Department of Emergency Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
Med Educ Online. 2024 Dec 31;29(1):2412399. doi: 10.1080/10872981.2024.2412399. Epub 2024 Oct 7.
The transition from medical student to intern is a recognized educational gap. To help address this, the Association of American Medical Colleges developed the Core Entrustable Professional Activities for entering residency. As these metrics outline expectations for all graduating students regardless of specialty, the described procedural expectations are appropriately basic. However, in procedure-heavy specialties such as emergency medicine, the ability to perform advanced procedures continues to contribute to the disconnect between undergraduate and graduate medical education. To prepare our graduating students for their internship in emergency medicine, we developed a simulation-based mastery learning curriculum housed within a specialty-specific program. Our overall goal was to develop the students' procedural competency for central venous catheter placement and endotracheal intubation before graduation from medical school.
Twenty-five students participated in a simulation-based mastery learning procedures curriculum for ultrasound-guided internal jugular central venous catheter placement and endotracheal intubation. Students underwent baseline assessment, deliberate practice, and post-test assessments. Both the baseline and post-test assessments used the same internally developed checklists with pre-established minimum passing scores.
Despite completing an emergency medicine rotation and a critical care rotation, none of the students met the competency standard during their baseline assessments. All twenty-five students demonstrated competency on both procedures by the end of the curriculum. A second post-test was required to demonstrate achievement of the central venous catheter and endotracheal intubation minimum passing scores by 16% and 28% of students, respectively.
Students demonstrated procedural competency for central venous catheter placement and endotracheal intubation by engaging in simulation-based mastery learning procedures curriculum as they completed their medical school training. With three instructional hours, students were able to achieve basic procedural competence for two common, high-risk procedures they will need to perform during emergency medicine residency training.
从医学生到实习医生的转变是一个公认的教育空白。为了帮助解决这个问题，美国医学院协会制定了核心可信赖专业活动，以进入住院医师实习期。由于这些指标概述了所有毕业学生的期望，无论专业如何，因此描述的程序期望都是适当的基础。然而，在程序繁重的专业，如急诊医学，执行高级程序的能力仍然导致本科和研究生医学教育之间存在脱节。为了让我们的毕业学生为急诊医学实习做好准备，我们开发了一个基于模拟的掌握学习课程，该课程包含在一个特定专业的项目中。我们的总体目标是在医学生毕业前培养学生进行超声引导下颈内静脉中央导管置管和气管插管的程序能力。
25 名学生参加了一个基于模拟的掌握学习超声引导下颈内静脉中央导管置管和气管插管程序课程。学生接受了基线评估、刻意练习和测试后评估。基线和测试后评估都使用了相同的内部开发检查表，具有预先设定的最低通过分数。
尽管完成了急诊医学轮转和重症监护轮转，但在基线评估中，没有一个学生达到了能力标准。在课程结束时，所有 25 名学生都在这两个程序上表现出了能力。需要进行第二次测试，才能分别使 16%和 28%的学生达到中央静脉导管和气管插管的最低通过分数标准。
学生通过完成医学院培训的基于模拟的掌握学习程序课程，表现出了中央静脉导管置管和气管插管的程序能力。通过三个教学小时，学生能够掌握两项常见的高风险程序的基本程序能力，这些程序是他们在急诊医学住院医师培训期间需要执行的。
