Ten Tips for Maximizing the Effectiveness of Emergency Medicine Procedure Laboratories
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Joshua D. Lenchus
To the Editor:
As medical director of Procedure Service at one of the nation’s largest academic medical centers, I was keenly interested to read the medical education article by Hughes et al1 in the June 2016 issue of The Journal of the American Osteopathic Association. The authors offered 10 tips to educators for designing an effective emergency medicine procedure laboratory, and they did a very good job in delineating some of the underpinnings of a successful simulation-based educational procedure experience. The program at the University of Miami-Jackson Memorial Hospital, previously described in this journal,2 subscribes to many of their tips.
With respect to employing instructors with formal training in adult learning concepts (tip 1), the University of Miami-Jackson Memorial Hospital uses a multifaceted approach that progresses gradually, from a show-and-tell demonstration of our program to faculty participation as a learner to mentoring (ie, faculty observe a teaching session led by a senior instructor) and proctoring (ie, faculty teach while being observed). Then they are prepared to directly supervise our team of residents as they perform clinically warranted procedures on patients. Even at this last stage, a senior instructor accompanies the team (ie, residents and a new instructor) into the clinical realm and is available as back-up.
Although I agree with most of the tips recommended by Hughes et al,1 I have some comments on others. In developing learning objectives that are well defined, specific, and measurable (tip 2), I would add the importance of identifying the role of the exercise. For example, in our program, we recognized the lack of uniformity in previous apprenticeship-based foundational training. By laying the foundation from the outset, students, house staff, and faculty alike benefit from a standardized training method. I disagree that providing learners with training materials before they arrive at procedure laboratories (tip 3) evens the playing field. In doing so, we would not be able to adequately obtain preintervention baseline data, which are necessary to demonstrate the effectiveness of the intervention.
Hughes et al1 recommend using mastery learning strategies (tip 6). Based on my experience, I disagree. In our paradigm, skills are perfected under direct attending supervision with pre-, peri-, and postprocedural feedback. This interaction occurs during learners’ performance on a dedicated procedure service rotation, the experiential piece that translates skill in the simulation laboratory to the clinical bedside. Because learners progress at different rates, some will never achieve technical proficiency. True competency includes, but is not defined by, skills performed on a mannequin. Rather, competency is determined by patient-based outcomes, such as procedural completion, complications, and “forward needle passes.”3
I applaud Hughes et al1 for their work and believe that their tips will serve the medical community well.
References
1. Hughes PG , CrespoM, MaierT, WhitmanA, AhmedR. Ten tips for maximizing the effectiveness of emergency medicine procedure laboratories.J Am Osteopath Assoc.2016;116(6):384-390. doi:10.7556/jaoa.2016.07910.7556/jaoa.2016.079Suche in Google Scholar PubMed
2. Lenchus JD . End of the “see one, do one, teach one” era: the next generation of invasive bedside procedural instruction.J Am Osteopath Assoc.2010;110(6):340-346.Suche in Google Scholar
3. Lenchus JD , CarvalhoCM, FerreriK, et al. Filling the void: defining invasive bedside procedural competency for internal medicine residents.J Grad Med Educ.2013;5(4):605-612. doi:10.4300/JGME-D-13-00030.110.4300/JGME-D-13-00030.1Suche in Google Scholar PubMed PubMed Central
© 2016 American Osteopathic Association
This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
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- Ten Tips for Maximizing the Effectiveness of Emergency Medicine Procedure Laboratories
- ORIGINAL CONTRIBUTION
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Artikel in diesem Heft
- LETTERS TO THE EDITOR
- Ten Tips for Maximizing the Effectiveness of Emergency Medicine Procedure Laboratories
- ORIGINAL CONTRIBUTION
- Assessment of Hospital Staff’s Knowledge of Osteopathic Manipulative Medicine: A Survey-Based Study
- Association Between WIC Enrollment and Exclusive Breastfeeding at 3 Months Postpartum Among Low-Income Mothers
- REVIEW
- Effectiveness of Shared Medical Appointments Targeting the Triple Aim Among Patients With Overweight, Obesity, or Diabetes
- CLINICAL REVIEW
- Are Low-Carbohydrate Diets Safe and Effective?
- MEDICAL EDUCATION
- Alternative Scheduling Models: Improving Continuity of Care, Medical Outcomes, and Graduate Medical Education in Resident Ambulatory Training
- SPECIAL COMMUNICATION
- Update on the Pharmacology and Legal Status of Kratom
- CASE REPORT
- Osteopathic Manipulative Treatment for Somatic Dysfunction After Acute Severe Traumatic Brain Injury
- CLINICAL IMAGES
- Bipartite Patella
