Background: Many emergency medicine procedures are rarely performed in clinical practice by faculty members. Simulation provides a safe and effective method to increase exposure to these treatments, theoretically improving provider confidence and technical ability, but is often not utilized by faculty.
Objective: Does emergency department faculty completion of a 2-hour rare procedure lab improve self-rated confidence in the ability to perform and teach the procedures safely and effectively?
Methods: This was a prospective, observational cohort study using a pre- and post-survey methodology for emergency department faculty physicians of an urban, Level One trauma center. The 16-item visual analog scale (VAS; 100mm) questionnaire asked participants to describe their ability to efficiently and safely perform and teach 4 different rare procedures (thoracotomy, lateral canthotomy, retrograde intubation, and ultrasound guided IJ placement). Following the pre-survey, participants completed standardized learning modules followed by simulated hands on rare procedural experience. Post-training surveys with the same 16-items were completed. Descriptive statistics were used to describe participant experience with each procedure prior to the education sessions. Wilcoxon signed rank test was used to compare pre- and post-survey results.
Results: 20 staff physicans participated in the procedure lab. Physicians reported the most experience with ultrasound guided IJ placement and the least experience with lateral canthotomy. Post-survey scores were significantly higher for self-reported confidence in their ability to efficiently and safely perform and teach each of the 4 procedures (p < 0.05 for all comparisons). The average change in VAS score from pre to post survey was largest for lateral canthotomy (efficiency = 38.6±27.6; safely = 35.4±29.6; teach = 46.8±28.8) and smallest for the rescue airway module (efficiency = 11.7±20.3; safely = 11.3±19.7; teach = 12.8±18.7). Previous experience with the procedure did not impact pre- and post-survey score improvement.
Conclusions: Providers reported improved confidence in their ability to efficiently and safely perform and teach 4 procedures following a rare procedures lab. Physicians reported the highest improvement in VAS scores for the lateral canthotomy module, with the least improvement in rescue airway.