Use of simulation‐based mastery learning to improve the quality of central venous catheter placement in a medical intensive care unit

Abstract

Disclosure: The authors have no financial or other potential conflicts of interest.BACKGROUND: Central venous catheter (CVC) insertions are performed frequently by internal medicine residents.Complications, including arterial puncture and pneumothorax, decrease when operators use fewer needle passes to insert the CVC. In this study, we evaluated the effect of simulation-based mastery learning on CVC insertion skill. DESIGN:This was a cohort study of internal jugular (IJ) and subclavian (SC) CVC insertions by 41 internal medicine residents rotating through the medical intensive care unit (MICU) over a five-month period. Thirteen traditionallytrained residents were surveyed about the number of needle passes, complications, and procedural self-confidence on CVCs inserted in the MICU. Concurrently, 28 residents completed simulation-based training in IJ and SC CVC insertions. Simulator-trained residents were expected to perform CVC insertions to mastery standards on a central line simulator. Simulator-trained residents then rotated through the MICU and were surveyed regarding CVC placement. The impact of simulation training was assessed by comparing group survey results. Central venous catheter (CVC) insertions are commonly performed at the bedside in medical intensive care unit (MICU) settings. Internal medicine residents are required to demonstrate knowledge regarding CVC indications, complications, and sterile technique, 1 and often perform the procedure during training. Education in CVC insertion is needed because many internal medicine residents are uncomfortable performing this procedure. 2 CVC insertion also carries the risk of potentially life-threatening complications including infection, pneumothorax, arterial puncture, deep vein thrombosis, and bleeding. Education and training may also contribute to improved patient care because increased physician experience with CVC insertion reduces complication risk. 3,4 Similarly, a higher number of needle passes or attempts during CVC insertion correlates with mechanical complications such as pneumothorax or arterial punctures. 4-8 Pneumothorax rates for internal jugular (IJ) CVCs have been reported to range from 0% to 0.2% and for subclavian (SC) CVCs from 1.5% to 3.1%. 4,5 The arterial puncture rate for IJ CVCs ranges from 5.0% to 9.4% and for SC CVCs from 3.1% to 4.9%. 4,5 Proper use of ultrasound to assist with IJ CVC insertion has been shown to decrease these mechanical complications. 4,5 However, studies of ultrasound use with SC CVC insertion have mixed results. 4 Simulation-based training has been used in medical education to increase knowledge, provide opportunities for deliberate and safe practice, and shape the development of RESULTS: Journal of Hospital Medicine Vol 4 No 7 September 2009 397clinical skills. 9,10 We previously used simulation-based mastery learning to improve the thoracentesis and advanced cardiac life support (ACLS) skills of internal medicine residents. 11,12 Although a few small studies have linked simulation-based interventions to imp...

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Improving neonatal intubation safety: A journey of a thousand miles

“…Using a simulation-based mastery learning method, as outlined in the LSPPDM pedagogy, Barsuk et al were able to improve success rates and decrease complications during central venous catheter placement by residents [20,21]. It is possible that the same results could extend to intubation [22].…”

Sim One, Do One, Teach One: Considerations in Designing Training Curricula for Surgical Simulation

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