Medicine that all residents must develop ''technical proficiency'' in several procedures, including central venous line placement.1 Developing competency in common procedural skills has long been a part of medical training. The philosophy of ''see-1, do-1, teach-1'' is still the most common means by which most residents seek to obtain this proficiency, even though serious concerns have been raised about this approach. 2 A typical first experience in central line placement usually involves an eager (or terrified) trainee making several clumsy attempts on an actual patient, under the hurried guidance of a senior resident who themselves received an unknown degree of training. In this scenario, rarely does standardized instruction, formal evaluation, or structured follow-up occur. A revitalized emphasis is now being placed on patient safety in healthcare, including an industry-wide commitment to minimizing procedural complications. The most common complications associated to central line placement include vascular damage and catheter-related bloodstream infections. A number of creative approaches are being developed to improve the quality of instruction on proper procedural techniques, all varying considerably in sophistication, scope, and rigor. Examples include the use of computer-assisted methods for training ultrasound-guided needle insertion techniques and ureteroscopy training, hands-on training with synthetic models for thoracentesis training, video training, and uterine aspiration using papayas.3-11 Implicit in this trend is recognition that we, as educators, healthcare providers, and patient advocates, must design more cost effective and efficient ways to teach medical and surgical procedural techniques to clinicians. Our approach was previously described in phase I of the Procedural Patient Safety Initiative (PPSI).12 In PPSI-I, we introduced a nonhuman tissue model (NHTM; Figure 1) as the basis for teaching physicians a more rigorous curriculum of essential central line placement skills. By way of brief review, the NHTMs were constructed by tunneling 0.2-mmthick rubber tubing (vessels) lengthwise through raw, whole chickens purchased at the grocery store. The vessels were filled with colored water to simulate blood. The NHTM has several unique features, including: (1) realistic-appearing vessels when viewed under ultrasound, which mimic the appearance of human internal jugular veins and carotid arteries ( Figure 2); (2) tissue turgor and vessel composition that produce realistic pops and flashes upon puncture and allow for multiple cannulations; (3) the ability to perform a complete central line placement (including wire advancement, dilation, line insertion, suturing, and sterile dressing placement); (4) cost effectiveness relative to other commercially-available products (each NHTM costs $120 and can withstand multiple cannulations over 2 days). [13][14][15][16][17] During the training sessions of Phase I, participants were oriented to the ultrasound machines, shown the contents of our central line kit,...