Simulation-based mastery learning reduces complications during central venous catheter insertion in a medical intensive care unit

被引:426
作者
Barsuk, Jeffrey H. [1 ]
McGaghie, William C. [2 ]
Cohen, Elaine R. [1 ]
O'Leary, Kevin J. [1 ]
Wayne, Diane B. [1 ]
机构
[1] Northwestern Univ, Feinberg Sch Med, Dept Med, Chicago, IL 60611 USA
[2] Northwestern Univ, Feinberg Sch Med, Off Med Educ & Fac Dev, Chicago, IL 60611 USA
关键词
central venous catheterization; medical education; anatomic model; complications; clinical competence; quality of health care; SKILLS; RESIDENTS; PERFORMANCE; TECHNOLOGY; COMPETENCE; ACQUISITION; QUALITY;
D O I
10.1097/CCM.0b013e3181a57bc1
中图分类号
R4 [临床医学];
学科分类号
1002 ; 100602 ;
摘要
Objective: To determine the effect of a simulation-based mastery learning model on central venous catheter insertion skill and the prevalence of procedure-related complications in a medical intensive care unit over a 1-yr period. Design. Observational cohort study of an educational intervention. Setting: Tertiary-care urban teaching hospital. Subjects: One hundred three internal medicine and emergency medicine residents. Interventions: Twenty-seven residents were traditionally trained and did not receive simulation-based education. These residents were surveyed regarding complications and procedural seff-confidence on actual central venous catheters they inserted in the medical intensive care unit. Subsequently, 76 residents completed simulation-based training in internal jugular and subclavian central venous catheter insertions. Simulator-trained residents were expected to meet or exceed a minimum passing score set by an expert panel and measured by performance on a skills checklist (given both before and after the educational intervention), using a central venous catheter simulator. Simulator-trained residents also took a written pre- and posttest. Simulator-trained residents were surveyed regarding complications and procedural self-confidence on actual central venous catheters they inserted in the medical intensive care unit. Measurements and Main Results. Simulator-trained residents reported fewer needle passes (p < .0005), arterial punctures (p < .0005), catheter adjustments (p = .002), and higher success rates (p = .005) for actual central venous catheters inserted in the medical intensive care unit than traditionally trained residents. At clinical skills examination pretest, 12 (16%) of 76 simulator-trained residents met the minimum passing score for internal jugular central venous catheter insertion and 11 (14%) of 76 residents met the minimum passing score for subclavian central venous catheter insertion: mean (internal jugular) = 50.6%, SD = 23.4%; mean (subclavian) = 48.4%, So = 26.8%. After simulation training, all residents met or exceeded the minimum passing score at postlest: mean (internal jugular) = 93.9%, SD = 10.2; mean (subclavian) = 91.5%, SD = 17.1 (p < .0005). Written examination performance improved from mean = 70.3%, SD = 7.7%, to 84.8%, SD = 4.8% (p < .0005). Conclusions. A simulation-based mastery learning program increased residents' skills in simulated central venous catheter insertion and decreased complications related to central venous catheter insertions in actual patient care. (Crit Care Med 2009; 37:2697-2701)
引用
收藏
页码:2697 / 2701
页数:5
相关论文
共 31 条
[1]  
*AM BOARD EM MED, 2007, MOD CLIN PRACT EM ME
[2]  
*AM BOARD INT MED, PROC REQ INT MED
[3]  
Andreatta PB, 2006, ANN SURG, V243, P854, DOI 10.1097/01.sla.0000219641.79092.e5
[4]  
[Anonymous], 2003, Statistical Methods for Rates and Proportions
[5]  
BARSUK JH, J HOSP MED IN PRESS
[6]   Bronchoscopy simulator effectively prepares junior residents to competently perform basic clinical bronchoscopy [J].
Blum, MG ;
Powers, TW ;
Sundaresan, S .
ANNALS OF THORACIC SURGERY, 2004, 78 (01) :287-291
[7]   Reliability and validity of a simulation-based acute care skills assessment for medical students and residents [J].
Boulet, JR ;
Murray, D ;
Kras, J ;
Woodhouse, J ;
McAllister, J ;
Ziv, A .
ANESTHESIOLOGY, 2003, 99 (06) :1270-1280
[8]   COEFFICIENT KAPPA - SOME USES, MISUSES, AND ALTERNATIVES [J].
BRENNAN, RL ;
PREDIGER, DJ .
EDUCATIONAL AND PSYCHOLOGICAL MEASUREMENT, 1981, 41 (03) :687-699
[9]   Systematic review: The relationship between clinical experience and quality of health care [J].
Choudhry, NK ;
Fletcher, RH ;
Soumerai, SB .
ANNALS OF INTERNAL MEDICINE, 2005, 142 (04) :260-273
[10]   Multicenter, randomized, controlled trial of virtual-reality simulator training in acquisition of competency in colonoscopy [J].
Cohen, Jonathan ;
Cohen, Seth A. ;
Vora, Kinjal C. ;
Xue, Xiaonan ;
Burdick, J. Steven ;
Bank, Simmy ;
Bini, Edmund J. ;
Bodenheimer, Henry ;
Cerulli, Maurice ;
Gerdes, Hans ;
Greenwald, David ;
Gress, Frank ;
Grosman, Irwin ;
Hawes, Robert ;
Mullen, Gerard ;
Schnoll-Sussman, Felice ;
Starpoli, Anthony ;
Stevens, Peter ;
Tenner, Scott ;
Villanueva, Gerald .
GASTROINTESTINAL ENDOSCOPY, 2006, 64 (03) :361-368