Mastery learning of temporary hemodialysis catheter insertion by nephrology fellows using simulation technology and deliberate practice.
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.


METHODS
Prospective observational cohort study.


METHODS
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.


METHODS
Completion of CVC simulation education session.


RESULTS
THDC insertion skill performance.


METHODS
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.


CONCLUSIONS
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.
Department of Medicine, MD Office of Medical Education and Faculty Development, Northwestern University Feinberg School of Medicine, Chicago, IL, USA. jbarsuk@northwestern.edu
Jeffrey H
JH
Barsuk
Shubhada N
SN
Ahya
Elaine R
ER
Cohen
William C
WC
McGaghie
Diane B
DB
Wayne
D000328:Adult; D002405:Catheterization, Central Venous / Q000295:instrumentation / Q000379:methods*; D003162:Competency-Based Education / Q000379:methods*; D003625:Data Collection; D004493:Education / Q000639:trends; D004501:Education, Medical; D005260:Female; D006801:Humans; D008297:Male; D008953:Models, Anatomic; D009398:Nephrology / Q000193:education*; D011361:Professional Competence / Q000592:standards; D011446:Prospective Studies; D006435:Renal Dialysis / Q000295:instrumentation / Q000379:methods*; D013038:Specialization