title: Acquiring procedural skills in ICUs: a prospective multicenter study*.
abstract: OBJECTIVE
  Providing appropriate training of procedural skills to residents while ensuring patient safety through trainee supervision is a difficult and constant challenge. We sought to determine how effective and safe procedural skill acquisition is in French ICUs and to identify failure and complication risk factors.
  
  
  METHODS
  Multicenter prospective observational study. Invasive procedures performed by residents were recorded during two consecutive semesters.
  
  
  METHODS
  Eighty-four residents.
  
  
  METHODS
  Eighty-four residents.
  
  
  METHODS
  None.
  
  
  RESULTS
  Number of invasive procedures performed, failure and complication rates, supervision, and assistance provided. Five thousand six hundred seventeen procedures were prospectively studied: 1,007 tracheal intubations, 1,272 arterial and 2,586 central venous catheter insertions, 457 fiberoptic bronchoscopies, and 295 chest tube insertions. During the semesters, residents performed a median of 10 intubations, 14 arterial catheter insertions, and 26 central venous catheter insertions. Complication rates were low, similar to those in the literature: 8.6% desaturation and 7.4% esophageal placement during intubation; 0.4% and 2.3% pneumothorax with jugular and subclavian central venous catheter insertions, respectively. We identified risk factors for failure and complications. Higher rates of failure and complications for intubation were associated with residents with no or little previous experience (p < 0.001); failure of internal jugular vein catheterization was associated with left-side insertion (p = 0.005) and absence of mechanical ventilation (p = 0.007). Supervision and assistance were more frequent at the beginning of the semester and for intubation and chest tube insertion. Finally, residents had less access to fiberoptic bronchoscopy and chest tube insertion.
  
  
  CONCLUSIONS
  Procedural skills acquisition by residents in the ICU appears feasible and safe with complication rates comparable to what has previously been reported. We identified specific procedures and situations associated with higher failure and complication rates that could require proactive training. Questions still remain regarding minimal numbers of procedures to attain competence and how best to provide procedural training.
authors.affiliation: 1AP-HP, Hôpital Louis Mourier, Service de Réanimation Médico-Chirurgicale, Colombes, France. 2UMRS-722, Univ Paris Diderot, Sorbonne Paris Cité, UMRS-722, Paris, France. 3Service de Réanimation Polyvalente, CHD Les Oudaries, La Roche sur Yon, France. 4AP-HP, Hôpital Saint-Louis, Service de Réanimation Médicale, Paris, France. 5Service de Réanimation Médicale, Hôpital Pellegrin-Tripode, CHU Bordeaux, Bordeaux, France. 6Service de Réanimation Polyvalente, CHI Poissy-Saint-Germain en Laye, site de Saint-Germain, Saint-Germain en Laye, France. 7Service de Réanimation, CHU, Clermont Ferrand, France. 8Service de Réanimation Médicale, Hôpital Sainte Marguerite, Marseille, France. 9Service de Réanimation Médicale, CHU Angers, Angers, France. 10Service de Réanimation Médicale, CHU Nice, Nice, France. 11AP-HP, Hôpital Pitié-Salpétrière, Service de Réanimation Médicale, Paris, France. 12AP-HP, Hôpital Cochin, Service de Réanimation Médicale, Paris, France. 13AP-HP, Hôpital Européen Georges Pompidou, Service de Réanimation Médicale, Paris, France. 14Service de Réanimation Médicale, Hôpital de la Côte de Nacre, Caen, France. 15Service de Réanimation Médicale, Hôpital de la Cavale Blanche, Brest, France. 16Service de Réanimation Médicale, CHU Tours, Tours, France. 17Service de Réanimation Médicale, CHU de Strasbourg, Strasbourg, France. 18Service de Réanimation Polyvalente, Hôpital Delafontaine, Saint-Denis, France. 19AP-HP, Hôpital Bichat, Service de Réanimation Médicale, Paris, France. 20Service de Réanimation Médicale et Polyvalente Hôpital Nord, CHU de Saint-Etienne, Saint-Etienne, France.
authors.forename: Damien
authors.initials: D
authors.lastname: Roux
authors.forename: Jean
authors.initials: J
authors.lastname: Reignier
authors.forename: Guillaume
authors.initials: G
authors.lastname: Thiery
authors.forename: Alexandre
authors.initials: A
authors.lastname: Boyer
authors.forename: Jan
authors.initials: J
authors.lastname: Hayon
authors.forename: Bertrand
authors.initials: B
authors.lastname: Souweine
authors.forename: Laurent
authors.initials: L
authors.lastname: Papazian
authors.forename: Alain
authors.initials: A
authors.lastname: Mercat
authors.forename: Gilles
authors.initials: G
authors.lastname: Bernardin
authors.forename: Alain
authors.initials: A
authors.lastname: Combes
authors.forename: Jean-Daniel
authors.initials: JD
authors.lastname: Chiche
authors.forename: Jean-Luc
authors.initials: JL
authors.lastname: Diehl
authors.forename: Damien
authors.initials: D
authors.lastname: du Cheyron
authors.forename: Erwan
authors.initials: E
authors.lastname: L'her
authors.forename: Dominique
authors.initials: D
authors.lastname: Perrotin
authors.forename: Francis
authors.initials: F
authors.lastname: Schneider
authors.forename: Marie
authors.initials: M
authors.lastname: Thuong
authors.forename: Michel
authors.initials: M
authors.lastname: Wolff
authors.forename: Fabrice
authors.initials: F
authors.lastname: Zeni
authors.forename: Didier
authors.initials: D
authors.lastname: Dreyfuss
authors.forename: Jean-Damien
authors.initials: JD
authors.lastname: Ricard
mesh_terms: D000328:Adult; D002405:Catheterization, Central Venous / Q000009:adverse effects / Q000379:methods; D015505:Chest Tubes / Q000009:adverse effects; D002983:Clinical Competence; D005260:Female; D005602:France; D006801:Humans; D007318:Inservice Training / Q000458:organization & administration*; D007362:Intensive Care Units / Q000458:organization & administration*; D007396:Internship and Residency / Q000458:organization & administration*; D007442:Intubation, Intratracheal / Q000009:adverse effects / Q000379:methods; D008297:Male; D011446:Prospective Studies; D012307:Risk Factors; D013997:Time Factors