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Physician Versus Nonphysician Instruction

Evaluating an Expert Curriculum-Competent Facilitator Model for Simulation-Based Central Venous Catheter Training

Musits, Andrew N. MD, MS; Phrampus, Paul E. MD; Lutz, John W. BS; Bear, Todd M. PhD, MPH; Maximous, Stephanie I. MD; Mrkva, Andrew J. MA; O'Donnell, John M. CRNA, MSN, DRPH

doi: 10.1097/SIH.0000000000000374
Empirical Investigations

Introduction Healthcare simulation supports educational opportunities while maintaining patient safety. To reduce costs and increase the availability of training, a randomized controlled study evaluated central venous catheter (CVC) insertion training in the simulation laboratory with nonphysician competent facilitators (NPCFs) as instructors.

Method A group of learners naive to central line placement participated in a blended curriculum consisting of interactive online materials and simulation-based training. Learners were randomized to training with NPCFs or attending physician faculty. The primary outcome was simulated CVC insertion task performance, graded with a validated checklist by blinded physician reviewers. Learner knowledge and satisfaction were also evaluated. Analysis was conducted using noninferiority testing.

Results Eighty-five students, 11 attending physicians, and 7 NPCFs voluntarily participated. Noninferiority testing of the difference in CVC insertion performance between NPCF-trained learners versus physician-trained learners found no significant difference [rejecting the null hypothesis of inferiority using an 8% noninferiority margin (P < 0.01)]. In addition, there was no difference found between the 2 groups on pre/post knowledge scores, self-reported learner comfort, course satisfaction, or instructor satisfaction.

Conclusions An introductory CVC curriculum can be taught to novice learners by carefully trained and supported NPCFs and achieve skill and knowledge outcomes similar to learners taught by physicians.

From the Department of Emergency Medicine (A.N.M.), Brown University Warren Alpert Medical School, Providence, RI; Department of Emergency Medicine (P.E.P.), University of Pittsburgh School of Medicine; Winter Institute for Simulation Education and Research (J.W.L., P.E.P., J.M.O.), University of Pittsburgh; Department of Behavioral and Community Health Sciences (T.M.B., A.J.M.), University of Pittsburgh School of Public Health; Department of Medicine (S.I.M.), Division of Pulmonary, Allergy, and Critical Care Medicine, University of Pittsburgh School of Medicine; and Department of Nurse Anesthesia (J.M.O.), University of Pittsburgh School of Nursing, Pittsburgh, PA.

Reprints: Andrew Musits, MD, MS, Lifespan Medical Simulation Center, One Hoppin St, Suite 106, Providence RI 02903 (e-mail:

The authors declare no conflict of interest.

This study was determined to have exempt status by the Human Research Protection Office at the University of Pittsburgh and approved by the research on medical students committee at the University of Pittsburgh Medical School.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s Web site (

Online date: May 21, 2019

© 2019 Society for Simulation in Healthcare