The effect of simulation-based mastery learning on thoracentesis referral patterns.
Internal medicine (IM) residents and hospitalist physicians commonly perform thoracenteses. National data show that thoracenteses are also frequently referred to other services such as interventional radiology (IR), increasing healthcare costs. Simulation-based mastery learning (SBML) is an effective method to boost physicians' procedural skills and self-confidence. This study aimed to (1) assess the effect of SBML on IM residents' simulated thoracentesis skills and (2) compare thoracentesis referral patterns, self-confidence, and reasons for referral between traditionally trained residents (non-SBML-trained), SBML-trained residents, and hospitalist physicians. A random sample of 112 IM residents at an academic medical center completed thoracentesis SBML from December 2012 to May 2015. We surveyed physicians caring for hospitalized patients with thoracenteses during the same time period and compared referral patterns, self-confidence, and reasons for referral. SBML-trained resident thoracentesis skills improved from a median of 57.6% (interquartile range [IQR] 43.3-76.9) at pretest to 96.2% (IQR 96.2-100.0) at post-test (P < 0.001). Surveys demonstrated that traditionally trained residents were more likely to refer to IR and cited lower confidence as reasons. SBML-trained residents were more likely to perform bedside thoracenteses. Hospitalist physicians were most likely to refer to pulmonary medicine and cited lack of time to perform the procedure as the main reason. SBML-trained residents were most confident about their thoracentesis skills, despite hospitalist physicians having more experience. This study identifies confidence and time as reasons physicians refer thoracenteses rather than perform them at the bedside. Thoracentesis SBML boosts skills and promotes bedside procedures that are safe and less expensive than referrals. Journal of Hospital Medicine 2016;11:792-795. © 2016 Society of Hospital Medicine.
Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois. jbarsuk@nm.org.|Department of Medical Education, Northwestern University Feinberg School of Medicine, Chicago, Illinois. jbarsuk@nm.org.
Jeffrey H
JH
Barsuk
Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
Elaine R
ER
Cohen
Department of Medicine, University of Kentucky School of Medicine, Lexington, Kentucky.
Mark V
MV
Williams
Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
Jordan
J
Scher
Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
Joe
J
Feinglass
Department of Medical Education, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
William C
WC
McGaghie
Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
Kelly
K
O'Hara
Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois.|Department of Medical Education, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
Diane B
DB
Wayne
D002983:Clinical Competence; D020445:Hospitalists / Q000193:education; D006801:Humans; D007388:Internal Medicine / Q000193:education; D007396:Internship and Residency; D012017:Referral and Consultation; D000066908:Simulation Training; D000069258:Thoracentesis / Q000379:methods*