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An innovative longitudinal curriculum to increase emergency medicine residents’ exposure to rarely encountered and technically challenging procedures

Authors Grall K, Stoneking L, DeLuca L, Waterbrook A, Pritchard TG, Denninghoff K

Received 22 November 2013

Accepted for publication 17 January 2014

Published 17 July 2014 Volume 2014:5 Pages 229—236

DOI https://doi.org/10.2147/AMEP.S58073

Checked for plagiarism Yes

Review by Single-blind

Peer reviewer comments 3


Kristi H Grall,1 Lisa R Stoneking,1 Lawrence A DeLuca,1 Anna L Waterbrook,1 T Gail Pritchard,2,3 Kurt R Denninghoff1

1Department of Emergency Medicine, The College of Medicine, The University of Arizona, 2Office Medical Student Education, 3Office of Graduate Medical Education, The College of Medicine, The University of Arizona, Tucson, AZ, USA

Background: Procedural skills have historically been taught at the bedside. In this study, we aimed to increase resident knowledge of uncommon emergency medical procedures to increase residents’ procedural skills in common and uncommon emergency medical procedures and to integrate cognitive training with hands-on procedural instruction using high- and low-fidelity simulation.
Methods: We developed 13 anatomically/physiologically-based procedure modules focusing on uncommon clinical procedures and/or those requiring higher levels of technical skills. A departmental expert directed each session with collaboration from colleagues in related subspecialties. Sessions were developed based on Manthey and Fitch’s stages of procedural competency including 1) knowledge acquisition, 2) experience/technical skill development, and 3) competency evaluation. We then distributed a brief, 10-question, online survey to our residents in order to solicit feedback regarding their perceptions of increased knowledge and ability in uncommon and common emergency medical procedures, and their perception of the effectiveness of integrated cognitive training with hands-on instruction through high- and low-fidelity simulation.
Results: Fifty percent of our residents (11/22) responded to our survey. Responses indicated the procedure series helped with understanding of both uncommon (65% strongly agreed [SA], 35% agreed [A]) and common (55% SA, 45% A) emergency medicine procedures and increased residents’ ability to perform uncommon (55% SA, 45% A) and common (45% SA, 55% A) emergency medical procedures. In addition, survey results indicated that the residents were able to reach their goal numbers.
Conclusion: Based on survey results, the procedure series improved our residents’ perceived understanding of and perceived ability to perform uncommon and more technically challenging procedures. Further, results suggest that the use of a cognitive curriculum model as developed by Manthey and Fitch is adaptable and could be modified to fit the needs of other medical specialties.

Keywords: graduate medical education, emergency medical education, procedural competency, high-fidelity simulation

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