title: Procedural competence in internal medicine residents: validity of a central venous catheter insertion assessment instrument.
abstract: OBJECTIVE
  Despite mandates from accreditation bodies for programs to ensure procedural competence, standardized measures do not exist to assess residents' skills in performing central venous catheter (CVC) insertion. The objective of the present study was to develop an instrument to assess residents in subclavian (SC) CVC insertion, to set performance standards, and to validate the tool using performance data.
  
  
  METHODS
  In 2007, the authors convened experts to create an assessment tool for CVC insertion using a modified Delphi method. They applied the Angoff method to a second set of experts to determine minimum passing scores (MPSs) for both the borderline trainee and the competent trainee. Two faculty evaluators then used the checklist to assess residents performing CVCs on simulators.
  
  
  RESULTS
  The authors created and experts confirmed a 24-item checklist. Using the Angoff method, the MPS required completion of 10 major and 2 minor criteria for a trainee to show borderline proficiency with CVC insertion under supervision. This MPS was correlated with a global rating of 2 on a 5-point scale. The MPS for competence was 17 major and 5 minor criteria. None of the residents deemed competent on a global rating scale achieved the MPS for competence.
  
  
  CONCLUSIONS
  The authors were able to create and validate a consensus-driven procedural assessment tool with data-driven standards for basic proficiency and competence that faculty can use to assess residents as they perform CVC insertion.
authors.affiliation: Carl J. Shapiro Institute for Education and Research, Harvard Medical School and Beth Israel Deaconess Medical Center, Boston, Massachusetts 02215, USA. ghuang@bidmc.harvard.edu
authors.forename: Grace C
authors.initials: GC
authors.lastname: Huang
authors.forename: Lori R
authors.initials: LR
authors.lastname: Newman
authors.forename: Richard M
authors.initials: RM
authors.lastname: Schwartzstein
authors.forename: Peter F
authors.initials: PF
authors.lastname: Clardy
authors.forename: David
authors.initials: D
authors.lastname: Feller-Kopman
authors.forename: Julie T
authors.initials: JT
authors.lastname: Irish
authors.forename: C Christopher
authors.initials: CC
authors.lastname: Smith
mesh_terms: D000328:Adult; D002405:Catheterization, Central Venous / Q000592:standards*; D002983:Clinical Competence / Q000592:standards*; D003697:Delphi Technique; D004503:Education, Medical, Graduate / Q000379:methods*; D004521:Educational Measurement / Q000379:methods*; D005260:Female; D006801:Humans; D007388:Internal Medicine / Q000193:education*; D007396:Internship and Residency; D008297:Male; D008348:Manikins; D013350:Subclavian Vein