Impact of web-based review on long-term retention of simulation-acquired knee and shoulder aspiration and injection skills.

BACKGROUND: Musculoskeletal problems are the reason for one-quarter of primary care visits. Opportunities for internal medicine residents to perform joint aspirations and injections have declined. Simulation has been shown to improve procedure skills post completion of simulation courses, yet controversy exists about the durability of simulation-acquired skills. OBJECTIVE: To investigate whether web-based review preserves residents' joint procedure skills 6 to 30 months after a simulation course. METHODS: Postgraduate year-1 internal medicine residents participated in a simulation-based Joint Aspiration Injection Course consisting of web-based instructional material, guided practice on joint models, and a multiple-choice test. Procedure proficiency was scored by using a 3-component skills checklist. Six to 30 months later, residents who had participated in the simulation were randomly assigned to review or not to review the original web-based instructional material before retesting. The groups were compared by using Wilcoxon rank sum and matched pairs signed rank tests. RESULTS: Compared to the performance at the end of the simulation course, scores of all 3 procedure components declined (informed consent, 64.7-43.0 versus 30.6-23.8, P < .001; procedure proficiency, 63.4-61.7 versus 46.4-44.3, P < .001; and postprocedure instructions, 58.0-54.1 versus 29.9-29.4, P < .001). However, the review group outperformed the nonreview group on informed consent (shoulder: 37.1 versus 24.6, P  =  .01) and postprocedure instructions (shoulder: 34.0 versus 25.2, P  =  .01; knee: 35.5 versus 24.8, P < .001). Residents who reported doing actual procedures maintained a higher confidence level, compared with those reporting none (6.8-5.1 versus 4.1-3.6, P < .001). CONCLUSION: Shoulder and knee simulation-acquired skills declined 6 to 30 months after a simulation course. However, rereview of web-based instructional material improved proficiency in informed consent, shoulder, and postprocedure instructions, shoulder and knee.