title: A curricular initiative for internal medicine residents to enhance proficiency in internal jugular central venous line placement.
abstract: OBJECTIVE
  To determine the feasibility, efficacy, and outcomes of teaching Internal Jugular (IJ) central venous line placement (CVLP) to internal medicine residents in a hands-on training experience with adult patients.
  
  
  METHODS
  Data were obtained from 47 residents during their 3-year residency program through questionnaires and a proprietary system that tracks resident procedures. Twenty-five postgraduate year (PGY) 2 residents at the Mayo Clinic in Rochester, Minn, were assigned to IJ-CVLP training in the cardiac catheterization laboratory from January 2001 to June 2001. Their experience, analyzed immediately after training and at completion of residency, was compared with that of 22 PGY-2 residents in the same class who were not assigned to IJ-CVLP training.
  
  
  RESULTS
  The median Likert scores of the residents' self-reported perception of independence in IJ-CVLP increased from 3.0 (mean +/- SD score, 2.8+/-1.4) before the intervention to 5.0 (4.4+/-0.9) after the intervention (P<.001, signed rank test). At graduation, trained residents had performed more IJ-CVLPs than the control residents (mean +/- SD, 17.8+/-8.4 vs 9.8+/-6.3, respectively; P<.001). Residents who received IJ-CVLP training, compared with those who did not, showed a significant increase in the mean percentage of IJ-CVLPs performed independently between PGY-1 (2.2%) and PGY-3 (31.2%) (P=.008).
  
  
  CONCLUSIONS
  Training internal medicine residents to perform IJ-CVLP is feasible in the cardiac catheterization laboratory with supervision from an attending cardiologist. Trained residents performed significantly more IJ-CVLPs independently during their third year compared with their first year of training. We believe this initiative may be implemented successfully in graduate medical education curriculums.
authors.affiliation: Department of Internal Medicine and Division of Cardiovascular Diseases, Mayo Clinic College of Medicine, Rochester, Minn 55905, USA.
authors.forename: Gautam
authors.initials: G
authors.lastname: Ramakrishna
authors.forename: Stuart T
authors.initials: ST
authors.lastname: Higano
authors.forename: Furman S
authors.initials: FS
authors.lastname: McDonald
authors.forename: Henry J
authors.initials: HJ
authors.lastname: Schultz
mesh_terms: D000328:Adult; D002405:Catheterization, Central Venous; D002983:Clinical Competence; D003162:Competency-Based Education / Q000379:methods*; D005240:Feasibility Studies; D005500:Follow-Up Studies; D006801:Humans; D007388:Internal Medicine / Q000193:education*; D007396:Internship and Residency; D007601:Jugular Veins / Q000601:surgery*; D011446:Prospective Studies