Simulation training for pediatric residents on central venous catheter placement: a pilot study.
OBJECTIVE
To assess the effect of simulation training on pediatric residents' acquisition and retention of central venous catheter insertion skills. A secondary objective was to assess the effect of simulation training on self-confidence to perform the procedure.


METHODS
Prospective observational pilot study.


METHODS
Single university clinical simulation center.


METHODS
Pediatric residents, postgraduate years 1-3.


METHODS
Residents participated in a 60- to 90-minute ultrasound-guided central venous catheter simulation training session. Video recordings of residents performing simulated femoral central venous catheter insertions were made before (baseline), after, and at 3-month following training. Three blinded expert raters independently scored the performances using a 24-item checklist and 100-mm global rating scale. At each time point, residents rated their confidence to perform the procedure on a 100-mm scale.


RESULTS
Twenty-six residents completed the study. Compared with baseline, immediately following training, median checklist score (54.2% [interquartile range, 40.8-68.8%] vs 83.3% [interquartile range, 70.0-91.7%]), global rating score (8.0 mm [interquartile range, 0.0-64.3 mm] vs 79.5 mm [interquartile range, 16.3-91.7 mm]), success rate (38.5% vs 80.8%), and self-confidence (8.0 mm [interquartile range, 3.8-19.0 mm] vs 52.0 mm [interquartile range, 43.5-66.5 mm]) all improved (p < 0.05 for all variables). Compared with baseline, median checklist score (54.2% [interquartile range, 40.8-68.8%] vs 54.2% [interquartile range, 45.8-80.4%], p = 0.47), global rating score (8.0 mm [interquartile range, 0.0-64.3 mm] vs 35.5 mm [interquartile range, 5.3-77.0], p = 0.62), and success rate (38.5% vs 65.4%, p = 0.35) were similar at 3-month follow-up. Self-confidence, however, remained above baseline at 3-month follow-up (8.0 mm [interquartile range, 3.8-19.0 mm] vs 61.0 mm [interquartile range, 31.5-71.8 mm], p < 0.01).


CONCLUSIONS
Simulation training improved pediatric residents' central venous catheter insertion procedural skills. Decay in skills was found at 3-month follow-up. This suggests that simulation training for this procedure should occur in close temporal proximity to times when these skills would most likely be used clinically and that frequent refresher training might be beneficial to prevent skills decay.
1Department of Pediatrics, Division of Pediatric Emergency Medicine, Washington University School of Medicine in St. Louis, St. Louis, MO. 2Saint Louis University Clinical Simulation Center, St. Louis, MO. 3Saint Louis University School of Medicine, St. Louis, MO. 4Department of Pediatrics, Division of Pediatric Emergency Medicine, Saint Louis University School of Medicine, St. Louis, MO.
Scott M
SM
Thomas
Wesley
W
Burch
Sarah E
SE
Kuehnle
Robert G
RG
Flood
Anthony J
AJ
Scalzo
James M
JM
Gerard
D002405:Catheterization, Central Venous; D002983:Clinical Competence; D006801:Humans; D007396:Internship and Residency / Q000379:methods*; D010372:Pediatrics / Q000193:education*; D010865:Pilot Projects; D011446:Prospective Studies; D012153:Retention, Psychology; D020377:Self Efficacy; D016037:Single-Blind Method; D013647:Task Performance and Analysis; D013997:Time Factors; D018084:Ultrasonography, Interventional