Procedural instruction in invasive bedside procedures: a systematic review and meta-analysis of effective teaching approaches
ImportanceOptimal approaches to teaching bedside procedures are unknown.ObjectiveTo identify effective instructional approaches in procedural training.Data sourcesWe searched PubMed, EMBASE, Web of Science and Cochrane Library through December 2014.Study selectionWe included research articles that a...
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| Veröffentlicht in: | BMJ quality & safety 2016-04, Vol.25 (4), p.281-294 |
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| creator | Huang, Grace C McSparron, Jakob I Balk, Ethan M Richards, Jeremy B Smith, C Christopher Whelan, Julia S Newman, Lori R Smetana, Gerald W |
| description | ImportanceOptimal approaches to teaching bedside procedures are unknown.ObjectiveTo identify effective instructional approaches in procedural training.Data sourcesWe searched PubMed, EMBASE, Web of Science and Cochrane Library through December 2014.Study selectionWe included research articles that addressed procedural training among physicians or physician trainees for 12 bedside procedures. Two independent reviewers screened 9312 citations and identified 344 articles for full-text review.Data extraction and synthesisTwo independent reviewers extracted data from full-text articles.Main outcomes and measuresWe included measurements as classified by translational science outcomes T1 (testing settings), T2 (patient care practices) and T3 (patient/public health outcomes). Due to incomplete reporting, we post hoc classified study outcomes as ‘negative’ or ‘positive’ based on statistical significance. We performed meta-analyses of outcomes on the subset of studies sharing similar outcomes.ResultsWe found 161 eligible studies (44 randomised controlled trials (RCTs), 34 non-RCTs and 83 uncontrolled trials). Simulation was the most frequently published educational mode (78%). Our post hoc classification showed that studies involving simulation, competency-based approaches and RCTs had higher frequencies of T2/T3 outcomes. Meta-analyses showed that simulation (risk ratio (RR) 1.54 vs 0.55 for studies with vs without simulation, p=0.013) and competency-based approaches (RR 3.17 vs 0.89, p |
| doi_str_mv | 10.1136/bmjqs-2014-003518 |
| format | Article |
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Two independent reviewers screened 9312 citations and identified 344 articles for full-text review.Data extraction and synthesisTwo independent reviewers extracted data from full-text articles.Main outcomes and measuresWe included measurements as classified by translational science outcomes T1 (testing settings), T2 (patient care practices) and T3 (patient/public health outcomes). Due to incomplete reporting, we post hoc classified study outcomes as ‘negative’ or ‘positive’ based on statistical significance. We performed meta-analyses of outcomes on the subset of studies sharing similar outcomes.ResultsWe found 161 eligible studies (44 randomised controlled trials (RCTs), 34 non-RCTs and 83 uncontrolled trials). Simulation was the most frequently published educational mode (78%). Our post hoc classification showed that studies involving simulation, competency-based approaches and RCTs had higher frequencies of T2/T3 outcomes. Meta-analyses showed that simulation (risk ratio (RR) 1.54 vs 0.55 for studies with vs without simulation, p=0.013) and competency-based approaches (RR 3.17 vs 0.89, p<0.001) were effective forms of training.Conclusions and relevanceThis systematic review of bedside procedural skills demonstrates that the current literature is heterogeneous and of varying quality and rigour. Evidence is strongest for the use of simulation and competency-based paradigms in teaching procedures, and these approaches should be the mainstay of programmes that train physicians to perform procedures. Further research should clarify differences among instructional methods (eg, forms of hands-on training) rather than among educational modes (eg, lecture vs simulation).</description><identifier>ISSN: 2044-5415</identifier><identifier>EISSN: 2044-5423</identifier><identifier>DOI: 10.1136/bmjqs-2014-003518</identifier><identifier>PMID: 26543067</identifier><language>eng</language><publisher>England: BMJ Publishing Group LTD</publisher><subject>Bias ; Clinical Competence ; Curriculum ; Education ; Feedback ; Female ; Health administration ; Humans ; Instructional design ; Intubation ; Male ; Medical personnel ; Methods ; Morbidity ; Patient Care - standards ; Point-of-Care Testing ; Practice Guidelines as Topic - standards ; Public health ; Randomized Controlled Trials as Topic ; Research methodology ; Simulation ; Skills ; Studies ; Teaching ; Training</subject><ispartof>BMJ quality & safety, 2016-04, Vol.25 (4), p.281-294</ispartof><rights>Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing</rights><rights>Copyright: 2016 Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-b366t-c32ff963546c897144037c52da59875154e52ad268b03685fd0a782f899fd5533</citedby><cites>FETCH-LOGICAL-b366t-c32ff963546c897144037c52da59875154e52ad268b03685fd0a782f899fd5533</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://qualitysafety.bmj.com/content/25/4/281.full.pdf$$EPDF$$P50$$Gbmj$$H</linktopdf><linktohtml>$$Uhttps://qualitysafety.bmj.com/content/25/4/281.full$$EHTML$$P50$$Gbmj$$H</linktohtml><link.rule.ids>114,115,314,780,784,3196,23571,27924,27925,77600,77631</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/26543067$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Huang, Grace C</creatorcontrib><creatorcontrib>McSparron, Jakob I</creatorcontrib><creatorcontrib>Balk, Ethan M</creatorcontrib><creatorcontrib>Richards, Jeremy B</creatorcontrib><creatorcontrib>Smith, C Christopher</creatorcontrib><creatorcontrib>Whelan, Julia S</creatorcontrib><creatorcontrib>Newman, Lori R</creatorcontrib><creatorcontrib>Smetana, Gerald W</creatorcontrib><title>Procedural instruction in invasive bedside procedures: a systematic review and meta-analysis of effective teaching approaches</title><title>BMJ quality & safety</title><addtitle>BMJ Qual Saf</addtitle><description>ImportanceOptimal approaches to teaching bedside procedures are unknown.ObjectiveTo identify effective instructional approaches in procedural training.Data sourcesWe searched PubMed, EMBASE, Web of Science and Cochrane Library through December 2014.Study selectionWe included research articles that addressed procedural training among physicians or physician trainees for 12 bedside procedures. Two independent reviewers screened 9312 citations and identified 344 articles for full-text review.Data extraction and synthesisTwo independent reviewers extracted data from full-text articles.Main outcomes and measuresWe included measurements as classified by translational science outcomes T1 (testing settings), T2 (patient care practices) and T3 (patient/public health outcomes). Due to incomplete reporting, we post hoc classified study outcomes as ‘negative’ or ‘positive’ based on statistical significance. We performed meta-analyses of outcomes on the subset of studies sharing similar outcomes.ResultsWe found 161 eligible studies (44 randomised controlled trials (RCTs), 34 non-RCTs and 83 uncontrolled trials). Simulation was the most frequently published educational mode (78%). Our post hoc classification showed that studies involving simulation, competency-based approaches and RCTs had higher frequencies of T2/T3 outcomes. Meta-analyses showed that simulation (risk ratio (RR) 1.54 vs 0.55 for studies with vs without simulation, p=0.013) and competency-based approaches (RR 3.17 vs 0.89, p<0.001) were effective forms of training.Conclusions and relevanceThis systematic review of bedside procedural skills demonstrates that the current literature is heterogeneous and of varying quality and rigour. Evidence is strongest for the use of simulation and competency-based paradigms in teaching procedures, and these approaches should be the mainstay of programmes that train physicians to perform procedures. Further research should clarify differences among instructional methods (eg, forms of hands-on training) rather than among educational modes (eg, lecture vs simulation).</description><subject>Bias</subject><subject>Clinical Competence</subject><subject>Curriculum</subject><subject>Education</subject><subject>Feedback</subject><subject>Female</subject><subject>Health administration</subject><subject>Humans</subject><subject>Instructional design</subject><subject>Intubation</subject><subject>Male</subject><subject>Medical personnel</subject><subject>Methods</subject><subject>Morbidity</subject><subject>Patient Care - standards</subject><subject>Point-of-Care Testing</subject><subject>Practice Guidelines as Topic - standards</subject><subject>Public health</subject><subject>Randomized Controlled Trials as Topic</subject><subject>Research methodology</subject><subject>Simulation</subject><subject>Skills</subject><subject>Studies</subject><subject>Teaching</subject><subject>Training</subject><issn>2044-5415</issn><issn>2044-5423</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2016</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><recordid>eNqNkTtvFDEURi1ERKIkP4AGWaKhYMDvselQxEuKRIpQjzz2NXg1j43vzEZb8N9xsksKKixL_opzz5X1EfKSs3ecS_O-Hzd32AjGVcOY1Nw-I2eCKdVoJeTzp8z1KblE3LB6pHOOyRfkVBitJDPtGfl9U-YAcS1-oHnCpaxhyfNUc707j3kHtIeIOQLdHlHAD9RT3OMCo19yoAV2Ge6pnyIdYfGNn_ywx4x0ThRSgqqsmgV8-JWnn9Rvq6lmwAtykvyAcHl8z8mPz59ur74219-_fLv6eN300pilCVKk5IzUygTrWq4Uk23QInrtbKu5VqCFj8LYnkljdYrMt1Yk61yKWkt5Tt4cvHXx3Qq4dGPGAMPgJ5hX7HjbKi0107air_9BN_Na6oceKWuNsdZVih-oUGbEAqnbljz6su846x7q6R7r6R7q6Q711JlXR_PajxCfJv6WUYG3B6DO_ofvDwGImoI</recordid><startdate>201604</startdate><enddate>201604</enddate><creator>Huang, Grace C</creator><creator>McSparron, Jakob I</creator><creator>Balk, Ethan M</creator><creator>Richards, Jeremy B</creator><creator>Smith, C Christopher</creator><creator>Whelan, Julia S</creator><creator>Newman, Lori R</creator><creator>Smetana, Gerald W</creator><general>BMJ Publishing Group LTD</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AN0</scope><scope>BENPR</scope><scope>BTHHO</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M1P</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>7X8</scope></search><sort><creationdate>201604</creationdate><title>Procedural instruction in invasive bedside procedures: a systematic review and meta-analysis of effective teaching approaches</title><author>Huang, Grace C ; McSparron, Jakob I ; Balk, Ethan M ; Richards, Jeremy B ; Smith, C Christopher ; Whelan, Julia S ; Newman, Lori R ; Smetana, Gerald W</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-b366t-c32ff963546c897144037c52da59875154e52ad268b03685fd0a782f899fd5533</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2016</creationdate><topic>Bias</topic><topic>Clinical Competence</topic><topic>Curriculum</topic><topic>Education</topic><topic>Feedback</topic><topic>Female</topic><topic>Health administration</topic><topic>Humans</topic><topic>Instructional design</topic><topic>Intubation</topic><topic>Male</topic><topic>Medical personnel</topic><topic>Methods</topic><topic>Morbidity</topic><topic>Patient Care - standards</topic><topic>Point-of-Care Testing</topic><topic>Practice Guidelines as Topic - standards</topic><topic>Public health</topic><topic>Randomized Controlled Trials as Topic</topic><topic>Research methodology</topic><topic>Simulation</topic><topic>Skills</topic><topic>Studies</topic><topic>Teaching</topic><topic>Training</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Huang, Grace C</creatorcontrib><creatorcontrib>McSparron, Jakob I</creatorcontrib><creatorcontrib>Balk, Ethan M</creatorcontrib><creatorcontrib>Richards, Jeremy B</creatorcontrib><creatorcontrib>Smith, C Christopher</creatorcontrib><creatorcontrib>Whelan, Julia S</creatorcontrib><creatorcontrib>Newman, Lori R</creatorcontrib><creatorcontrib>Smetana, Gerald W</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Nursing & Allied Health Database</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>British Nursing Database</collection><collection>ProQuest Central</collection><collection>BMJ Journals</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Nursing & Allied Health Premium</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>MEDLINE - Academic</collection><jtitle>BMJ quality & safety</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Huang, Grace C</au><au>McSparron, Jakob I</au><au>Balk, Ethan M</au><au>Richards, Jeremy B</au><au>Smith, C Christopher</au><au>Whelan, Julia S</au><au>Newman, Lori R</au><au>Smetana, Gerald W</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Procedural instruction in invasive bedside procedures: a systematic review and meta-analysis of effective teaching approaches</atitle><jtitle>BMJ quality & safety</jtitle><addtitle>BMJ Qual Saf</addtitle><date>2016-04</date><risdate>2016</risdate><volume>25</volume><issue>4</issue><spage>281</spage><epage>294</epage><pages>281-294</pages><issn>2044-5415</issn><eissn>2044-5423</eissn><abstract>ImportanceOptimal approaches to teaching bedside procedures are unknown.ObjectiveTo identify effective instructional approaches in procedural training.Data sourcesWe searched PubMed, EMBASE, Web of Science and Cochrane Library through December 2014.Study selectionWe included research articles that addressed procedural training among physicians or physician trainees for 12 bedside procedures. Two independent reviewers screened 9312 citations and identified 344 articles for full-text review.Data extraction and synthesisTwo independent reviewers extracted data from full-text articles.Main outcomes and measuresWe included measurements as classified by translational science outcomes T1 (testing settings), T2 (patient care practices) and T3 (patient/public health outcomes). Due to incomplete reporting, we post hoc classified study outcomes as ‘negative’ or ‘positive’ based on statistical significance. We performed meta-analyses of outcomes on the subset of studies sharing similar outcomes.ResultsWe found 161 eligible studies (44 randomised controlled trials (RCTs), 34 non-RCTs and 83 uncontrolled trials). Simulation was the most frequently published educational mode (78%). Our post hoc classification showed that studies involving simulation, competency-based approaches and RCTs had higher frequencies of T2/T3 outcomes. Meta-analyses showed that simulation (risk ratio (RR) 1.54 vs 0.55 for studies with vs without simulation, p=0.013) and competency-based approaches (RR 3.17 vs 0.89, p<0.001) were effective forms of training.Conclusions and relevanceThis systematic review of bedside procedural skills demonstrates that the current literature is heterogeneous and of varying quality and rigour. Evidence is strongest for the use of simulation and competency-based paradigms in teaching procedures, and these approaches should be the mainstay of programmes that train physicians to perform procedures. Further research should clarify differences among instructional methods (eg, forms of hands-on training) rather than among educational modes (eg, lecture vs simulation).</abstract><cop>England</cop><pub>BMJ Publishing Group LTD</pub><pmid>26543067</pmid><doi>10.1136/bmjqs-2014-003518</doi><tpages>14</tpages></addata></record> |
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| subjects | Bias Clinical Competence Curriculum Education Feedback Female Health administration Humans Instructional design Intubation Male Medical personnel Methods Morbidity Patient Care - standards Point-of-Care Testing Practice Guidelines as Topic - standards Public health Randomized Controlled Trials as Topic Research methodology Simulation Skills Studies Teaching Training |
| title | Procedural instruction in invasive bedside procedures: a systematic review and meta-analysis of effective teaching approaches |
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