title: Assistant instructors facilitate simulation for medical students.
abstract: BACKGROUND
  A procedural training protocol for medical students must be cognizant of faculty opportunity costs, which may preclude individually supervised practice. Meanwhile, sporadic exposure in large group settings yields suboptimal proficiency. The purpose of this study is to assess the effectiveness of undergraduate assistant instructors in providing one-on-one simulation-based instruction for basic invasive techniques.
  
  
  METHODS
  Investigators designed proficiency-based checklists by faculty consensus for three simulation tasks as follows: orotracheal intubation, central venous catheterization, and suturing. Four undergraduate students were trained as instructors. Interrater agreement between instructors using the task checklists ranged from 0.754-0.866. Instructors conducted up to seven flexibly scheduled, one-on-one practice sessions with clinically inexperienced medical student participants. Sessions comprised repetitive task attempts with an evaluation after every attempt. On completion of the training protocol, participants underwent evaluation by an experienced surgeon blinded to practice session performance. Study participants were surveyed to assess satisfaction.
  
  
  RESULTS
  Twenty-nine participants completed the study. Median total practice time was 8.75 h (interquartile range 7.12-8.75). Posttest pass rates were 93% (26/28), 71% (20/28), and 68% (19/28) for suturing, intubation, and central venous catheterization, respectively. Ninety-seven percent (27/28) of participants were satisfied with their experience, and 62% (18/29) advocated for protocol adoption into the standard preclinical curriculum. Estimated cost saved using student instructors, based on departmental collections for surgical faculty, was $43,760.
  
  
  CONCLUSIONS
  Clinically inexperienced assistants may be trained as instructors for basic simulation tasks with excellent interrater reliability. Deploying these assistant instructors makes effective, one-on-one technical training for preclinical medical students financially feasible.
authors.affiliation: Department of Surgery, University of Virginia School of Medicine, Charlottesville, Virginia.
authors.forename: Yinin
authors.initials: Y
authors.lastname: Hu
authors.affiliation: Department of Surgery, University of Virginia School of Medicine, Charlottesville, Virginia.
authors.forename: Joanna
authors.initials: J
authors.lastname: Choi
authors.affiliation: Department of Surgery, University of Virginia School of Medicine, Charlottesville, Virginia.
authors.forename: Adela
authors.initials: A
authors.lastname: Mahmutovic
authors.affiliation: Department of Surgery, University of Virginia School of Medicine, Charlottesville, Virginia.
authors.forename: Helen
authors.initials: H
authors.lastname: Kim
authors.affiliation: Department of Surgery, University of Virginia School of Medicine, Charlottesville, Virginia.
authors.forename: Ivy A
authors.initials: IA
authors.lastname: Le
authors.affiliation: Department of Surgery, University of Virginia School of Medicine, Charlottesville, Virginia. Electronic address: skr3f@virginia.edu.
authors.forename: Sara K
authors.initials: SK
authors.lastname: Rasmussen
mesh_terms: D002405:Catheterization, Central Venous; D002983:Clinical Competence; D004504:Education, Medical, Undergraduate / Q000379:methods*; D005260:Female; D006801:Humans; D007442:Intubation, Intratracheal; D008297:Male; D013536:Suture Techniques / Q000193:education; D013663:Teaching / Q000379:methods*; D055815:Young Adult
keywords: Medical; Simulation; Student; Surgical education