Competency-based instruction in critical invasive skills improves both resident performance and patient safety. Discussion.
Annual Meeting of the Society of University Surgeons. Milwaukee, WI, USA, 1998/02/12.
Correct performance of invasive skills is essential, but residents often undertake such procedures after no or minimal instruction.
We instructed eight postgraduate year 1 (PGY1) residents in the cadaver laboratory using a competency-based approach (CBI).
Each resident had been evaluated before the laboratory during patient encounters.
Group instruction in endotracheal tube insertion (ET), venous cutdown (VC), and chest tube insertion (CT) was followed by individual pretesting and hands-on teaching, with 100% competency the goal.
Failure was considered an inability to perform the task correctly or within 120 seconds.
After the laboratory, residents were evaluated for correctness and rapidity of performance.
Prelaboratory failures consisted of ET, 7 ; CT, 5 ; VC, 7. Postlaboratory failures were 0 for all.
Prelaboratory complications consisted of ET, 3.3 ± 1.1 ; CT, 1.9 ± 1.0 ; VC, 3 ± 1.0. Postlaboratory complications were 0 for all.
Prelaboratory times (seconds) were ET, 66.5 ± 30.8 ; CT, 104 ± 4.1 ; VC, 116.3 ± 0.7. Postlaboratory times were ET, 25 ± 7 ; CT, 65.5 ± 10.7 ; VC, 81.3 ± 2.5. Changes were statistically significant for all (P<. 03, nonparametric).
Residents performed 20 CTs with 1 pneumothorax, 80 ETs with 2 failures, and 20 VCs with no complications.
Initial trauma resuscitation time decreased from 25 to 10 minutes. (...)
Mots-clés Pascal : Enseignement professionnel, Expérience professionnelle, Evaluation, Contrôle connaissance, Programme éducatif, Evaluation performance, Homme
Mots-clés Pascal anglais : Occupational education, Professional experience, Evaluation, Examination, Educational schedule, Performance evaluation, Human
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Cote : 98-0492061
Code Inist : 002B30A09. Création : 19/02/1999.