title: The development and validation of hand motion analysis to evaluate competency in central line catheterization.
abstract: OBJECTIVE
  Traditionally, technical skills proficiency has been assessed by direct observation. While direct observation and feedback are essential components in technical skills learning, they demand considerable investment of faculty time, and as an assessment tool, direct observation is inherently subjective and has been criticized as unreliable. The purpose of this study was to determine if quantitative electromagnetic motion tracking is feasible and can discriminate between experts and nonexperts during simulated ultrasound (US)-guided insertion of a central venous catheter (CVC) guidewire.
  
  
  METHODS
  Ten nonexperts (junior emergency medicine residents) and 10 experts (critical care fellows or attending physicians) were recruited. Electromagnetic sensor probes were used to capture hand motion during an US-guided internal jugular cannulation on a standardized manikin. Hand, US, and needle motion were analyzed for the following metrics: total path length, total time, translational movements, and rotational movements. Subjects were also videotaped and evaluated using a modified, validated global rating scale (GRS) by a blinded expert.
  
  
  RESULTS
  There was a significant difference in almost all examined motion parameters between experts and nonexperts. Experts took 66% less time (50.2 seconds vs. 148.7 seconds, p < 0.001) and had significantly less right-hand and US motion (total path length and translational and rotational movements). Left-hand total path length was the only parameter that was not significantly different between groups. Concurrent validity of motion parameters was established by strong correlations (r2 > 0.74) to a previously published, modified GRS.
  
  
  CONCLUSIONS
  Electromagnetic hand and instrument motion analysis is technically feasible for assessing competence in US-guided insertion of a CVC guidewire in a simulation setting. In showing that it discriminates between the performances of nonexperts and experts, this study has provided evidence for construct validity. It also shows excellent correlation with a modified version of a previously validated GRS, providing evidence of concurrent validity.
authors: The Department of Emergency Medicine, Queen's University, Kingston, Ontario, Canada.
authors: David
authors: D
authors: Clinkard
authors: Matthew
authors: M
authors: Holden
authors: Tamas
authors: T
authors: Ungi
authors: David
authors: D
authors: Messenger
authors: Colleen
authors: C
authors: Davison
authors: Gabor
authors: G
authors: Fichtinger
authors: Robert
authors: R
authors: McGraw
mesh_terms: D000328:Adult; D002405:Catheterization, Central Venous / Q000379:methods* / Q000592:standards; D002983:Clinical Competence; D004521:Educational Measurement; D004635:Emergency Medicine / Q000193:education* / Q000592:standards; D005260:Female; D006225:Hand; D006801:Humans; D007396:Internship and Residency; D007601:Jugular Veins; D008297:Male; D008348:Manikins; D008875:Middle Aged; D015588:Observer Variation; D010820:Physicians; D013996:Time and Motion Studies