Hybrid simulation for knee arthrocentesis: improving fidelity in procedures training.

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. AIM: To create a HS model for teaching arthrocentesis to internal medicine residents.
SETTING: Internal medicine residency program at the University of Toronto. PARTICIPANTS: Twenty four second-year internal medicine residents. PROGRAM DESCRIPTION: 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. PROGRAM EVALUATION: 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. DISCUSSION: HS facilitates simultaneous acquisition of technical and communication skills. Future research should examine whether HS improves transfer of skills to the clinical setting.