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Development and Evaluation of a Simulation-based Curriculum for Ultrasound-guided Central Venous Catheterization

  • Robert McGraw (a1), Tim Chaplin (a2), Conor McKaigney (a2), Louise Rang (a2), Melanie Jaeger (a3), Damian Redfearn (a4), Colleen Davison (a5), Tamas Ungi (a6), Matthew Holden (a6), Caitlin Yeo (a7), Zsuzsanna Keri (a6) and Gabor Fichtinger (a6)...
Abstract
Objective

To develop a simulation-based curriculum for residents to learn ultrasound-guided (USG) central venous catheter (CVC) insertion, and to study the volume and type of practice that leads to technical proficiency.

Methods

Ten post-graduate year two residents from the Departments of Emergency Medicine and Anesthesiology completed four training sessions of two hours each, at two week intervals, where they engaged in a structured program of deliberate practice of the fundamental skills of USG CVC insertion on a simulator. Progress during training was monitored using regular hand motion analysis (HMA) and performance benchmarks were determined by HMA of local experts. Blinded assessment of video recordings was done at the end of training to assess technical competence using a global rating scale.

Results

None of the residents met any of the expert benchmarks at baseline. Over the course of training, the HMA metrics of the residents revealed steady and significant improvement in technical proficiency. By the end of the fourth session six of 10 residents had faster procedure times than the mean expert benchmark, and nine of 10 residents had more efficient left and right hand motions than the mean expert benchmarks. Nine residents achieved mean GRS scores rating them competent to perform independently.

Conclusion

We successfully developed a simulation-based curriculum for residents learning the skills of USG CVC insertion. Our results suggest that engaging residents in three to four distributed sessions of deliberate practice of the fundamental skills of USG CVC insertion leads to steady and marked improvement in technical proficiency with individuals approaching or exceeding expert level benchmarks.

Objectifs

L’étude visait à élaborer un programme de formation axé sur la simulation et conçu à l’intention des résidents en vue de l’apprentissage de la mise en place échoguidée de cathéters veineux centraux (CVC), et à déterminer le nombre et le type d’exercices pratiques permettant d’en arriver à la compétence technique.

Méthode

Dix résidents, en deuxième année d’études de cycles supérieurs, en médecine d’urgence et en anesthésie ont participé à quatre séances de formation de deux heures chacune, tenues à deux semaines d’intervalle, dans le cadre d’un programme structuré de pratique intentionnelle sur simulateur, en vue de l’acquisition des compétences de base dans la mise en place échoguidée de CVC. Les progrès réalisés durant la formation ont été suivis de près à l’aide d’un outil régulier de mesure, l’Hand Motion Analysis (HMA), et les valeurs de référence ont été déterminées par l’HMA des experts locaux. À la fin des séances de formation, les compétences techniques enregistrées sur bande vidéo ont fait l’objet d’une évaluation à l’insu par des experts, sur une échelle globale de notation (EGN).

Résultats

Au départ, aucun des résidents n’atteignait l’une ou l’autre des valeurs de référence. Au fil de la formation, les mesures de l’HMA des résidents ont révélé une amélioration constante et importante de la compétence technique. À la fin de la quatrième séance, 6 résidents sur 10 avaient des durées de réalisation plus rapides que la valeur moyenne de référence des experts, et les mouvements de la main droite ou de la main gauche chez 9 résidents sur 10 avaient une efficacité supérieure aux valeurs moyennes de référence des experts. Enfin, les résultats moyens obtenus sur l’EGN par 9 résidents en ont fait des praticiens suffisamment compétents pour intervenir seuls.

Conclusions

Le programme de formation axé sur la simulation et élaboré par les auteurs à l’intention des résidents en vue de l’apprentissage de la mise en place échoguidée de CVC a été couronné de succès. De plus, les résultats autorisent à penser que le fait de suivre trois ou quatre séances de pratique intentionnelle, réparties dans le temps, en vue de l’acquisition des compétences de base dans la mise en place échoguidée de CVC conduit à une amélioration constante et importante de la compétence technique, de sorte que des résidents atteignent presque, voire dépassent, les valeurs de référence des experts.

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Copyright
Corresponding author
Correspondence to: Robert McGraw, MD, MEd, Department of Emergency Medicine, Kingston General Hospital, 76 Stuart Street, Kingston, ON, K7L2V7; Email: 3rcm4@queensu.ca
References
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1. Frank, JR, Jabbour, M, et al. Eds. Report of the CanMEDS Phase IV Working Groups. Ottawa: The Royal College of Physicians and Surgeons of Canada; 2005.
2. Troianos, CA, Hartman, GS, Glas, KE, et al. Guidelines for performing ultrasound guided vascular cannulation: recommendations of the American Society of Echocardiography and the Society of Cardiovascular Anesthesiologists. J Am Soc Echocardiogr 2011;24(12):1291-1318.
3. Chapman, GA, Johnson, D, Bodenham, AR. Visualization of needle position using ultrasonography. Anaesthesia 2006;61(2):148-158.
4. Gale, JA, Alan, DK. Ultrasound-Guided Central Vein Cannulation: Current Recommendations and Guidelines. Anesthesiology News 2012:1-8. Available at: http://www.anesthesiologynews.com.
5. Barsuk, JH, McGaghie, WC, Cohen, WR, et al. Use of simulation-based mastery learning to improve quality of central venous catheter placement in a medical intensive care unit. J Hosp Med 2009;4(7):397-403.
6. Ma, IW, Brindle, ME, Ronksley, PE, et al. Use of simulation-based education to improve outcomes of central venous catheterization: a systematic review and meta-analysis. Acad Med 2011;86(9):1137-1147.
7. Evans, LV, Dodge, KL, Shah, TD, et al. Simulation training in central venous catheter insertion: improved performance in clinical practice. Acad Med 2010;85(9):1462-1469.
8. McGaghie, WC, Issenberg, SB, Cohen, ER, et al. Does simulation-based medical education with deliberate practice yield better results than traditional clinical education? A meta-analytical comparative review of the evidence. Acad Med 2011;86(6):706-711.
9. Kneebone, R. Evaluating clinical simulations for learning procedural skills: a theory-based approach. Acad Med 2005;80(6):549-553.
10. Nguyen, BV, Prat, G, Vincent, JL, et al. Determination of learning curve for ultrasound-guided jugular central venous catheter placement. Intensive Care Med 2014;40(1):66-73, doi: 10.1007/s00134-013-3069-7.
11. Ericsson, KA, Krampe, RT, Tesch-Romer, C. The role of deliberate practice in the acquisition of expert performance. Psychol Rev 1993;100(3):363-406.
12. Swing, SR. Perspectives on competency-based medical education from the learning sciences. Med Teach 2010;32(8):663-668.
13. Datta, V, Mackay, S, Mandalia, M, et al. The use of electromagnetic motion tracking analysis to objectively measure open surgical skill in the laboratory-based model. J Am Coll Surg 2001;193(5):479-485.
14. Grober, ED, Roberts, M, Shin, EJ, et al. Intraoperative assessment of technical skills on live patients using economy of hand motion: establishing learning curves of surgical competence. Am J Surg 2010;199(1):81-85.
15. Clinkard, D, Holden, M, Ungi, T, et al. The development and validation of hand motion analysis to evaluate competency in central line catheterization. Acad Emerg Med 2015;22(2):212-218, doi: 10.1111/acem.12590.
16. Chin, KJ, Tse, C, Chan, V, et al. Hand motion analysis using the Imperial College Surgical Assessment Device: Validation of a novel and objective performance measure in ultrasound-guided peripheral nerve blockade. Reg Anesth Pain Med 2011;36(3):213-219.
17. Ungi, T, Sargent, D, Moult, E, et al. Perk Tutor: An Open-Source Training Platform for Ultrasound-Guided Needle Insertions. IEEE Trans Biomed Eng 2012;59(12):3475-3481.
18. Ma, IW, Zalunardo, N, Pachev, G, et al. Comparing the use of global rating scales with checklists for the assessment of central venous catheterization skills using simulation. Adv Health Sci Educ Theory Pract 2012;17(4):457-470.
19. Fairbrother, JT. Fundamentals of Motor Behaviour: Human Kinetics Fundamentals of Sport and Exercise Science Series. Champaign: Human Kinetics; 2010.
20. Reznick, R, MacRae, H. Teaching surgical skills-changes in the wind. N Engl J Med 2006;355(25):2664-2669.
21. Arthur, W, Bennet, W, Stanush, P, et al. Factors that influence skill decay and retention; a quantitative review and analysis. Hum Perform 1998;11(1):57-101.
22. Sites, BD, Spence, BC, Gallagher, JD, et al. Characterizing novice behavior associated with learning ultrasound-guided peripheral regional anesthesia. Reg Anesth Pain Med 2007;32(2):107-115.
23. Ziv, A, Wolpe, PR, Small, SD, et al. Simulation-based medical education: an ethical imperative. Acad Med 2003;78(8):783-788.
24. Frank, JR, Snell, LS, Cate, OT, et al. Competency-based medical education: theory to practice. Med Teach 2010;32(8):638-645.
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Canadian Journal of Emergency Medicine
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  • EISSN: 1481-8035
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