Simulation-based mastery learning reduces complications during central venous catheter insertion in a medical intensive care unit

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Abstract

Objective: To determine the effect of a simulation-based mastery learning model on central venous catheter insertion skill and the prevalence of procedure-related complications in a medical intensive care unit over a 1-yr period. Design: Observational cohort study of an educational intervention. Setting: Tertiary-care urban teaching hospital. Subjects: One hundred three internal medicine and emergency medicine residents. Interventions: Twenty-seven residents were traditionally trained and did not receive simulation-based education. These residents were surveyed regarding complications and procedural self-confidence on actual central venous catheters they inserted in the medical intensive care unit. Subsequently, 76 residents completed simulation-based training in internal jugular and subclavian central venous catheter insertions. Simulator-trained residents were expected to meet or exceed a minimum passing score set by an expert panel and measured by performance on a skills checklist (given both before and after the educational intervention), using a central venous catheter simulator. Simulator-trained residents also took a written pre- and posttest. Simulator-trained residents were surveyed regarding complications and procedural self-confidence on actual central venous catheters they inserted in the medical intensive care unit. Measurements and Main Results: Simulator-trained residents reported fewer needle passes (p < .0005), arterial punctures (p < .0005), catheter adjustments (p = .002), and higher success rates (p = .005) for actual central venous catheters inserted in the medical intensive care unit than traditionally trained residents. At clinical skills examination pretest, 12 (16%) of 76 simulator-trained residents met the minimum passing score for internal jugular central venous catheter insertion and 11 (14%) of 76 residents met the minimum passing score for subclavian central venous catheter insertion: mean (internal jugular) = 50.6%, sd = 23.4%; mean (subclavian) = 48.4%, sd = 26.8%. After simulation training, all residents met or exceeded the minimum passing score at posttest: mean (internal jugular) = 93.9%, sd = 10.2; mean (subclavian) = 91.5%, sd = 17.1 (p < .0005). Written examination performance improved from mean = 70.3%, sd = 7.7%, to 84.8%, sd = 4.8% (p < .0005). Conclusions: A simulation-based mastery learning program increased residents' skills in simulated central venous catheter insertion and decreased complications related to central venous catheter insertions in actual patient care.

Original languageEnglish (US)
Pages (from-to)2697-2701
Number of pages5
JournalCritical care medicine
Volume37
Issue number10
DOIs
StatePublished - Oct 2009

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Keywords

  • Anatomic model
  • Central venous catheterization
  • Clinical competence
  • Complications
  • Medical education
  • Quality of health care

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

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