Evidence map›Paper›PMID 34400443›Full record

ArticleBMJ open2021

Cohort study of hospitalists' procedural skills: baseline competence and durability after simulation-based training.

Caleb Hale, Jonathan Crocker, Anita Vanka, Daniel N Ricotta, Jakob I McSparron, Grace C Huang

Open access · goldAbstract read
In one paragraph

Article in BMJ open, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers.

0numbers the graph read from it
0cells of the map it votes in
4citing papers in PubMed
1.1field-weighted citation impact, top 24% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

4 citing papers in PubMed, 12 citations in OpenAlex.

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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

6 authors at 2 institutions in 1 country.

Caleb Hale *Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.
Jonathan Crocker *Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.
Anita VankaDepartment of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.
Daniel N RicottaDepartment of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.
Jakob I McSparronDepartment of Medicine, University of Michigan Health System, Ann Arbor, Michigan, USA.
Grace C HuangDepartment of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA ghuang@bidmc.harvard.edu.ORCID 0000-0003-2965-0341
Beth Israel Deaconess Medical Center · USUniversity of Michigan · US

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

objectivesHospitalists are expected to be competent in performing bedside procedures, which are associated with significant morbidity and mortality. A national decline in procedures performed by hospitalists has prompted questions about their procedural competency. Additionally, though simulation-based mastery learning (SBML) has been shown to be effective among trainees whether this approach has enduring benefits for independent practitioners who already have experience is unknown. We aimed to assess the baseline procedural skill of hospitalists already credentialed to perform procedures. We hypothesised that simulation-based training of hospitalists would result in durable skill gains after several months.

designProspective cohort study with pretraining and post-training measurements.

settingSingle, large, urban academic medical centre in the USA.

participantsTwenty-two out of 38 eligible participants defined as hospitalists working on teaching services where they would supervise trainees performing procedures.

interventionsOne-on-one, 60 min SBML of lumbar puncture (LP) and abdominal paracentesis (AP). PRIMARY AND SECONDARY OUTCOME MEASURES: Our primary outcome was the percentage of hospitalists obtaining minimum passing scores (MPS) on LP and AP checklists; our secondary outcomes were average checklist scores and self-reported confidence.

resultsAt baseline, only 16% hospitalists met or exceeded the MPS for LP and 32% for AP. Immediately after SBML, 100% of hospitalists reached this threshold. Reassessment an average of 7 months later revealed that only 40% of hospitalists achieved the MPS. Confidence increased initially after training but declined over time.

conclusionsHospitalists may be performing invasive bedside procedures without demonstration of adequate skill. A single evidence-based training intervention was insufficient to sustain skills for the majority of hospitalists over a short period of time. More stringent practices for certifying hospitalists who perform risky procedures are warranted, as well as mechanisms to support skill maintenance, such as periodic simulation-based training and assessment.

Indexed as

HospitalistsSimulation TrainingClinical CompetenceCohort StudiesHumansProspective Studiesgeneral medicine (see Internal Medicine)health & safetymedical education & training

Identifiers

PMID34400443
PMCPMC8370503
OpenAlexW3195803194

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.