Simulation-based mastery learning reduces complications during  central venous catheter insertion in a medical intensive care unit.
OBJECTIVE
To determine the effect of a simulation-based mastery learning model on central venous catheter insertion skill and the prevalence of procedure-related complications in a medical intensive care unit over a 1-yr period.


METHODS
Observational cohort study of an educational intervention.


METHODS
Tertiary-care urban teaching hospital.


METHODS
One hundred three internal medicine and emergency medicine residents.


METHODS
Twenty-seven residents were traditionally trained and did not receive simulation-based education. These residents were surveyed regarding complications and procedural self-confidence on actual central venous catheters they inserted in the medical intensive care unit. Subsequently, 76 residents completed simulation-based training in internal jugular and subclavian central venous catheter insertions. Simulator-trained residents were expected to meet or exceed a minimum passing score set by an expert panel and measured by performance on a skills checklist (given both before and after the educational intervention), using a central venous catheter simulator. Simulator-trained residents also took a written pre and posttest. Simulator-trained residents were surveyed regarding complications and procedural self-confidence on actual central venous catheters they inserted in the medical intensive care unit.


RESULTS
Simulator-trained residents reported fewer needle passes (p < .0005), arterial punctures (p < .0005), catheter adjustments (p = .002), and higher success rates (p = .005) for actual central venous catheters inserted in the medical intensive care unit than traditionally trained residents. At clinical skills examination pretest, 12 (16%) of 76 simulator-trained residents met the minimum passing score for internal jugular central venous catheter insertion and 11 (14%) of 76 residents met the minimum passing score for subclavian central venous catheter insertion: mean (internal jugular) = 50.6%, SD = 23.4%; mean (subclavian) = 48.4%, SD = 26.8%. After simulation training, all residents met or exceeded the minimum passing score at posttest: mean (internal jugular) = 93.9%, SD = 10.2; mean (subclavian) = 91.5%, SD = 17.1 (p < .0005). Written examination performance improved from mean = 70.3%, SD = 7.7%, to 84.8%, SD = 4.8% (p < .0005).


CONCLUSIONS
A simulation-based mastery learning program increased residents' skills in simulated central venous catheter insertion and decreased complications related to central venous catheter insertions in actual patient care.
Barsuk
Jeffrey H
JH
Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA. jbarsuk@northwestern.edu
McGaghie
William C
WC
Cohen
Elaine R
ER
O'Leary
Kevin J
KJ
Wayne
Diane B
DB
D000328:Adult; D002405:Catheterization, Central Venous / Q000009:adverse effects / Q000379:methods* / Q000592:standards; D002983:Clinical Competence / Q000592:standards; D003479:Curriculum; D004503:Education, Medical, Graduate; D004635:Emergency Medicine / Q000193:education*; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D007388:Internal Medicine / Q000193:education*; D007396:Internship and Residency; D007601:Jugular Veins; D008297:Male; D008953:Models, Anatomic; D011785:Quality Assurance, Health Care / Q000592:standards; D019984:Quality Indicators, Health Care; D013350:Subclavian Vein