When teaching procedures in simulation, do simulation adjuncts translate to better performance?

Background: Learners should ideally be taught low-frequency, high-acuity procedures in a simulated clinical environment to limit patient harm. Evidence supporting a simulation scenario with educational adjuncts to teach procedures versus a traditional procedure laboratory have not been previously demonstrated. To investigate the effects of simulation adjuncts on procedural skills attainment, we compared performances of learners who trained on a modified airway task trainer within the context of a simulation scenario with educational adjuncts for balloon tamponade placement to those who trained on the same task trainer in a typical procedure laboratory setting.

Methods: Fifty learners completed the curriculum: 37 emergency medicine residents, 8 emergency medicine/internal medicine residents, and 5 gastroenterology fellows. Learners were randomized into a simulation scenario with adjuncts (SA) or a control group using a modified task trainer in a procedure laboratory (PL) setting. We conducted baseline, approximately 1-month, and 5-month post-training assessments of self-identified competence, knowledge of the procedure, and observed procedural skills.

Results: Learners from both groups demonstrated significant improvement on all three assessments from baseline to the first post-training session. Between the first and second follow-ups, both groups significantly improved on self-assessed competence. At the second follow-up, the PL-trained group scored significantly higher than the SA group on the performance assessment.

Conclusions: All learners demonstrated significant improvements in knowledge, skills performance, and feelings of competence. The PL group demonstrated significantly higher skills performance during the second follow-up after training. This finding suggests that structured practice alone is an effective learning strategy for balloon tamponade placement without needing the resources of accompanying adjuncts within a simulation scenario, and that education with additional adjuncts may contribute to skills decay over time.