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.
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.
Authors: Jeffrey H Barsuk; Elaine R Cohen; Timothy Caprio; William C McGaghie; Tanya Simuni; Diane B Wayne Journal: Neurology Date: 2012-06-06 Impact factor: 9.910
Authors: Rory F McQuillan; Edward Clark; Alireza Zahirieh; Elaine R Cohen; James J Paparello; Diane B Wayne; Jeffrey H Barsuk Journal: Clin J Am Soc Nephrol Date: 2015-09-25 Impact factor: 8.237
Authors: Lisa K Prince; Dustin J Little; Katherine I Schexneider; Christina M Yuan Journal: Clin J Am Soc Nephrol Date: 2016-11-10 Impact factor: 8.237
Authors: Jeffrey H Barsuk; Elaine R Cohen; John A Vozenilek; Lanty M O'Connor; William C McGaghie; Diane B Wayne Journal: J Grad Med Educ Date: 2012-03
Authors: David F Pepley; Hong-En Chen; Yichun Tang; Sanjib Das Adhikary; Scarlett R Miller; Jason Z Moore Journal: IEEE Trans Haptics Date: 2019-05-02 Impact factor: 2.487