Mastery learning improves simulated central venous catheter insertion by emergency medicine teaching faculty

Abstract

Objectives Routine competency assessments of procedure skills, such as central venous catheter (CVC) insertion, do not occur beyond residency training. Evidence suggests variable, suboptimal attending physician procedure skills. Our study aimed to assess CVC insertion skill by academic emergency physicians, determine whether a simulation‐based mastery learning (SBML) intervention improves performance and investigate for variables that predict competence. Methods This is a pretest–posttest study that evaluated simulated CVC insertion by emergency medicine (EM) faculty physicians. We assessed 44 volunteer participants at a large academic medical center over a 1‐month period using a published 29‐item checklist. Our primary outcome was the difference in assessment score before and after a SBML intervention. A secondary analysis evaluated predictors of pretest performance. Results A total of 44 subjects participated. Only four of 44 (9.1%) of subjects met a predefined minimum passing score on pretest. Mean assessment scores increased by 21.5% following the SBML intervention (95% confidence interval [CI] of the difference = 18.1% to 24.8%, p < 0.001). In a regression model, pretest scores increased by 10.8% (95% CI = 2.9 to 18.7%, p = 0.009) if subjects completed postgraduate training within 5 years. Frequency of CVC insertion did not predict performance, but 25 of 44 (56.8%) faculty members had no documented performance or supervision of a CVC insertion within 1 year of assessment. Conclusions SBML is a promising method to assess and improve CVC insertion performance by EM faculty physicians. Recent completion of postgraduate training was a significant predictor of CVC insertion performance. Our results require validation in larger cohorts of EM physicians across other academic institutions.

Preparing interns for clinical practice through an institution-wide simulation-based mastery learning program for teaching central venous catheter placement

“…Studies have shown reduced needle passes, arterial punctures, catheter adjustments, and central line-associated bloodstream infections with SBML training in EM and IM residents. [22,23] Multiple studies have also described previous CVC training curricula, [24][25][26][27] orientation-based CVC curricula, [28][29][30] CVC curricula with SBML principles, [31,32] and an SBML orientation which included paracentesis and lumbar puncture for IM residents and medical students. [33,34] These previous efforts have focused on just-in-time education [22,23,31] or assessment of residents who traditionally performed more procedures during their training.…”

The role of teamwork and non-technical skills for improving emergency surgical outcomes: an international perspective

“…Medical simulation is an effective method of practical education: standardized, objective, adjustable, repeatable, safe, and attractive for the students, avoiding risks to patients and learners. Critical life skills can be controlled and adjusted during simulation scenarios, such as: leadership, collaboration, organization, critical thinking, problem-solving skills, independent learning skills, empathy, tolerance, communication skills, teamwork, and accountability [ 63 , 64 ]. It is essential to work with NTS concepts with the medical students since the beginning of the course.…”