• Scott M Thomas, Wesley Burch, Sarah E Kuehnle, Robert G Flood, Anthony J Scalzo, and James M Gerard.
• 1Department of Pediatrics, Division of Pediatric Emergency Medicine, Washington University School of Medicine in St. Louis, St. Louis, MO. 2Saint Louis University Clinical Simulation Center, St. Louis, MO. 3Saint Louis University School of Medicine, St. Louis, MO. 4Department of Pediatrics, Division of Pediatric Emergency Medicine, Saint Louis University School of Medicine, St. Louis, MO.
• Pediatr Crit Care Me. 2013 Nov 1;14(9):e416-23.

ObjectiveTo assess the effect of simulation training on pediatric residents' acquisition and retention of central venous catheter insertion skills. A secondary objective was to assess the effect of simulation training on self-confidence to perform the procedure.DesignProspective observational pilot study.SettingSingle university clinical simulation center.SubjectsPediatric residents, postgraduate years 1-3.InterventionsResidents participated in a 60- to 90-minute ultrasound-guided central venous catheter simulation training session. Video recordings of residents performing simulated femoral central venous catheter insertions were made before (baseline), after, and at 3-month following training. Three blinded expert raters independently scored the performances using a 24-item checklist and 100-mm global rating scale. At each time point, residents rated their confidence to perform the procedure on a 100-mm scale.Measurements And Main ResultsTwenty-six residents completed the study. Compared with baseline, immediately following training, median checklist score (54.2% [interquartile range, 40.8-68.8%] vs 83.3% [interquartile range, 70.0-91.7%]), global rating score (8.0 mm [interquartile range, 0.0-64.3 mm] vs 79.5 mm [interquartile range, 16.3-91.7 mm]), success rate (38.5% vs 80.8%), and self-confidence (8.0 mm [interquartile range, 3.8-19.0 mm] vs 52.0 mm [interquartile range, 43.5-66.5 mm]) all improved (p < 0.05 for all variables). Compared with baseline, median checklist score (54.2% [interquartile range, 40.8-68.8%] vs 54.2% [interquartile range, 45.8-80.4%], p = 0.47), global rating score (8.0 mm [interquartile range, 0.0-64.3 mm] vs 35.5 mm [interquartile range, 5.3-77.0], p = 0.62), and success rate (38.5% vs 65.4%, p = 0.35) were similar at 3-month follow-up. Self-confidence, however, remained above baseline at 3-month follow-up (8.0 mm [interquartile range, 3.8-19.0 mm] vs 61.0 mm [interquartile range, 31.5-71.8 mm], p < 0.01).ConclusionsSimulation training improved pediatric residents' central venous catheter insertion procedural skills. Decay in skills was found at 3-month follow-up. This suggests that simulation training for this procedure should occur in close temporal proximity to times when these skills would most likely be used clinically and that frequent refresher training might be beneficial to prevent skills decay.

21 keywords...

hide…