Effectiveness of a cardiology review course for internal medicine residents using simulation technology and deliberate practice

Background: Objective evaluations of residents' clinical skills reveal serious deficits. Purpose: To develop, implement, and evaluate outcomes from a review course in cardiology bedside skills for internal medicine residents. Methods: We used a 1-group pretest-posttest design with historical comparisons. The study was conducted at the University of Miami School of Medicine as part of the internal medicine residency program from July 1999 to June 2000. A total of 67 2nd- and 3rd-year medicine residents received an educational intervention involving deliberate practice using simulation technology. A total of 155 4th-year medical students in one intervention and one comparison group (n = 53) served as historical comparisons. Outcome measures were a reliable computer-delivered pretest and posttest that evaluate cardiology bedside skills. Results: Residents who received the review course and medical students who received a comparable educational intervention showed large and statistically significant pre-test-to-posttest improvement in bedside skills. These 2 groups are also significantly and substantially different at posttest from a comparison group of 4th-year medical students that did not receive a specific educational intervention. Conclusion: Educational interventions using simulation technology that engage learners in deliberate practice of clinical skills produce large improvements in a relatively short time, with little faculty involvement.