Skip to main content
Top
Published in: BMC Primary Care 1/2019

Open Access 01-12-2019 | Research article

An educational study to investigate the efficacy of three training methods for infiltration techniques on self-efficacy and skills of trainees in general practice

Authors: Nele R. Michels, Els Vanhomwegen

Published in: BMC Primary Care | Issue 1/2019

Login to get access

Abstract

Background

Research shows that few general practitioners perform intra- and periarticular infiltrations. Lack of good training strategies to teach these skills would be an important reason for this observation. In this study, we investigated and compared three different training strategies for infiltrations of the glenohumeral joint, subacromial space, lateral epicondyle, carpal tunnel and knee joint.

Methods

Trainees in general practice were randomized into three teaching groups: a theoretical lecture (n = 18), or a theoretical lecture with training on anatomical models (n = 19) or with a training on cadavers (n = 11). The study period was 3 months. Before and after the training, the self-efficacy (questionnaire) and skills (Objective Structured Clinical Examination or OSCE, test on anatomical models) were evaluated. The self-efficacy was assessed again 3 months later. A Kruskal-Wallis test was used to compare the results before versus after training and between groups (p < 0.05).

Results

All three training strategies had a significantly positive effect on the self-efficacy concerning knowledge and skills. This benefit remained 3 months after training. However, some participants still felt uncomfortable to perform infiltrations. Best scores for self-efficacy concerning skills and best scores on the OSCE were observed after training on cadavers, followed by training on anatomical models.

Conclusions

Based on this study we suggest the combination of a theoretical lecture with a training on cadavers to teach infiltration techniques. To achieve an optimal long-term effect, additional refresher trainings may be necessary.
Appendix
Available only for authorised users
Literature
1.
go back to reference Gardner GC. Teaching arthrocentesis and injection techniques: what is the best way to get our point across? J Rheumatol. 2007;34(7):1448–50.PubMed Gardner GC. Teaching arthrocentesis and injection techniques: what is the best way to get our point across? J Rheumatol. 2007;34(7):1448–50.PubMed
2.
go back to reference Liddell WG, Carmichael CR, McHugh NJ. Joint and soft tissue injections: a survey of general practitioners. Rheumatology (Oxford). 2005;44(8):1043–6.CrossRef Liddell WG, Carmichael CR, McHugh NJ. Joint and soft tissue injections: a survey of general practitioners. Rheumatology (Oxford). 2005;44(8):1043–6.CrossRef
3.
go back to reference Wittich CM, Ficalora RD, Mason TG, Beckman TJ. Musculoskeletal injection. Mayo Clin Proc. 2009;84(9):831–6 quiz 7.CrossRef Wittich CM, Ficalora RD, Mason TG, Beckman TJ. Musculoskeletal injection. Mayo Clin Proc. 2009;84(9):831–6 quiz 7.CrossRef
4.
go back to reference Nichols A. Complications associated with the use of corticosteroids in the treatment of athletic injuries. Clin J Sport Med. 2005;15(5):370–5.CrossRef Nichols A. Complications associated with the use of corticosteroids in the treatment of athletic injuries. Clin J Sport Med. 2005;15(5):370–5.CrossRef
5.
go back to reference Cole B, Schumacher HJ. Injectable corticosteroids in modern practice. J Am Acad Orthop Surg. 2005;13(1):37–46.CrossRef Cole B, Schumacher HJ. Injectable corticosteroids in modern practice. J Am Acad Orthop Surg. 2005;13(1):37–46.CrossRef
6.
go back to reference Gormley GJ, Corrigan M, Steele WK, Stevenson M, Taggart AJ. Joint and soft tissue injections in the community: questionnaire survey of general practitioners' experiences and attitudes. Ann Rheum Dis. 2003;62(1):61–4.CrossRef Gormley GJ, Corrigan M, Steele WK, Stevenson M, Taggart AJ. Joint and soft tissue injections in the community: questionnaire survey of general practitioners' experiences and attitudes. Ann Rheum Dis. 2003;62(1):61–4.CrossRef
7.
go back to reference Jolly M, Curran JJ. Underuse of intra-articular and periarticular corticosteroid injections by primary care physicians: discomfort with the technique. J Clin Rheumatol. 2003;9(3):187–92.CrossRef Jolly M, Curran JJ. Underuse of intra-articular and periarticular corticosteroid injections by primary care physicians: discomfort with the technique. J Clin Rheumatol. 2003;9(3):187–92.CrossRef
8.
go back to reference RDa K, Manoharan A, Nematollahi S, Nelson J, Cummings SH, WJA R, et al. A novel fresh cadaver model for education and assessment of joint aspiration. J Orthop. 2016;13:419–24.CrossRef RDa K, Manoharan A, Nematollahi S, Nelson J, Cummings SH, WJA R, et al. A novel fresh cadaver model for education and assessment of joint aspiration. J Orthop. 2016;13:419–24.CrossRef
9.
go back to reference Flores O, Seminario SS, Contreras E, Pérez P. Therapeutic attitude of tutors and fourth year residents of family and community medicine from Girona towards peri-articular infiltration. Aténcion Primaria. 2016;48(6):421–2.CrossRef Flores O, Seminario SS, Contreras E, Pérez P. Therapeutic attitude of tutors and fourth year residents of family and community medicine from Girona towards peri-articular infiltration. Aténcion Primaria. 2016;48(6):421–2.CrossRef
10.
go back to reference Sterrett A, Bateman H, Guthrie J, Rehman A, Osting V, Carter J, et al. Virtual rheumatology: using simultors and a formal workshop to teach medical students, internal medicine residents, and rheumatology subspecialty residents arthrocentesis. J Clin Rheumatology. 2011;17(3):121–3.CrossRef Sterrett A, Bateman H, Guthrie J, Rehman A, Osting V, Carter J, et al. Virtual rheumatology: using simultors and a formal workshop to teach medical students, internal medicine residents, and rheumatology subspecialty residents arthrocentesis. J Clin Rheumatology. 2011;17(3):121–3.CrossRef
11.
go back to reference Gormley GJ, Steele WK, Stevenson M, McKane R, Ryans I, Cairns AP, et al. A randomised study of two training programmes for general practitioners in the techniques of shoulder injection. Ann Rheum Dis. 2003;62(10):1006–9.CrossRef Gormley GJ, Steele WK, Stevenson M, McKane R, Ryans I, Cairns AP, et al. A randomised study of two training programmes for general practitioners in the techniques of shoulder injection. Ann Rheum Dis. 2003;62(10):1006–9.CrossRef
12.
go back to reference Jansen JJ, Grol RP, Van Der Vleuten CP, Scherpbier AJ, Crebolder HF, Rethans JJ. Effect of a short skills training course on competence and performance in general practice. Med Educ. 2000;34(1):66–71.CrossRef Jansen JJ, Grol RP, Van Der Vleuten CP, Scherpbier AJ, Crebolder HF, Rethans JJ. Effect of a short skills training course on competence and performance in general practice. Med Educ. 2000;34(1):66–71.CrossRef
13.
go back to reference Vogelgesang SA, Karplus TM, Kreiter CD. An instructional program to facilitate teaching joint/soft-tissue injection and aspiration. J Gen Intern Med. 2002;17(6):441–5.CrossRef Vogelgesang SA, Karplus TM, Kreiter CD. An instructional program to facilitate teaching joint/soft-tissue injection and aspiration. J Gen Intern Med. 2002;17(6):441–5.CrossRef
14.
go back to reference Stitik TP, Foye PM, Nadler SF, Chen B, Schoenherr L, Von Hagen S. Injections in patients with osteoarthritis and other musculoskeletal disorders: use of synthetic injection models for teaching physiatry residents. Am J Phys Med Rehabil. 2005;84(7):550–9.CrossRef Stitik TP, Foye PM, Nadler SF, Chen B, Schoenherr L, Von Hagen S. Injections in patients with osteoarthritis and other musculoskeletal disorders: use of synthetic injection models for teaching physiatry residents. Am J Phys Med Rehabil. 2005;84(7):550–9.CrossRef
15.
go back to reference Leopold SS, Morgan HD, Kadel NJ, Gardner GC, Schaad DC, Wolf FM. Impact of educational intervention on confidence and competence in the performance of a simple surgical task. J Bone Joint Surg Am. 2005;87(5):1031–7.CrossRef Leopold SS, Morgan HD, Kadel NJ, Gardner GC, Schaad DC, Wolf FM. Impact of educational intervention on confidence and competence in the performance of a simple surgical task. J Bone Joint Surg Am. 2005;87(5):1031–7.CrossRef
16.
go back to reference Berman JR, Ben-Artzi A, Fisher MC, Bass AR, Pillinger MH. A comparison of arthrocentesis teaching tools: cadavers, synthetic joint models, and the relative utility of different educational modalities in improving trainees' comfort with procedures. J Clin Rheumatol. 2012;18(4):175–9.CrossRef Berman JR, Ben-Artzi A, Fisher MC, Bass AR, Pillinger MH. A comparison of arthrocentesis teaching tools: cadavers, synthetic joint models, and the relative utility of different educational modalities in improving trainees' comfort with procedures. J Clin Rheumatol. 2012;18(4):175–9.CrossRef
17.
go back to reference Bandura A. Guide for constructing self-efficacy scales. In: Pajares F, Urdan T, editors. Self-efficacy beliefs of adolescents: Information Age Publishing; 2006. p. 367. Bandura A. Guide for constructing self-efficacy scales. In: Pajares F, Urdan T, editors. Self-efficacy beliefs of adolescents: Information Age Publishing; 2006. p. 367.
18.
go back to reference Cardone DA, Tallia AF. Diagnostic and therapeutic injection of the elbow region. Am Fam Physician. 2002;66(11):2097–100.PubMed Cardone DA, Tallia AF. Diagnostic and therapeutic injection of the elbow region. Am Fam Physician. 2002;66(11):2097–100.PubMed
19.
go back to reference Cardone DA, Tallia AF. Diagnostic and therapeutic injection of the hip and knee. Am Fam Physician. 2003;67(10):2147–52.PubMed Cardone DA, Tallia AF. Diagnostic and therapeutic injection of the hip and knee. Am Fam Physician. 2003;67(10):2147–52.PubMed
20.
go back to reference Tallia AF, Cardone DA. Diagnostic and therapeutic injection of the shoulder region. Am Fam Physician. 2003;67(6):1271–8.PubMed Tallia AF, Cardone DA. Diagnostic and therapeutic injection of the shoulder region. Am Fam Physician. 2003;67(6):1271–8.PubMed
21.
go back to reference Tallia AF, Cardone DA. Diagnostic and therapeutic injection of the wrist and hand region. Am Fam Physician. 2003;67(4):745–50.PubMed Tallia AF, Cardone DA. Diagnostic and therapeutic injection of the wrist and hand region. Am Fam Physician. 2003;67(4):745–50.PubMed
22.
go back to reference Cardone DA, Tallia AF. Joint and soft tissue injection. Am Fam Physician. 2002;66(2):283–8.PubMed Cardone DA, Tallia AF. Joint and soft tissue injection. Am Fam Physician. 2002;66(2):283–8.PubMed
23.
go back to reference Khan K, Ramachandran S, Gaunt K, Pushkar P. The objective structured clinical examination (OSCE): AMEE guide no. 81. Part I: an historical and theoretical perspective. Med Teach. 2013;35(9):e1437–46.CrossRef Khan K, Ramachandran S, Gaunt K, Pushkar P. The objective structured clinical examination (OSCE): AMEE guide no. 81. Part I: an historical and theoretical perspective. Med Teach. 2013;35(9):e1437–46.CrossRef
24.
go back to reference De Winter B, Hendrickx K, Michels N, Peeraer G. OSCE : objective structured clinical examination. Bijblijven : cumulatief geneeskundig nascholingssysteem. 2007;23(6):41–7.CrossRef De Winter B, Hendrickx K, Michels N, Peeraer G. OSCE : objective structured clinical examination. Bijblijven : cumulatief geneeskundig nascholingssysteem. 2007;23(6):41–7.CrossRef
25.
go back to reference Davis DA, Mazmanian PE, Fordis M, Van Harrison R, Thorpe KE, Perrier L. Accuracy of physician self-assessment compared with observed measures of competence: a systematic review. Jama. 2006;296(9):1094–102.CrossRef Davis DA, Mazmanian PE, Fordis M, Van Harrison R, Thorpe KE, Perrier L. Accuracy of physician self-assessment compared with observed measures of competence: a systematic review. Jama. 2006;296(9):1094–102.CrossRef
26.
go back to reference Bugaj T, Nikendei C. Practical Clinical Training in Skills Labs: Theory and Practice. GMS J Med Educ. 2016;33(4):Doc63.PubMedPubMedCentral Bugaj T, Nikendei C. Practical Clinical Training in Skills Labs: Theory and Practice. GMS J Med Educ. 2016;33(4):Doc63.PubMedPubMedCentral
27.
go back to reference Katz LM, Finch A, McKinnish T, Gilliland K, Tolleson-Rinehart S, Marks BL. Teaching procedural skills to medical students: a pilot procedural skills lab. Education for Health. 2017;30:79–83.CrossRef Katz LM, Finch A, McKinnish T, Gilliland K, Tolleson-Rinehart S, Marks BL. Teaching procedural skills to medical students: a pilot procedural skills lab. Education for Health. 2017;30:79–83.CrossRef
28.
go back to reference Issenberg SB, Mcgaghie WC, Petrusa ER, Gordon DL, Scalese RJ. Features and uses of high-fidelity medical simulations that lead to effective learning: a BEME systematic review. Med Teach. 2005;27(1):10–28.CrossRef Issenberg SB, Mcgaghie WC, Petrusa ER, Gordon DL, Scalese RJ. Features and uses of high-fidelity medical simulations that lead to effective learning: a BEME systematic review. Med Teach. 2005;27(1):10–28.CrossRef
29.
go back to reference Ramani S, Leinster S. AMEE guide no. 34: teaching in the clinical environment. Med Teach. 2008;30(4):347–64.CrossRef Ramani S, Leinster S. AMEE guide no. 34: teaching in the clinical environment. Med Teach. 2008;30(4):347–64.CrossRef
30.
go back to reference Kilminster S, Cottrell D, Grant J, Jolly B. AMEE guide no. 27: effective educational and clinical supervision. Med Teach. 2007;29(1):2–19.CrossRef Kilminster S, Cottrell D, Grant J, Jolly B. AMEE guide no. 27: effective educational and clinical supervision. Med Teach. 2007;29(1):2–19.CrossRef
Metadata
Title
An educational study to investigate the efficacy of three training methods for infiltration techniques on self-efficacy and skills of trainees in general practice
Authors
Nele R. Michels
Els Vanhomwegen
Publication date
01-12-2019
Publisher
BioMed Central
Published in
BMC Primary Care / Issue 1/2019
Electronic ISSN: 2731-4553
DOI
https://doi.org/10.1186/s12875-019-1023-7

Other articles of this Issue 1/2019

BMC Primary Care 1/2019 Go to the issue