title: An Educational Intervention to Improve Ultrasound Competency in Ultrasound-Guided Central Venous Access.
abstract: OBJECTIVE
  Ultrasound (US) guidance for central venous catheter (CVC) placement results in improved success and overall safety, but is a new skill for pediatric emergency medicine (PEM) physicians. No study to date has used simulation-based learning to evaluate the ability of PEM providers to perform US-guided CVC placement.Our objective was to assess the competency of physicians in a rarely performed procedure, US-guided CVC placement, before and after an educational intervention using simulation-based mastery learning.
  
  
  METHODS
  We performed a prospective cohort study evaluating change in PEM physician competency in US-guided CVC placement before and after an educational intervention. Subjects participated in a curriculum composed of 3 sessions: an intervention session, a 2-month follow-up session, and a 12-month follow-up session. At each session, subjects were observed using US to guide CVC placement on a simulation model and technical skill was scored using a validated direct-observation checklist. Competency was defined as successfully completing 7 critical items on the checklist.
  
  
  RESULTS
  Of the 28 PEM physicians participating, competency improved from 32% at preintervention to 93% at 2-month follow-up (difference, 62%; 95% confidence interval, 36%-84%). At 12-month follow-up, competency remained high (85%; difference, 53%; 95% confidence interval, 32%-75%).
  
  
  CONCLUSIONS
  Physician competency in US-guided CVC placement improved with a simulation-based educational intervention, and the effect was maintained over time. This study may serve as a model for outcomes-based education and certification in rarely performed procedures in pediatrics.
authors.affiliation: From the *Division of Pediatric Emergency Medicine, Boston Medical Center and †Division of Emergency Medicine, Boston Children's Hospital, Boston, MA.
authors.forename: Heidi C
authors.initials: HC
authors.lastname: Werner
authors.forename: Rebecca L
authors.initials: RL
authors.lastname: Vieira
authors.forename: Rachel G
authors.initials: RG
authors.lastname: Rempell
authors.forename: Jason A
authors.initials: JA
authors.lastname: Levy
mesh_terms: D000328:Adult; D002405:Catheterization, Central Venous / Q000295:instrumentation / Q000379:methods*; D062905:Central Venous Catheters; D003162:Competency-Based Education / Q000379:methods*; D004501:Education, Medical / Q000379:methods*; D004635:Emergency Medicine / Q000193:education / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010372:Pediatrics / Q000193:education / Q000379:methods; D011446:Prospective Studies; D000066908:Simulation Training; D018084:Ultrasonography, Interventional / Q000379:methods*