Simulation-based objective assessment discerns clinical proficiency in central line placement: a construct validation.
BACKGROUND
Central venous catheterization (CVC) is associated with patient risks known to be inversely related to clinician experience. We developed and evaluated a performance assessment tool for use in a simulation-based central line workshop. We hypothesized that instrument scores would discriminate between less experienced and more experienced clinicians.


METHODS
Participants included trainees enrolled in an institutionally mandated CVC workshop and a convenience sample of faculty attending physicians. The workshop integrated several experiential learning techniques, including practice on cadavers and part-task trainers. A group of clinical and education experts developed a 15-point CVC Proficiency Scale using national and institutional guidelines. After the workshop, participants completed a certification exercise in which they independently performed a CVC in a part-task trainer. Two authors reviewed videotapes of the certification exercise to rate performance using the CVC Proficiency Scale. Participants were grouped by self-reported CVC experience.


RESULTS
One hundred and five participants (92 trainees and 13 attending physicians) participated. Interrater reliability on a subset of 40 videos was 0.71, and Cronbach a was 0.81. The CVC Proficiency Scale Composite score varied significantly by experience: mean of 85%, median of 87% (range 47%-100%) for low experience (0-1 CVCs in the last 2 years, n = 27); mean of 88%, median of 87% (range 60%-100%) for moderate experience (2-49 CVCs, n = 62); and mean of 94%, median of 93% (range 73%-100%) for high experience (> 49 CVCs, n = 16) (P = .02, comparing low and high experience).


CONCLUSIONS
Evidence from multiple sources, including appropriate content, high interrater and internal consistency reliability, and confirmation of hypothesized relations to other variables, supports the validity of using scores from this 15-item scale for assessing trainee proficiency following a central line workshop.
Dong
Yue
Y
Division of Pulmonary and Critical Care Medicine, College of Medicine, Mayo Clinic, 200 1st St SW, Rochester, MN 55905, USA.
Suri
Harpreet S
HS
Cook
David A
DA
Kashani
Kianoush B
KB
Mullon
John J
JJ
Enders
Felicity T
FT
Rubin
Orit
O
Ziv
Amitai
A
Dunn
William F
WF
D002405:Catheterization, Central Venous / Q000379:methods*; D002568:Certification; D002983:Clinical Competence / Q000592:standards*; D017408:Guidelines as Topic; D006801:Humans; D008348:Manikins; D008503:Medical Staff / Q000193:education*; D011446:Prospective Studies; D015272:Pulmonary Medicine / Q000193:education / Q000295:instrumentation; D015203:Reproducibility of Results