Who is teaching and supervising our junior residents' central venous catheterizations?

Abstract

BackgroundThe extent to which medical residents are involved in the teaching and supervision of medical procedures is unknown. This study aims to evaluate the teaching and supervision of junior residents in central venous catheterization (CVC) by resident-teachers.MethodsAll PGY-1 internal medicine residents at two Canadian academic institutions were invited to complete a survey on their CVC experience, teaching, and supervision prior to their enrolment in a simulator CVC training curriculum.ResultsOf the 69 eligible PGY-1 residents, 32 (46%) consenting participants were included in the study. There were no significant baseline differences between participants from the two institutions in terms of sex, number of ICU months completed, previous CVC training received, number of CVCs observed and performed. Only 16 participants (50%) received any CVC training at baseline. Of those who received any training, 63% were taught only by senior resident-teachers. A total of 81 CVCs were placed by 17 participants. Thirty-two CVCs (45%) were supervised by resident-teachers.ConclusionsResident-teachers play a significant role both in the teaching and supervision of CVCs placed by junior residents. Educational efforts should focus on preparing residents for their role in teaching and supervision of procedures.

Simulation-based ultrasound-guided central venous cannulation training program

“…Therefore, the incorporation of senior residents emerges as an alternative that can reduce the number of faculty surgeons who are transferred from patient care for simulation environments without compromising learning 9 . For this, all educational efforts should focus on preparing residents for their role in teaching and supervision of US-guided CVC 9 . With this measure, faculty surgeons would focus on teaching complex tasks and cognitive aspects of surgical education (decision making in the operating theater).…”

“…In most residency programs, residents-in-training learn CVC by the apprenticeship model "see one, do one, teach one" 9,23 . However, in the last two decades, the efficiency, effectiveness and ethics of this training model have been increasingly questioned 19 .…”

“…. Additionally, although residents have reported that the use of US was one of the most important factors to avoid bedside procedural complications 9,10 , the US-guided technique requires knowledge of ultrasonography and hand-eye coordination, and most residents have little formal training in these fields 10 . Thus, given the apparent gap between regulatory expectations and actual performance, the development of alternatives for this training is of utmost importance 4 .…”

“…The adoption of a 1:4 (or 1:5) instructor: trainee ratio is recommended to maximize the hands-on training 18 . Additionally, as the number of faculty surgeons for simulation-based training is scarce, all feedback process can be given by attending physicians, surgical fellows, or residents without compromising the learning 8,9 . In our residency training program, senior surgical residents (second-or -third year) play an important role in the teaching and supervision of US-guided CVC for junior general surgical residents (first-year), similar to what was demonstrated in a recent study 9 conducted at two Canadian residency programs.…”

A Comparative Study between Two Central Venous Access Techniques Performed by Junior Residents

“…The ability to perform CVA competently is an important part of the initial surgical training [13], and both standard techniques of SC (infraclavicular approach) and IJ (anterior approach) access procedures have been mainly and equally taught at our department in order to provide our residents with comprehensive surgical skills in performing CVA. From an anatomical point of view, right-sided procedures have been preferred [14], and other alternative techniques of CVA by puncture or surgical cut-down access has also been taught.…”