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Simulation Training for Pediatric Residents on Central Venous Catheter Placement: A Pilot Study*

Thomas, Scott M. MD1; Burch, Wesley AAH2; Kuehnle, Sarah E. BA3; Flood, Robert G. MD4; Scalzo, Anthony J. MD2,4; Gerard, James M. MD4

Pediatric Critical Care Medicine: November 2013 - Volume 14 - Issue 9 - p e416–e423
doi: 10.1097/PCC.0b013e31829f5eda
Online Clinical Investigations

Objective: To 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.

Design: Prospective observational pilot study.

Setting: Single university clinical simulation center.

Subjects: Pediatric residents, postgraduate years 1–3.

Interventions: Residents 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 Results: Twenty-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).

Conclusions: Simulation 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.

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.

* See also p. 908.

This study was conducted at the Saint Louis University Clinical Simulation Center, St. Louis, MO.

Supported, in part, by an intramural Fleur-de-lis Grant. This study used a central venous catheter task trainer that was purchased for the Saint Louis University Clinical Simulation Center by the not-for-profit Glennon Guild.

The authors have disclosed that they do not have any potential conflicts of interest.

For information regarding this article, E-mail: gerardjm@slu.edu

©2013The Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies