title: Improving internal medicine residents' performance, knowledge, and confidence in central venous catheterization using simulators.
abstract: BACKGROUND
  Efficacy of simulators in teaching central venous catheterization (CVC) in an internal medicine residency program is unknown.
  
  
  OBJECTIVE
  To determine whether or not learning CVC on simulators is associated with improvement in performance of CVC, knowledge about the procedure, and self-reported confidence.
  
  
  METHODS
  All consenting first-year internal medicine residents who completed training in CVC on simulators were included. Participants were evaluated pre- and post-training by video-recorded CVC insertion and multiple-choice knowledge assessments. Procedural technique was rated in a blinded fashion by two independent adjudicators. Knowledge retention and self-reported confidence were reassessed at 18 months.
  
  
  METHODS
  Primary outcome of CVC performance was assessed based on global rating score (minimum 1, maximum 5). Secondary measures include checklist score (out of ten), knowledge score and self-reported confidence (6-point Likert scale ranging from "none" to "complete").
  
  
  RESULTS
  Median global rating scores in 30 participants increased from 3.5 (IQR = 3-4) to 4.5 (IQR = 4-4.5) (P < 0.001). Checklist score increased from 9 (IQR = 6-9.5) to 9.5 (IQR = 9-9.5) (P < 0.001). Knowledge score increased from 65.7 +/- 11.9% to 81.2 +/- 10.7% (P < 0.001). Confidence increased from 3 ("moderate", IQR = 2-3) to 4 ("good", IQR=3-4) (P < 0.001). Sixteen participants completed the retention tests. Improvement in knowledge score and confidence at 18 months was retained compared with baseline (P = 0.002 and P < 0.0001 respectively).
  
  
  CONCLUSIONS
  Use of simulators in teaching CVC in an internal medicine residency program results in improved procedural performance, knowledge, and self-reported confidence. Improvement in knowledge and confidence was retained at 18 months.
authors.affiliation: Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada.
authors.forename: Scott J
authors.initials: SJ
authors.lastname: Millington
authors.forename: Roger Y
authors.initials: RY
authors.lastname: Wong
authors.forename: Barry O
authors.initials: BO
authors.lastname: Kassen
authors.forename: James M
authors.initials: JM
authors.lastname: Roberts
authors.forename: Irene W Y
authors.initials: IW
authors.lastname: Ma
mesh_terms: D000328:Adult; D000704:Analysis of Variance; D002405:Catheterization, Central Venous / Q000592:standards*; D057189:Checklist; D002983:Clinical Competence; D004503:Education, Medical, Graduate / Q000379:methods*; D004521:Educational Measurement; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007388:Internal Medicine / Q000193:education*; D007396:Internship and Residency; D008297:Male; D008348:Manikins