title: Use of simulation-based mastery learning to improve the quality of central venous catheter placement in a medical intensive care unit.
abstract: BACKGROUND
  Central venous catheter (CVC) insertions are performed frequently by internal medicine residents. Complications, including arterial puncture and pneumothorax, decrease when operators use fewer needle passes to insert the CVC. In this study, we evaluated the effect of simulation-based mastery learning on CVC insertion skill.
  
  
  METHODS
  This was a cohort study of internal jugular (IJ) and subclavian (SC) CVC insertions by 41 internal medicine residents rotating through the medical intensive care unit (MICU) over a five-month period. Thirteen traditionally-trained residents were surveyed about the number of needle passes, complications, and procedural self-confidence on CVCs inserted in the MICU. Concurrently, 28 residents completed simulation-based training in IJ and SC CVC insertions. Simulator-trained residents were expected to perform CVC insertions to mastery standards on a central line simulator. Simulator-trained residents then rotated through the MICU and were surveyed regarding CVC placement. The impact of simulation training was assessed by comparing group survey results.
  
  
  RESULTS
  No resident met the minimum passing score (MPS) (79.1%) for CVC insertion at baseline: mean (M) (IJ) = 48.4%, standard deviation (SD) = 23.1, M(SC) = 45.2%, SD = 26.3. All residents met or exceeded the MPS at testing after simulation training: M(IJ) = 94.8%, SD = 10.0, M(SC) = 91.1%, SD = 17.8 (p < 0.001). In the MICU, simulator-trained residents required fewer needle passes to insert a CVC than traditionally-trained residents: M = 1.79, SD = 1.0 versus M = 2.78, SD = 1.77 (p = 0.04). Simulator-trained residents displayed more self-confidence about their procedural skills: (M = 81, SD = 11 versus M = 68, SD = 20, p = 0.02).
  
  
  CONCLUSIONS
  Simulation-based mastery learning increased residents' skills in simulated CVC insertion, decreased the number of needle passes when performing actual procedures, and increased resident self-confidence.
authors.affiliation: Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA. jbarsuk@northwestern.edu
authors.forename: Jeffrey H
authors.initials: JH
authors.lastname: Barsuk
authors.forename: William C
authors.initials: WC
authors.lastname: McGaghie
authors.forename: Elaine R
authors.initials: ER
authors.lastname: Cohen
authors.forename: Jayshankar S
authors.initials: JS
authors.lastname: Balachandran
authors.forename: Diane B
authors.initials: DB
authors.lastname: Wayne
mesh_terms: D002405:Catheterization, Central Venous / Q000592:standards*; D016009:Chi-Square Distribution; D002983:Clinical Competence; D015331:Cohort Studies; D003162:Competency-Based Education / Q000379:methods*; D004503:Education, Medical, Graduate / Q000379:methods*; D004521:Educational Measurement; D020445:Hospitalists / Q000193:education*; D006801:Humans; D007362:Intensive Care Units; D007388:Internal Medicine / Q000193:education*; D007396:Internship and Residency; D008348:Manikins