A Canadian Perspective of simulation-based skill attainment in Internal Medicine Residency (Preprint)

BACKGROUND Clinical simulation is defined as “a technique to replace or amplify real experiences with guided experiences, often immersive in nature, that evoke or replicate substantial aspects of the real world in a fully interactive fashion”. In medicine, its advantages include repeatability, a nonthreatening environment, absence of the need to intervene for patient safety issues during critical events, thus minimizing ethical concerns and promotion of self-reflection with facilitation of feedback [1] Apparently, simulation based education is a standard tool for introducing procedural skills in residency training [3]. However, while performance is clearly enhanced in the simulated setting, there is little information available on the translation of these skills to the actual patient care environment (transferability) and the retention rates of skills acquired in simulation-based training [1]. There has been significant interest in using simulation for both learning and assessment [2]. As Canadian internal medicine training programs are moving towards assessing entrustable professional activities (EPA), simulation will become imperative for training, assessment and identifying opportunities for improvement [4, 5]. Hence, it is crucial to assess the current state of skill learning, acquisition and retention in Canadian IM residency training programs. Also, identifying any challenges to consolidating these skills. We hope the results of this survey would provide material that would help in implementing an effective and targeted simulation-based skill training (skill mastery). OBJECTIVE 1. Appraise the status and impact of existing simulation training on procedural skill performance 2. Identify factors that might interfere with skill acquisition, consolidation and transferability METHODS An electronic bilingual web-based survey; Fluid survey platform utilized, was designed (Appendix 1). It consists of a mix of closed-ended, open-ended and check list questions to examine the attitudes, perceptions, experiences and feedback of internal medicine (IM) residents. The survey has been piloted locally with a sample of five residents. After making any necessary corrections, it will be distributed via e-mail to the program directors of all Canadian IM residency training programs, then to all residents registered in each program. Two follow up reminder e-mails will be sent to all participating institutions. Participation will be voluntarily and to keep anonymity, there will be no direct contact with residents and survey data will be summarized in an aggregate form. SPSS Software will be used for data analysis, and results will be shared with all participating institutions. The survey results will be used for display and presentation purposes during medical conferences and forums and might be submitted for publication. All data will be stored within the office of internal medicine program at Memorial University for a period of five years. Approval of Local Research Ethics board (HREB) at Memorial University has been obtained. RESULTS Pilot Results Residents confirmed having simulation-based training for many of the core clinical skills, although some gaps persist There was some concern regarding the number of sim sessions, lack of clinical opportunities, competition by other services and lack of bed side supervision Some residents used internet video to fill their training gaps and/or increase their skill comfort level before performing clinical procedure Resident feedback included desire for more corrective feedback, and more sim sessions per skill (Average 2-4 sessions) CONCLUSIONS This study is anticipated to provide data on current practices for skill development in Canadian IM residency training programs. Information gathered will be used to foster a discourse between training programs including discussion of barriers, sharing of solutions and proposing recommendations for optimal use of simulation in the continuum of procedural skills training.