Improving Resident Performance of Fine Needle Aspirations with a Step-Wise Assessment Tool.
Carrie B Marshall, Andrew B Sholl, Garth Aasen, Stephen Raab. University of Colorado Denver, Aurora
Background: Most residents learn the technique of performing a fine needle aspiration (FNA) in a non-standardized way. They are rarely exposed to the technique until they rotate on to the cytology service and their exposure is typically restricted to the cases which are aspirated during their tenure on the service. Furthermore, the instruction on FNA technique they receive can vary greatly depending on different faculty members they work with. In this study, we developed a step-wise checklist as a teaching tool to standardize and improve resident performed FNAs.
Design: We developed and pilot tested a step-wise checklist to assess competency in FNA technique. Residents who had minimal or no experience in the performance of FNA participated in a hands-on practical “wet-lab” in which they practiced FNAs on mock specimens. After a faculty demonstration of the technique, residents performed FNAs under direct observation of instructors. Each step of the procedure was graded either as performed well, performed poorly, or not performed. Different practical labs were organized with increasing levels of difficulty and complexity including: basic aspiration techniques, targeting palpable lesions of varying sizes, and aspiration of cystic lesions. The results of the checklist and areas for improvement were reviewed with the resident, with or without video footage of their performance.
Results: Residents from all levels of training showed improvement in their performance of FNAs after reviewing and practicing their technique step-by-step in a low pressure setting. Specific areas that were frequently performed poorly by residents included expressing aspirated material onto slides and creating optimally smeared slides.
Conclusions: By using a step-wise checklist, the residents received more standardized instruction regarding the proper technique of FNA. The residents became familiar with the steps and technique of the procedure and gained competency with the mechanical skills required for FNA. We feel this will lead to greater resident confidence, a better educational experience, and a reduction in the number of unsatisfactory or borderline samples when these residents perform FNAs on live patients in a clinical setting.
Tuesday, March 1, 2011 9:30 AM
Poster Session III # 131, Tuesday Morning