Mastery Learning of Temporary Hemodialysis Catheter Insertion by Nephrology Fellows Using Simulation Technology and Deliberate Practice

Jeffrey H. Barsuk*, Shubhada N. Ahya, Elaine R. Cohen, William C. McGaghie, Diane B. Wayne

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

130 Scopus citations

Abstract

Background: Temporary hemodialysis catheter (THDC) insertion is a required skill for nephrology fellows. Traditional fellowship training may provide inadequate preparation to perform this procedure. Our aim was to use a central venous catheter (CVC) simulator to assess nephrology fellows' THDC insertion skills and evaluate the impact of an educational intervention on skill development to mastery standards. Study Design: Prospective observational cohort study. Setting & Participants: 18 nephrology fellows from 3 academic centers in Chicago from May to August 2008. Six graduating fellows (traditionally-trained) underwent assessment of internal jugular THDC insertion skill using a CVC simulator. Subsequently, 12 first-year fellows (simulator-trained) underwent baseline testing and received a 2-hour education session featuring deliberate practice with the CVC simulator. Simulator-trained fellows were retested after the intervention and expected to meet or exceed a minimum passing score. Predictor: Completion of CVC simulation education session. Outcomes: THDC insertion skill performance. Measurements: Skills examination was scored on a 27-item checklist. Minimum passing score was set by an expert panel. Results: Performance of traditionally-trained graduating fellows in THDC insertion was poor (mean, 53.1%), and only 17% met the minimum passing score. Performance of simulator-trained first-year fellows improved from a mean of 29.5% to a mean of 88.6% after simulator training (P = 0.002). Simulator-trained fellows showed significantly higher THDC insertion performance than traditionally-trained graduating fellows (P = 0.001). The education program was rated highly. Limitations: Although it represents fellows from 3 programs, sample size was small. Conclusions: A curriculum featuring deliberate practice dramatically increased the skill of nephrology fellows to mastery standards in THDC insertion. This program illustrates a feasible and reliable mechanism to achieve and document procedural competency.

Original languageEnglish (US)
Pages (from-to)70-76
Number of pages7
JournalAmerican Journal of Kidney Diseases
Volume54
Issue number1
DOIs
StatePublished - Jul 2009

Funding

Support: This work was supported by the Excellence in Academic Medicine Act of the Illinois Department of Public Aid administered by Northwestern Memorial Hospital and by the Augusta Webster Research Award from Northwestern University Feinberg School of Medicine.

Keywords

  • Central venous catheterization
  • clinical competence
  • mastery learning
  • medical education
  • nephrology
  • simulation-based education
  • temporary hemodialysis catheter
  • ultrasound

ASJC Scopus subject areas

  • Nephrology

Fingerprint

Dive into the research topics of 'Mastery Learning of Temporary Hemodialysis Catheter Insertion by Nephrology Fellows Using Simulation Technology and Deliberate Practice'. Together they form a unique fingerprint.

Cite this