Transforming invasive bedside procedural instruction

Abstract

Context and setting Because there is a lack of standardised methodology to teach invasive bedside procedures, the incidence of associated complications remains unacceptably high and variations in teaching may be a contributing factor. Successful interventions are needed to change these poor outcomes and improve patient safety. Therefore, the University of Miami-Jackson Memorial Hospital Center for Patient Safety (CPS) launched an innovative educational initiative. Specifically designed to fill the training gap, the programme provides a standardised curriculum for procedural instruction. Why the idea was necessary At academic medical centres throughout the USA, residents perform the majority of invasive bedside procedures. By contrast with the apparent flaws in the outdated and frequently unsafe ‘see one, do one, teach one’ model of training, standardised procedural training targets hands-on learning and direct observation as the keystones for building confidence and competence. What was done To capitalise on this educational opportunity, a uniform teaching method was created incorporating the six Accreditation Council for Graduate Medical Education core competencies: patient care; medical knowledge; practice-based learning and improvement; interpersonal and communication skills; professionalism, and systems-based practice. We developed a simulation-based curriculum for those procedures recently listed by the American Board of Internal Medicine as necessitating technical competence (central venous catheter insertion, lumbar puncture, paracentesis, thoracentesis), tailored for residents who will be asked to deliver these critical aspects of patient care. Our initiative combines the established, efficacious use of simulators, practice with ultrasound and the utility of checklists in ensuring patient-safe practices. To date, we have trained anaesthesiology, emergency medicine, internal medicine, neurology and surgery residents and medical students. The four pillars of the procedural training include: