Adriana G Ramirez1, Yinin Hu1, Helen Kim2, Sara K Rasmussen3. 1. Department of Surgery, University of Virginia, Charlottesville, Virginia. 2. Department of Surgery, University of Virginia, Charlottesville, Virginia; Eastern Virginia Medical School, Norfolk, Virginia. 3. Department of Surgery, University of Virginia, Charlottesville, Virginia. Electronic address: skr3f@virginia.edu.
Abstract
OBJECTIVE: Cumulative sum (CuSum) is a real-time proficiency-monitoring tool adapted for simulation-based training. This study's objective was to investigate long-term outcomes of a double blinded, randomized control trial conducted with medical students assessingCuSum-guided curriculum against volume-based standards. The trial found a nearly 20% reduction in practice time to reach proficiency using the CuSum curriculum but long-term effects of decreased practice volume on proficiency is unknown. DESIGN: Prior participants completed a survey assessing confidence, exposure, and feedback at 12 to 18 months following trial completion. They underwent retention testing of suturing, intubation, and central venous catheter placement (CVC), which was video-recorded and assessed by an expert evaluator. Baseline characteristics among repeat subjects were compared using chi-squared tests. Retention and initial trial outcome were compared using paired parametric statistical methods. SETTING: The study was conducted at a major tertiary care center and training hospital. PARTICIPANTS: Medical students, which completed the initial randomized control trial were eligible for enrollment. A total of 30/46(65%) responded to the survey, whereas 33/46(72%) completed retention testing. RESULTS:Average scores and decay in procedural tasks over time for suturing, intubation and CVC were 91.6% (-4.7%), 86.1% (-4.1%), and 76.2% (-14.8%), respectively. Compared to the control group, the CuSum group mean difference in retention evaluation scores was -5.6% (p = 0.12). Confidence was not associated with initial or retention testing performance in any procedural task. Higher confidence was associated with additional exposure to the procedural task in suturing and intubation (p = 0.03 and p = 0.02, respectively). For intubation, higher confidence was reported by participants who received positive feedback (p = 0.01), and those assigned to the volume-based training arm (p = 0.03). CONCLUSION:CuSum-guided training was equivalent to conventional training for suturing, intubation, and CVC. These findings importantly suggest medical students can retain competency in invasive surgical tasks with modest decay in proficiency over time regardless of initial training method.
RCT Entities:
OBJECTIVE: Cumulative sum (CuSum) is a real-time proficiency-monitoring tool adapted for simulation-based training. This study's objective was to investigate long-term outcomes of a double blinded, randomized control trial conducted with medical students assessing CuSum-guided curriculum against volume-based standards. The trial found a nearly 20% reduction in practice time to reach proficiency using the CuSum curriculum but long-term effects of decreased practice volume on proficiency is unknown. DESIGN: Prior participants completed a survey assessing confidence, exposure, and feedback at 12 to 18 months following trial completion. They underwent retention testing of suturing, intubation, and central venous catheter placement (CVC), which was video-recorded and assessed by an expert evaluator. Baseline characteristics among repeat subjects were compared using chi-squared tests. Retention and initial trial outcome were compared using paired parametric statistical methods. SETTING: The study was conducted at a major tertiary care center and training hospital. PARTICIPANTS: Medical students, which completed the initial randomized control trial were eligible for enrollment. A total of 30/46(65%) responded to the survey, whereas 33/46(72%) completed retention testing. RESULTS: Average scores and decay in procedural tasks over time for suturing, intubation and CVC were 91.6% (-4.7%), 86.1% (-4.1%), and 76.2% (-14.8%), respectively. Compared to the control group, the CuSum group mean difference in retention evaluation scores was -5.6% (p = 0.12). Confidence was not associated with initial or retention testing performance in any procedural task. Higher confidence was associated with additional exposure to the procedural task in suturing and intubation (p = 0.03 and p = 0.02, respectively). For intubation, higher confidence was reported by participants who received positive feedback (p = 0.01), and those assigned to the volume-based training arm (p = 0.03). CONCLUSION:CuSum-guided training was equivalent to conventional training for suturing, intubation, and CVC. These findings importantly suggest medical students can retain competency in invasive surgical tasks with modest decay in proficiency over time regardless of initial training method.
Authors: Samer G Mattar; Adnan A Alseidi; Daniel B Jones; D Rohan Jeyarajah; Lee L Swanstrom; Ralph W Aye; Steven D Wexner; José M Martinez; Sharona B Ross; Michael M Awad; Morris E Franklin; Maurice E Arregui; Bruce D Schirmer; Rebecca M Minter Journal: Ann Surg Date: 2013-09 Impact factor: 12.969
Authors: Yinin Hu; Varun Puri; Traves D Crabtree; Daniel Kreisel; Alexander S Krupnick; Alexander G Patterson; Bryan F Meyers Journal: J Thorac Cardiovasc Surg Date: 2013-09-24 Impact factor: 5.209
Authors: Najma Ahmed; Katharine S Devitt; Itay Keshet; Jonathan Spicer; Kevin Imrie; Liane Feldman; Jonathan Cools-Lartigue; Ahmed Kayssi; Nir Lipsman; Maryam Elmi; Abhaya V Kulkarni; Chris Parshuram; Todd Mainprize; Richard J Warren; Paola Fata; M Sean Gorman; Stan Feinberg; James Rutka Journal: Ann Surg Date: 2014-06 Impact factor: 12.969