Learning and Retention Rates after Training in Posterior Epistaxis Management


  • Presented at the Society for Academic Emergency Medicine Annual Meeting, Boston, MA, May 30, 2003.

Address for correspondence and reprints: Richard L. Lammers, MD; e-mail: lammers@kcms.msu.edu.


Objectives:  The objective of the study was to compare the learning and retention rates of resident physicians trained in posterior epistaxis management with nasal gauze packing on a simulation model following two training methods.

Methods:  This was a prospective, repeated-measures study. An objective, criterion-referenced performance standard, consisting of the number of major steps completed in the proper sequence, and the number of minor steps completed within a specified time, was used by an evaluator to assess performances. Subjects underwent two pretraining assessments 1 week prior to and the day of training and then were randomized to one of two training methods: the traditional “observation” method or a “pause-and-perfect” method. After training, both groups repeated the procedure until meeting the performance standard. Subjects were retested 1 and 3 months after training.

Results:  Twenty-eight subjects participated. Baseline performance measures were similar between groups and did not change prior to training. During performance testing, experimental subjects completed a greater percentage of major steps (84%) and minor steps (86%) in less time (25 minutes) than the controls (65 and 68%, in 35 minutes) during the first attempt. All subjects met the standard within three attempts. There were no differences in major and minor steps completed between the two groups at either 1 week or 3 months after training, but performance times were shorter in the experimental group. After 3 months, 13% of control and none of experimental subjects met the performance standard.

Conclusions:  The pause-and-perfect training method produced more rapid progress toward a performance standard during the initial attempt and better performance times after 3 months than the traditional, observational training method. Without further practice, this skill deteriorated after 3 months with both methods of training.