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June 6, 2012

Simulation-based education with mastery learning improves residents' lumbar puncture skills

July 10, 2012 issue
79 (2) 132-137

Abstract

Objective:

To evaluate the effect of simulation-based mastery learning (SBML) on internal medicine residents' lumbar puncture (LP) skills, assess neurology residents' acquired LP skills from traditional clinical education, and compare the results of SBML to traditional clinical education.

Methods:

This study was a pretest-posttest design with a comparison group. Fifty-eight postgraduate year (PGY) 1 internal medicine residents received an SBML intervention in LP. Residents completed a baseline skill assessment (pretest) using a 21-item LP checklist. After a 3-hour session featuring deliberate practice and feedback, residents completed a posttest and were expected to meet or exceed a minimum passing score (MPS) set by an expert panel. Simulator-trained residents' pretest and posttest scores were compared to assess the impact of the intervention. Thirty-six PGY2, 3, and 4 neurology residents from 3 medical centers completed the same simulated LP assessment without SBML. SBML posttest scores were compared to neurology residents' baseline scores.

Results:

PGY1 internal medicine residents improved from a mean of 46.3% to 95.7% after SBML (p < 0.001) and all met the MPS at final posttest. The performance of traditionally trained neurology residents was significantly lower than simulator-trained residents (mean 65.4%, p < 0.001) and only 6% met the MPS.

Conclusions:

Residents who completed SBML showed significant improvement in LP procedural skills. Few neurology residents were competent to perform a simulated LP despite clinical experience with the procedure.

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Supplementary Material

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Information & Authors

Information

Published In

Neurology®
Volume 79Number 2July 10, 2012
Pages: 132-137
PubMed: 22675080

Publication History

Received: September 13, 2011
Accepted: November 17, 2011
Published online: June 6, 2012
Published in print: July 10, 2012

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Disclosure

The authors report no disclosures relevant to the manuscript. Go to Neurology.org for full disclosures.

Authors

Affiliations & Disclosures

Jeffrey H. Barsuk, MD, MS
From the Department of Medicine (J.H.B., E.R.C., T.C., D.B.W.), Center for Education in Medicine (W.C.M.), and Department of Neurology (T.S.), Northwestern University Feinberg School of Medicine, Chicago, IL.
Disclosure
Scientific Advisory Boards:
1.
NONE
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
NONE
Editorial Boards:
1.
Journal of Hospital Medicine, Associate Editor, 2009 to present
Patents:
1.
NONE
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
NONE
Speakers’ Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
NONE
Research Support, Government Entities:
1.
NONE
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
NONE
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
Stock/stock Options, Medical Equipment & Materials:
1.
NONE
Legal Proceedings:
1.
Witness, 2007 to present. Medical Malpractice only.
Elaine R. Cohen, MEd
From the Department of Medicine (J.H.B., E.R.C., T.C., D.B.W.), Center for Education in Medicine (W.C.M.), and Department of Neurology (T.S.), Northwestern University Feinberg School of Medicine, Chicago, IL.
Disclosure
Scientific Advisory Boards:
1.
NONE
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
NONE
Editorial Boards:
1.
NONE
Patents:
1.
NONE
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
NONE
Speakers’ Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
NONE
Research Support, Government Entities:
1.
NONE
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
NONE
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
Stock/stock Options, Medical Equipment & Materials:
1.
NONE
Legal Proceedings:
1.
NONE
Timothy Caprio, MD
From the Department of Medicine (J.H.B., E.R.C., T.C., D.B.W.), Center for Education in Medicine (W.C.M.), and Department of Neurology (T.S.), Northwestern University Feinberg School of Medicine, Chicago, IL.
Disclosure
Scientific Advisory Boards:
1.
NONE
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
NONE
Editorial Boards:
1.
NONE
Patents:
1.
NONE
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
NONE
Speakers’ Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
NONE
Research Support, Government Entities:
1.
NONE
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
NONE
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
Stock/stock Options, Medical Equipment & Materials:
1.
NONE
Legal Proceedings:
1.
NONE
William C. McGaghie, PhD
From the Department of Medicine (J.H.B., E.R.C., T.C., D.B.W.), Center for Education in Medicine (W.C.M.), and Department of Neurology (T.S.), Northwestern University Feinberg School of Medicine, Chicago, IL.
Disclosure
Scientific Advisory Boards:
1.
NONE
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
NONE
Editorial Boards:
1.
1. Advances in Health Sciences Education, Assoc. Editor, 2008-2011 2. Teaching and Learning in Medicine, Assoc. Editor, 1998- 2011 3. Medical Teacher, Assoc. Editor, 2000-2011
Patents:
1.
NONE
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
NONE
Speakers’ Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
NONE
Research Support, Government Entities:
1.
National Center for Research Resources, National Institutes of Health. UL 1 RR 025741 Project Evaluator 3 years
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
NONE
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
Stock/stock Options, Medical Equipment & Materials:
1.
NONE
Legal Proceedings:
1.
NONE
Tanya Simuni, MD
From the Department of Medicine (J.H.B., E.R.C., T.C., D.B.W.), Center for Education in Medicine (W.C.M.), and Department of Neurology (T.S.), Northwestern University Feinberg School of Medicine, Chicago, IL.
Disclosure
Scientific Advisory Boards:
1.
Dr Simuni has contributed to advisory boards for GE Healthcare, Teva, Novartis, BI, UCB, IMPAX, Mertz
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
Dr Simuni has contributed to speakers’ bureaus for Boehringer-Ingelheim, Ibsen, Novartis, GE and Teva, and received honoraria from the Parkinson’s Disease Foundation, MJFF and National Parkinson Foundation.
Editorial Boards:
1.
NONE
Patents:
1.
NONE
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
Dr Simuni has consulted for GE Healthcare, Teva, Novartis, BI and UCB, Metz, Allergan Speakers’ Bureaus: Dr Simuni has been on a speaker bureau for Teva, Novartis, BI, Ibsen, GE
Speakers’ Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
Received research funding from TEVA, IMPAX, Serono, SYN, Metz,
Research Support, Government Entities:
1.
Received research funding from NINDS
Research Support, Academic Entities:
1.
Received research funding from MJFF and Northwestern Dixon Foundation
Research Support, Foundations and Societies:
1.
Received research funding from MJFF and Northwestern Dixon Foundation
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
Stock/stock Options, Medical Equipment & Materials:
1.
NONE
Legal Proceedings:
1.
NONE
Diane B. Wayne, MD
From the Department of Medicine (J.H.B., E.R.C., T.C., D.B.W.), Center for Education in Medicine (W.C.M.), and Department of Neurology (T.S.), Northwestern University Feinberg School of Medicine, Chicago, IL.
Disclosure
Scientific Advisory Boards:
1.
NONE
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
NONE
Editorial Boards:
1.
Journal of General Internal Medicine, 2006-present, Deputy Editor
Patents:
1.
NONE
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
NONE
Speakers’ Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
NONE
Research Support, Government Entities:
1.
NONE
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
NONE
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
Stock/stock Options, Medical Equipment & Materials:
1.
NONE
Legal Proceedings:
1.
NONE

Notes

Study funding: The research was funded through the Excellence in Academic Medicine Act by the Illinois Department of Healthcare and Family Services. Dr. McGaghie's contribution was supported in part by the Jacob R. Suker, MD, professorship in medical education and by grant UL 1 RR 025741 from the National Center for Research Resources, NIH. The NIH had no role in the preparation, review, or approval of the manuscript.
Correspondence & reprint requests to Dr. Barsuk: [email protected]

Author Contributions

J. Barsuk was involved in study concept and design, collecting data, statistical analysis and interpretation of data, study supervision, and drafting and revising the manuscript. E. Cohen was involved in study concept and design, collecting data, statistical analysis and interpretation of data, study supervision, and drafting and revising the manuscript. T. Caprio was involved in collecting and interpreting study data, and revising the manuscript. W. McGaghie was involved in study concept and design, statistical analysis and interpretation of data, study supervision, and revising the manuscript. T. Simuni was involved in study concept and design, interpretation of data, and revising the manuscript. D. Wayne was involved in study concept and design, statistical analysis and interpretation of data, study supervision, obtaining funding, and revising the manuscript.

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