Feasibility and efficacy of simulation training for joint dislocation management in residency

Background

Residents in EM training programs are required by the Accreditation Council of Graduate Medical Education (ACGME) to achieve competency in joint dislocation management. Our study group developed three large joint dislocation task trainers and evaluated their feasibility and efficacy in residency training.

Methods

During the study period, participants attempted reduction of the dislocation task trainers. Study personnel collected data from these attempts, including procedural success, time to hand placement, and time to joint reduction. Hands-on education was then provided. Learners participated a second time during the study period, and collection of data was repeated. Rates of successful joint dislocation reductions were determined and reported with exact 95 % binomial confidence intervals (95 % CI). Medians and upper and lower quartiles for time to hand placement and time to successful reduction were calculated and reported.

Results

Among first-time users, the successful reduction rates for the shoulder, hip and elbow were 63 % (19/30, 95 % CI 43–80 %), 83 % (25/30, 95 % CI 62–94 %), and 90 % (27/30, 95 % CI 73-97 %) respectively. For second-time users, successful reduction rates were 100 % (30/30, 95 % CI 88–100 %) for all joints. Among first-time participants, the median times to achieve successful shoulder, hip, and elbow reduction were 69 s (IQR 32, 92), 35 s (IQR 22, 49), and 16 s (IQR 13, 24) respectively. For second-time users, the median times to reduce these joints were 24 s (IQR 14, 40), 14 s (IQR 11, 17) and 10 s (IQR 7, 12).

Conclusion

Our data suggest that large joint dislocation management training is feasible using high-fidelity simulation task trainers. Additional study is planned to assess the potential role of this approach for improving procedural competency in the clinical realm.