Background/Purpose: Simulation training is now widely used in various residency programs, especially in the field of critical care, to train and prepare residents for real life medical cases and procedures. Training in rheumatologic procedures such as arthrocentesis however, is a neglected part of many internal medicine residency programs. The purpose of this study was to explore the impact of simulation based training curriculum on the residents’ confidence and knowledge to perform these procedures independently.

Methods: A case-based simulation training curriculum was developed in our internal medicine residency program based in an urban tertiary care center. The initial assessment consisted of surveying the participants’ past experience with arthrocentesis and corticosteroid injections, current satisfaction with such training in their program and knowledge regarding the basic anatomical landmarks. Understanding the indications/contraindications of performing these procedures was also reviewed. The training sessions included faculty led, hands on, simulation based instruction using knee and shoulder anatomic models. The post-training questionnaire was provided to assess for any difference in outcome. Simulation models provided instant feedback by providing a sound when the needle was placed in the correct location. The training was not complete until all participants had located and inserted the needle in the appropriate location as verified by the auditory feedback.

Results: A total of 37 participants (54% men and 46% women), enrolled in the educational curriculum. 9 (24%) of the medical residents were Year-1, 13 (35%) Year-2, 12 (32%) Year-3; 3 participants were medical students and attending physicians. Among the medical residents, 28 (76%) participants were International Medical Graduates and 9 (24%) were American Medical Graduates. Analysis was completed using SAS 9.4 and paired t-test. Median post training satisfaction and confidence in the procedural skills were higher (p-value <0.05). There was also improvement in the mean post-training objective knowledge based questionnaire scores in 4 out of 8 areas (p-value <0.05). All 37 participants were interested in training in similar sessions in the future.

Conclusion: Simulation based training helps residents learn complex medical cases and practice invasive procedures in a safe environment. This study shows that use of knee and shoulder models to practice joint injections increases residents’ confidence and satisfaction and improves their clinical skills. We feel that simulation based arthrocentesis training should be incorporated as part of the basic internal medicine curriculum.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/impact-of-case-based-simulation-training-on-the-confidence-and-knowledge-of-medical-residents-to-perform-rheumatologic-procedures/