Use of a National Continuing Medical Education Meeting to Provide Simulation-Based Training in Temporary Hemodialysis Catheter Insertion Skills: A Pre-Test Post-Test Study

Abstract

BackgroundSimulation-based-mastery-learning (SBML) is an effective method to train nephrology fellows to competently insert temporary, non-tunneled hemodialysis catheters (NTHCs). Previous studies of SBML for NTHC-insertion have been conducted at a local level.ObjectivesDetermine if SBML for NTHC-insertion can be effective when provided at a national continuing medical education (CME) meeting. Describe the correlation of demographic factors, prior experience with NTHC-insertion and procedural self-confidence with simulated performance of the procedure.DesignPre-test – post-test study.Setting2014 Canadian Society of Nephrology annual meeting.ParticipantsNephrology fellows, internal medicine residents and medical students.MeasurementsParticipants were surveyed regarding demographics, prior NTHC-insertion experience, procedural self-confidence and attitudes regarding the training they received. NTHC-insertion skills were assessed using a 28-item checklist.MethodsParticipants underwent a pre-test of their NTHC-insertion skills at the internal jugular site using a realistic patient simulator and ultrasound machine. Participants then had a training session that included a didactic presentation and 2 hours of deliberate practice using the simulator. On the following day, trainees completed a post-test of their NTHC-insertion skills. All participants were required to meet or exceed a minimum passing score (MPS) previously set at 79%. Trainees who did not reach the MPS were required to perform more deliberate practice until the MPS was achieved.ResultsTwenty-two individuals participated in SBML training. None met or exceeded the MPS at baseline with a median checklist score of 20 (IQR, 7.25 to 21). Seventeen of 22 participants (77%) completed post-testing and improved their scores to a median of 27 (IQR, 26 to 28; p < 0.001). All met or exceeded the MPS on their first attempt. There were no significant correlations between demographics, prior experience or procedural self-confidence with pre-test performance.LimitationsSmall sample-size and self-selection of participants. Costs could limit the long-term feasibility of providing this type of training at a CME conference.ConclusionsDespite most participants reporting having previously inserted NTHCs in clinical practice, none met the MPS at baseline; this suggests their prior training may have been inadequate.

Performance of Temporary Hemodialysis Catheter Insertion by Nephrology Fellows and Attending Nephrologists

“…Practice sessions using models are hard work work, higher procedural self-confidence was associated with higher simulated THDC insertion skills in this study (6,7,12,(18)(19)(20)(21). Nevertheless, the vast majority of attending nephrologists and all fellows failed to meet the MPS at baseline, indicating poor overall ability to self-assess procedural skill.…”

“…These findings are concerning but also, reminiscent of the wide variability in skills among attending surgeons performing laparoscopic gastric bypass surgery (17) and multiple studies showing that traditional clinical training does not reliably ensure that physicians can competently perform required procedures (6,7,(18)(19)(20). Our results are particularly troubling, because they show that attending nephrologists are not adequately trained to supervise and teach fellows in THDC insertion, which is a required skill established by the Royal College of Physicians and Surgeons of Canada (2).…”

“…Skills were assessed using a previously published 28-item skills checklist and a central venous catheter insertion simulator (6,7). Each attending nephrologist was assessed individually and asked to perform the THDC insertion as if it were an actual patient.…”

“…Simulation-based mastery learning (SBML) is superior to the traditional see one, do one, teach one method to develop THDC insertion skills among nephrology fellows (6,7). SBML is an extreme form of competencebased learning that requires learners to complete a structured curriculum, including pretesting, deliberate skills practice with feedback, and post-testing (8,9).…”

“…Prior research has analyzed the skills and confidence of nephrology fellows regarding THDC insertion and the benefit derived from SBML (6,7,14). However, little is known about the actual competence of supervising attending nephrologists to perform the procedure themselves.…”