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

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.