• Jeffrey H Barsuk, Shubhada N Ahya, Elaine R Cohen, William C McGaghie, and Diane B Wayne.
• Department of Medicine, MD Office of Medical Education and Faculty Development, Northwestern University Feinberg School of Medicine, Chicago, IL, USA. jbarsuk@northwestern.edu
• Am. J. Kidney Dis. 2009 Jul 1;54(1):70-6.

BackgroundTemporary 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 DesignProspective observational cohort study.Setting & Participants18 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.PredictorCompletion of CVC simulation education session.OutcomesTHDC insertion skill performance.MeasurementsSkills examination was scored on a 27-item checklist. Minimum passing score was set by an expert panel.ResultsPerformance 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.LimitationsAlthough it represents fellows from 3 programs, sample size was small.ConclusionsA 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.

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