title: Simulation training in central venous catheter insertion: improved performance in clinical practice.
abstract: OBJECTIVE
  To determine whether simulation training of ultrasound (US)-guided central venous catheter (CVC) insertion skills on a partial task trainer improves cannulation and insertion success rates in clinical practice.
  
  
  METHODS
  This prospective, randomized, controlled, single-blind study of first- and second-year residents occurred at a tertiary care teaching hospital from January 2007 to September 2008. The intervention group (n = 90) received a didactic and hands-on, competency-based simulation training course in US-guided CVC insertion, whereas the control group (n = 95) received training through a traditional, bedside apprenticeship model. Success at first cannulation and successful CVC insertion served as the primary outcomes. Secondary outcomes included reduction in technical errors and decreased mechanical complications.
  
  
  RESULTS
  Blinded independent raters observed 495 CVC insertions by 115 residents over a 21-month period. Successful first cannulation occurred in 51% of the intervention group versus 37% of the control group (P = .03). CVC insertion success occurred for 78% of the intervention group versus 67% of the control group (P = .02). Simulation training was independently and significantly associated with success at first cannulation (odds ratio: 1.7; 95% confidence interval: 1.1-2.8) and with successful CVC insertion (odds ratio: 1.7; 95% confidence interval: 1.1-2.8)--both independent of US use, patient comorbidities, or resident specialty. No significant differences related to technical errors or mechanical complications existed between the two groups.
  
  
  CONCLUSIONS
  Simulation training was associated with improved in-hospital performance of CVC insertion. Procedural simulation was associated with improved residents' skills and was more effective than traditional training.
authors.affiliation: Yale University School of Medicine, Department of Emergency Medicine, New Haven, Connecticut 06519, USA. leigh.evans@yale.edu
authors.forename: Leigh V
authors.initials: LV
authors.lastname: Evans
authors.forename: Kelly L
authors.initials: KL
authors.lastname: Dodge
authors.forename: Tanya D
authors.initials: TD
authors.lastname: Shah
authors.forename: Lewis J
authors.initials: LJ
authors.lastname: Kaplan
authors.forename: Mark D
authors.initials: MD
authors.lastname: Siegel
authors.forename: Christopher L
authors.initials: CL
authors.lastname: Moore
authors.forename: Cara J
authors.initials: CJ
authors.lastname: Hamann
authors.forename: Zhenqiu
authors.initials: Z
authors.lastname: Lin
authors.forename: Gail
authors.initials: G
authors.lastname: D'Onofrio
mesh_terms: D002405:Catheterization, Central Venous / Q000592:standards*; D016009:Chi-Square Distribution; D002983:Clinical Competence; D003162:Competency-Based Education / Q000379:methods*; D004503:Education, Medical, Graduate / Q000379:methods*; D004521:Educational Measurement; D006801:Humans; D007362:Intensive Care Units; D007396:Internship and Residency; D016544:Patient Simulation; D011446:Prospective Studies; D012044:Regression Analysis; D016037:Single-Blind Method; D018709:Statistics, Nonparametric; D018084:Ultrasonography, Interventional