Practice makes perfect: Using simulation to build and assess competency in bone marrow biopsy for heme/onc fellows.

9042 Background: The American Board of Internal Medicine (ABIM) requires that Hematology/Oncology fellows demonstrate competence in bone marrow biopsies (BMB). However, offers no guidance in assessment methods. Neither the "see one, do one, teach one" nor the "complete 5 procedures" approach is sufficient to ensure competency. As this is a potentially painful procedure that requires knowledge of landmarks, simulation in a safe environment is an ideal way to introduce BMB to trainees. In 2015, we started a simulation program to teach fellows how to perform BMB using a cadaver pelvis, and assess their BMB competency. Methods: The Hematology Oncology Fellowship Program at Gundersen Health System holds a half-day simulation for our 6 fellows each July. We begin with a self-evaluation of current skills, using an 8-question pre-test. We then view a demonstration video, pausing to discuss key learning points. Fellows are given a detailed check list of the steps of the procedure. They then experiment with the tools of the procedure and practice sterile technique. We discuss the indications, contraindications, consent, and the procedure itself. For part two, fellows are divided into two groups, each consisting of a first year (F1), second year (F2), and third year (F3) fellow. A cadaver pelvis is used as the model and is positioned in a prone position. Each team is assigned a side of the pelvis. The F3 demonstrates the procedure from start to finish while the F2 and staff assesses competency and the F1 follows with the procedure check list. Once the F3 has completed the procedure and is deemed "competent" they become the leader of the session for their team. F1s can practice as many times as desired, under the guidance of the F2 and F3. F2s also have a chance to refine their skills. After the simulation is complete, fellows repeat the self-evaluation, and we debrief. Results: 44 fellows completed the simulation (F1=16, F2=14, F3=14). Questions for the pre- and post-tests were ranked on a 5-point Likert Scale of strongly agree (1) to strongly disagree (5). F1s had the worst self-assessment prior to the procedure, with a mean score of 2.4 for all questions. However, their post-test self-assessment improved to 1.6. F2s started at 1.5 and improved to 1.1 after the simulation. F3s started at 1.2 and improved to 1.0. All fellows answered that this was a useful exercise and should be continued. Comments were consistently positive, speaking to the importance of a check list, the relaxed atmosphere, and having senior fellows teach the junior fellows. Conclusions: BMB simulation allows for a low-stakes introduction to a stressful procedure, while promoting a team approach to learning. It also gives an opportunity to verify competence for graduating fellows. Fellows self-reported improvement following the session as well as from year to year. Fellows value this learning experience and look forward to it each year.