M. Sivarajah1,2, I. Staff1,2, K. Butler1,2 1Hartford Hospital,Surgical Critical Care,Hartford, CT, USA 2University Of Connecticut,Surgery,Hartford, CT, USA
Introduction:
Simulation in critical care education represents an emerging tool that allows deliberate practice of cognitive skills in a simulated patient environment where mistakes are explored, assessments refined and feedback provided to improve performance. Clinical competency in surgery requires increasing experience with direct patient care and incremental gains in knowledge as the training program progresses. Achieving these milestones permits safe patient care as residents transition from junior to senior levels. We have previously shown that, in first year residents, cognitive simulation improves shock recognition and management. It is unclear if retention of simulation-imparted knowledge during the PGY-1 year occurs as the resident progresses through the next four years of training. The purpose of this quality project is to determine if there is deterioration of simulation-induced knowledge and if so, at what point does it appear.
Methods:
The results of resident performance on a 12-item multiple-choice question test (MCQ) designed to measure the knowledge of shock recognition and management were analyzed. Construct validity of the MCQ was previously determined using known-groups validation. Residents in the PGY2-5 years completed the MCQ at the midpoint of the academic year (January) and the results (percentage correct) were analyzed to assess knowledge retention from the simulation experience gained during the PGY-1 year. Comparisons between PGY-1, PGY-2 and PGY 3-5 residents were made. MCQ results were analyzed for overall differences among all three groups with Kruskal-Wallis test; pairwise comparisons were made with Wilcoxon Ranked Sum test.
Results:
Test results were available from 17 PGY-1, 8 PGY-2 and 6 PGY-3-5 residents. Comparisons among the three groups showed a significant effect of resident year (p=0.002). There was a decline in knowledge (MCQ test performance) seen during the PGY 2 year and then an increase in PGY- 3-5 (80%±9 vs. 74%±13 vs. 96%±7 for PGY-1 vs. PGY-2 vs. PGY-3,4,5 respectively). Performance of the PGY 3-5 residents on the MCQ was significantly better compared to their PGY-1 and PGY-2 junior counterparts (p=0.002 and p<0.005, respectively).
Conclusion:
Knowledge gained during the PGY-1 year from manikin-based simulation on the recognition and management of shock declines during the PGY-2 year. It is essential for educators to be aware that knowledge declination may occur following cognitive simulation. We believe that a ‘booster shot’ from simulation to maintain the critical skill of recognition and management of shock may be necessary during this crucial training year. This may represent an important opportunity for enhancing surgical training and improving patient safety.