Clinical Impact of a Simulation-Based Mastery Learning Intervention on Academic Emergency Physicians for Distal Radius Fracture Management

Emergency medicine (EM) physicians must be proficient in managing distal radius fractures (DRFs), yet excessive faculty-directed consultation with orthopedic surgery during residency training may reduce opportunities for EM residents to practice closed reduction and splinting techniques. This study aimed to: 1) determine if an educational intervention for teaching faculty would increase EM-performed DRF closed reductions, and 2) evaluate for associated changes in patient room to disposition time or repeat reduction attempts.

This was an observational cohort study of an educational intervention on 51 EM clinical faculty members at a large teaching hospital. Faculty members participated in a simulation-based mastery learning (SBML) intervention on DRF management between August and December 2023. We compared clinical data related to participant treatment encounters with patients ≥18 years old that had a DRF requiring closed reduction one year before and after the intervention, with participants serving as their own controls. Our primary outcome was the change in proportion of patients with a DRF that underwent closed reduction by the treating EM team rather than orthopedic surgery. Secondary outcomes included comparisons of patient room-to-disposition time and repeat reduction attempts. We performed a mixed model regression analysis with fixed effects to control for confounding variables and a random effect to account for non-independence of encounters treated by the same participant.

Of the 51 participants, 43 (84.3%) encountered 117 adult patients with a DRF requiring closed reduction during the study period. In the mixed effects model, the proportion of participants performing a DRF closed reduction was higher after the intervention (OR 2.50, 95%CI 1.03-6.25, p=0.044), accounting for associated fractures, clinical shifts per month, participant years since completion of residency training, and resident involvement in patient care. Average patient room-to-disposition time and the number of repeat closed reduction attempts did not significantly change.

A SBML intervention on DRF management for teaching faculty increased clinical learning opportunities for EM residents without a significant change in patient throughput times or repeat reduction attempts.