiliation: Department of Emergency Medicine, The College of Medicine, The University of Arizona, Tucson, AZ, USA.
authors.forename: Lawrence A
authors.initials: LA
authors.lastname: DeLuca
authors.affiliation: Department of Emergency Medicine, The College of Medicine, The University of Arizona, Tucson, AZ, USA.
authors.forename: Anna L
authors.initials: AL
authors.lastname: Waterbrook
authors.affiliation: Office Medical Student Education, The College of Medicine, The University of Arizona, Tucson, AZ, USA ; Office of Graduate Medical Education, The College of Medicine, The University of Arizona, Tucson, AZ, USA.
authors.forename: T Gail
authors.initials: TG
authors.lastname: Pritchard
authors.affiliation: Department of Emergency Medicine, The College of Medicine, The University of Arizona, Tucson, AZ, USA.
authors.forename: Kurt R
authors.initials: KR
authors.lastname: Denninghoff
keywords: emergency medical education; graduate medical education; high-fidelity simulation; procedural competency
references.citation: Simul Healthc. 2011 Aug;6 Suppl:S10-3
references.pmid: 21817857
references.citation: Clin Teach. 2012 Oct;9(5):317-9
references.pmid: 22994471
references.citation: Anesthesiology. 2003 Feb;98(2):349-53
references.pmid: 12552192
references.citation: Med Teach. 2005 Jan;27(1):10-28
references.pmid: 16147767
references.citation: Med Educ. 2009 Jul;43(7):661-8
references.pmid: 19573189
references.citation: Med Teach. 2003 Nov;25(6):664-6
references.pmid: 15369918
references.citation: Br J Anaesth. 2011 Oct;107(4):533-9
references.pmid: 21659406