{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,3]],"date-time":"2026-01-03T14:47:46Z","timestamp":1767451666134},"reference-count":30,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2021,5,6]],"date-time":"2021-05-06T00:00:00Z","timestamp":1620259200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2021,5,6]],"date-time":"2021-05-06T00:00:00Z","timestamp":1620259200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Med Educ"],"published-print":{"date-parts":[[2021,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Competency-based education has been shown to enhance clinical skills, improve patient care, and reduce number of complications resulting in a better return on investments. Residents constitute an important workforce at many hospitals. Yet, the effect of training on residents\u2019 contribution to production in patient care is scarcely studied. This study evaluated the effects of early competency-based procedural training on residents\u2019 contribution to patient care in central venous catheterization and spinal and epidural anesthesia.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>The design was a non-randomized cohort study of first-year anesthesiology residents. The intervention group received additional early focused skills training while three control groups received traditional competency-based education. The residents\u2019 contributions to patient care were compared between the intervention group (<jats:italic>n<\/jats:italic>\u2009=\u200920), a historical control group (<jats:italic>n<\/jats:italic>\u2009=\u200919), and between a contemporary control group (<jats:italic>n<\/jats:italic>\u2009=\u20097) and a historical control group (n\u2009=\u20097) from different departments. The residents\u2019 vs specialists\u2019 procedural production share was compared between years within each study group. We calculated specialist time saved compared to the time spent providing additional skills training in the intervention group.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>We found statistically significant increases in residents\u2019 vs specialists\u2019 share of total production after the intervention for epidural anesthesia: 2015: 0.51 (0.23, 0.70) to 2017: 0.94 (0.78, 1.05),<jats:italic>p<\/jats:italic>\u2009=\u20090.011 and central venous catheterization: 2015: 0.30 (0.23, 0.36) to 2016: 0.46 (0.35, 0.55),<jats:italic>p<\/jats:italic>\u2009=\u2009.008; and to 2017: 0.64 (0.50, 0.79),<jats:italic>p<\/jats:italic>\u2009=\u20090.008.<\/jats:p><jats:p>Comparison between residents and specialists on production of the three procedures before and after the intervention showed a surplus of 21\u2009h of freed specialist time per year.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Early procedural training results in more productive residents and freed specialist time for additional supervision, other clinical tasks or research. This provides empirical support for a positive correlation between early focused training and increased independent production among residents.<\/jats:p><\/jats:sec>","DOI":"10.1186\/s12909-021-02693-w","type":"journal-article","created":{"date-parts":[[2021,5,6]],"date-time":"2021-05-06T15:02:35Z","timestamp":1620313355000},"update-policy":"http:\/\/dx.doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Early procedural training increases anesthesiology residents\u2019 clinical production: a comparative pre-post study of the payoff in clinical training"],"prefix":"10.1186","volume":"21","author":[{"given":"Claus Hedebo","family":"Bisgaard","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Svein Aage","family":"Rodt","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Peter","family":"Musaeus","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jens Aage K\u00f8lsen","family":"Petersen","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sune Leisgaard M\u00f8rck","family":"Rubak","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2021,5,6]]},"reference":[{"key":"2693_CR1","unstructured":"Bloom BS. Learning for Mastery. Instruction and Curriculum. Regional Education Laboratory for the Carolinas and Virginia, Topical Papers and Reprints, Number 1. Eval. comment. 1968;"},{"issue":"1","key":"2693_CR2","doi-asserted-by":"publisher","first-page":"26","DOI":"10.3102\/0013189X018001026","volume":"18","author":"JB Carroll","year":"1989","unstructured":"Carroll JB. The Carroll model: a 25-year retrospective and prospective view. Educ Res [Internet]. 1989;18(1):26\u201331. Available from: http:\/\/edr.sagepub.com\/cgi\/doi\/10.3102\/0013189X018001026.","journal-title":"Educ Res [Internet]"},{"key":"2693_CR3","doi-asserted-by":"crossref","unstructured":"Long DM. Competency-based Residency Training: The Next Advance in Graduate Medical Education. Acad. Med. [Internet]. 2000;75. Available from: http:\/\/journals.lww.com\/academicmedicine\/Fulltext\/2000\/12000\/Competency_based_Residency_Training__The_Next.9.aspx","DOI":"10.1097\/00001888-200012000-00009"},{"issue":"1","key":"2693_CR4","doi-asserted-by":"publisher","first-page":"49","DOI":"10.1111\/j.1365-2923.2011.04142.x","volume":"46","author":"SJ Lurie","year":"2012","unstructured":"Lurie SJ. History and practice of competency-based assessment. Med Educ. 2012;46(1):49\u201357. https:\/\/doi.org\/10.1111\/j.1365-2923.2011.04142.x.","journal-title":"Med Educ"},{"key":"2693_CR5","doi-asserted-by":"crossref","unstructured":"Gruppen LD, Mangrulkar RS, Kolars JC, Frenk J, Chen L, Bhutta Z, et al. The promise of competency-based education in the health professions for improving global health. Hum. Resour. Health [Internet]. 2012;10:43. Available from: http:\/\/human-resources-health.biomedcentral.com\/articles\/10.1186\/1478-4491-10-43","DOI":"10.1186\/1478-4491-10-43"},{"key":"2693_CR6","doi-asserted-by":"crossref","unstructured":"Ebert TJ, Fox CA. Competency-based Education in Anesthesiology. Anesthesiology [Internet]. 2014;120:24\u201331. Available from: http:\/\/anesthesiology.pubs.asahq.org\/Article.aspx?doi=10.1097\/ALN.0000000000000039","DOI":"10.1097\/ALN.0000000000000039"},{"issue":"1","key":"2693_CR7","doi-asserted-by":"publisher","first-page":"125","DOI":"10.1111\/medu.13407","volume":"52","author":"J Sargeant","year":"2018","unstructured":"Sargeant J, Wong BM, Campbell CM. CPD of the future: a partnership between quality improvement and competency-based education. Med Educ. 2018;52(1):125\u201335. https:\/\/doi.org\/10.1111\/medu.13407.","journal-title":"Med Educ"},{"issue":"5","key":"2693_CR8","doi-asserted-by":"publisher","first-page":"464","DOI":"10.7861\/clinmedicine.10-5-464","volume":"10","author":"T Garrood","year":"2010","unstructured":"Garrood T, Iyer A, Gray K, Prentice H, Bamford R, Jenkin R, et al. A structured course teaching junior doctors invasive medical procedures results in sustained improvements in self-reported confidence. Clin Med England. 2010;10(5):464\u20137. https:\/\/doi.org\/10.7861\/clinmedicine.10-5-464.","journal-title":"Clin Med England"},{"key":"2693_CR9","unstructured":"McGaghie WC, Miller GE, Sajid AW, Telder TW. Competency-based curriculum development in medical education: an introduction [Internet]. Public Health Pap. 1978. Available from: http:\/\/eric.ed.gov\/?id=ED168447%5Cn; http:\/\/apps.who.int\/iris\/handle\/10665\/39703%5Cn. http:\/\/whqlibdoc.who.int\/php\/WHO_PHP_68.pdf."},{"key":"2693_CR10","doi-asserted-by":"crossref","unstructured":"Ringsted C, \u00d8stergaard D, Ravn L, Pedersen J a, Berlac P a, van der Vleuten CPM. A feasibility study comparing checklists and global rating forms to assess resident performance in clinical skills. Med. Teach. [Internet]. 2003 [cited 2014 Apr 9];25:654\u20138. Available from: http:\/\/www.ncbi.nlm.nih.gov\/pubmed\/15369915.","DOI":"10.1080\/01421590310001605642"},{"issue":"4","key":"2693_CR11","doi-asserted-by":"publisher","first-page":"165","DOI":"10.1097\/EJA.0b013e32834da759","volume":"29","author":"E Van Gessel","year":"2012","unstructured":"Van Gessel E, Mellin-Olsen J, \u00d8stergaard HT, Niemi-Murola L. Postgraduate training in anaesthesiology, pain and intensive care. Eur J Anaesthesiol [Internet]. 2012;29(4):165\u20138. Available from: http:\/\/content.wkhealth.com\/linkback\/openurl?sid=WKPTLP:landingpage&an=00003643-201204000-00001. https:\/\/doi.org\/10.1097\/EJA.0b013e32834da759.","journal-title":"Eur J Anaesthesiol [Internet]"},{"key":"2693_CR12","unstructured":"Accreditation Council for Graduate Medical Education. ACGME Program Requirements for Graduate Medical Education in Anesthesiology Critical Care Medicine. 2016;1\u201320. Available from: https:\/\/www.acgme.org\/Portals\/0\/PFAssets\/ProgramRequirements\/040_anesthesiology_2016.pdf"},{"key":"2693_CR13","unstructured":"ACGME. Report of the ACGME Work Group on Resident Duty Hours, June 11, 2002. 2002;1\u20139. Available from: http:\/\/www.acgme.org"},{"key":"2693_CR14","doi-asserted-by":"crossref","unstructured":"Jamal MH, Wong S, Whalen T V, Britt L, Sachdeva A, Healy G, et al. Effects of the reduction of surgical residents\u2019 work hours and implications for surgical residency programs: a narrative review. BMC Med. Educ. [Internet]. 2014;14:S14. Available from: http:\/\/bmcmededuc.biomedcentral.com\/articles\/10.1186\/1472-6920-14-S1-S14","DOI":"10.1186\/1472-6920-14-S1-S14"},{"key":"2693_CR15","unstructured":"DASAIM. Curriculum for Specialist Training in Anaesthesiology Core Training Programme for the Introduction year. 2013; Available from: http:\/\/www.dasaim.dk\/wp-content\/uploads\/2014\/04\/Core-curriculum-for-the-introduction-year.pdf"},{"key":"2693_CR16","doi-asserted-by":"crossref","unstructured":"Kogan JR, Whelan AJ, Gruppen LD, Lingard LA, Teunissen PW, ten Cate O. What Regulatory Requirements and Existing Structures Must Change If Competency-Based, Time-Variable Training Is Introduced Into the Continuum of Medical Education in the United States? Acad. Med. [Internet]. 2018;93:S27\u201331. Available from: http:\/\/insights.ovid.com\/crossref?an=00001888-201803001-00006","DOI":"10.1097\/ACM.0000000000002067"},{"issue":"8","key":"2693_CR17","doi-asserted-by":"publisher","first-page":"1025","DOI":"10.1097\/ACM.0000000000000734","volume":"90","author":"T Sawyer","year":"2015","unstructured":"Sawyer T, White M, Zaveri P, Chang T, Ades A, French H, et al. Learn, see, practice, prove, do. Maintain Acad Med [Internet]. 2015;90(8):1025\u201333. Available from: http:\/\/content.wkhealth.com\/linkback\/openurl?sid=WKPTLP:landingpage&an=00001888-201508000-00013. https:\/\/doi.org\/10.1097\/ACM.0000000000000734.","journal-title":"Maintain Acad Med [Internet]"},{"key":"2693_CR18","doi-asserted-by":"crossref","unstructured":"Wayne DB, Barsuk JH, O\u2019Leary KJ, Fudala MJ, McGaghie WC. Mastery learning of thoracentesis skills by internal medicine residents using simulation technology and deliberate practice. J. Hosp. Med. [Internet]. United States; 2008 [cited 2014 mar 25];3:48\u201354. Available from: http:\/\/www.ncbi.nlm.nih.gov\/pubmed\/18257046.","DOI":"10.1002\/jhm.268"},{"key":"2693_CR19","doi-asserted-by":"crossref","first-page":"387","DOI":"10.1002\/ccd.22812","volume":"78","author":"SBEW Rader","year":"2011","unstructured":"Rader SBEW, Jorgensen E, Bech B, Lonn L, Ringsted CV. Use of performance curves in estimating number of procedures required to achieve proficiency in coronary angiography. Catheter. Cardiovasc. Interv United States. 2011;78:387\u201393.","journal-title":"Catheter. Cardiovasc. Interv United States"},{"key":"2693_CR20","unstructured":"Kopacz DJ, Neal JM, Pollock JE. The regional anesthesia \u201clearing curve\u201d: What is the minimum number of epidural and spinal blocks to reach consistancy? [Internet]. Reg. Anesth. Pain Med. 1996. p. 182\u201390. Available from: http:\/\/journals.lww.com\/rapm\/Abstract\/1996\/21030\/The_Regional_Anesthesia__Learning_Curve___What_Is.2.aspx"},{"key":"2693_CR21","doi-asserted-by":"publisher","unstructured":"van Rossum TR, Scheele F, Sluiter HE, Bosman PJ, Rijksen L, Heyligers IC. Flexible competency based medical education: more time efficient, higher costs. Med. Teach. [Internet]. Informa UK ltd.; 2017;0:1\u20133. Available from: https:\/\/doi.org\/10.1080\/0142159X.2017.1395404, 2018.","DOI":"10.1080\/0142159X.2017.1395404"},{"key":"2693_CR22","volume-title":"Accelerating Competency-Based Anesthesiology Education: A non-randomized, intervention study. Submitted","author":"CH Bisgaard","year":"2020","unstructured":"Bisgaard CH, Rodt SA, Musaeus P, Petersen JAK, SLM R. Accelerating Competency-Based Anesthesiology Education: A non-randomized, intervention study. Submitted; 2020."},{"issue":"4","key":"2693_CR23","doi-asserted-by":"publisher","first-page":"375","DOI":"10.1111\/medu.12391","volume":"48","author":"WC McGaghie","year":"2014","unstructured":"McGaghie WC, Issenberg SB, Barsuk JH, Wayne DB. A critical review of simulation-based mastery learning with translational outcomes. Med Educ England. 2014;48(4):375\u201385. https:\/\/doi.org\/10.1111\/medu.12391.","journal-title":"Med Educ England"},{"key":"2693_CR24","doi-asserted-by":"crossref","unstructured":"Naik VN, Wong AK, Hamstra SJ. Review article: leading the future: guiding two predominant paradigm shifts in medical education through scholarship. Can. J. Anaesth. [Internet]. 2012 [cited 2014 Apr 1];59:213\u201323. Available from: http:\/\/www.ncbi.nlm.nih.gov\/pubmed\/22161271.","DOI":"10.1007\/s12630-011-9640-1"},{"issue":"1","key":"2693_CR25","doi-asserted-by":"publisher","first-page":"28","DOI":"10.1016\/S0002-9610(98)00289-X","volume":"177","author":"M Bridges","year":"1999","unstructured":"Bridges M, Diamond DL. The financial impact of teaching surgical residents in the operating room. Am J Surg. 1999;177(1):28\u201332. https:\/\/doi.org\/10.1016\/S0002-9610(98)00289-X.","journal-title":"Am J Surg"},{"issue":"3S","key":"2693_CR26","doi-asserted-by":"publisher","first-page":"S32","DOI":"10.1097\/ACM.0000000000002078","volume":"93","author":"RG Hoff","year":"2018","unstructured":"Hoff RG, Frenkel J, Imhof SM, ten Cate O. Flexibility in Postgraduate medical training in the Netherlands. Acad Med [Internet]. 2018;93(3S):S32\u20136. Available from: http:\/\/insights.ovid.com\/crossref?an=00001888-201803001-00007. https:\/\/doi.org\/10.1097\/ACM.0000000000002078.","journal-title":"Acad Med [Internet]"},{"issue":"2","key":"2693_CR27","doi-asserted-by":"publisher","first-page":"186","DOI":"10.1177\/1046878192232006","volume":"23","author":"B Steinwachs","year":"1992","unstructured":"Steinwachs B. How to facilitate a debriefing. Simul Gaming [Internet]. 1992;23(2):186\u201395. Available from: http:\/\/sag.sagepub.com\/cgi\/doi\/10.1177\/1046878192232006.","journal-title":"Simul Gaming [Internet]"},{"key":"2693_CR28","doi-asserted-by":"crossref","unstructured":"Friedman M. The Use of Ranks to Avoid the Assumption of Normality Implicit in the Analysis of Variance. J. Am. Stat. Assoc. [Internet]. 1937;32:675. Available from: http:\/\/www.jstor.org\/stable\/2279372?origin=crossref","DOI":"10.1080\/01621459.1937.10503522"},{"key":"2693_CR29","doi-asserted-by":"crossref","unstructured":"Wilcoxon F. Individual Comparisons by Ranking Methods Author ( s ): Frank Wilcoxon Published by : International Biometric Society. Biometrics Bull. [Internet]. 1945;1:80\u20133. Available from: http:\/\/www.jstor.org\/stable\/3001968","DOI":"10.2307\/3001968"},{"issue":"1","key":"2693_CR30","doi-asserted-by":"publisher","first-page":"154","DOI":"10.1186\/s12909-018-1262-7","volume":"18","author":"CH Bisgaard","year":"2018","unstructured":"Bisgaard CH, Rubak SLM, Rodt SA, Petersen JAK, Musaeus P. The effects of graduate competency-based education and mastery learning on patient care and return on investment: a narrative review of basic anesthetic procedures. BMC Med Educ. 2018;18(1):154. https:\/\/doi.org\/10.1186\/s12909-018-1262-7.","journal-title":"BMC Med Educ"}],"container-title":["BMC Medical Education"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12909-021-02693-w.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12909-021-02693-w\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12909-021-02693-w.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,8,30]],"date-time":"2024-08-30T08:16:40Z","timestamp":1725005800000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmcmededuc.biomedcentral.com\/articles\/10.1186\/s12909-021-02693-w"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,5,6]]},"references-count":30,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2021,12]]}},"alternative-id":["2693"],"URL":"https:\/\/doi.org\/10.1186\/s12909-021-02693-w","relation":{},"ISSN":["1472-6920"],"issn-type":[{"type":"electronic","value":"1472-6920"}],"subject":[],"published":{"date-parts":[[2021,5,6]]},"assertion":[{"value":"21 February 2021","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"5 April 2021","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"6 May 2021","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Ethics approval was waivered as the focus of the study is the residents, not the patients according to Central Denmark Committee on Health Research Ethics (case no: 1\u201310\u201372-113-14).All methods were carried out in accordance with relevant guidelines and regulations.All participants provided informed consent.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable owing to the anonymized data.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare that they have no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"262"}}