title: Intraosseous access can be taught to medical students using the four-step approach.
abstract: BACKGROUND
  The intraosseous (IO) access is an alternative route for vascular access when peripheral intravascular catheterization cannot be obtained. In Denmark the IO access is reported as infrequently trained and used. The aim of this pilot study was to investigate if medical students can obtain competencies in IO access when taught by a modified Walker and Peyton's four-step approach.
  
  
  METHODS
  Nineteen students attended a human cadaver course in emergency procedures. A lecture was followed by a workshop. Fifteen students were presented with a case where IO access was indicated and their performance was evaluated by an objective structured clinical examination (OSCE) and rated using a weighted checklist. To evaluate the validity of the checklist, three raters rated performance and Cohen's kappa was performed to assess inter-rater reliability (IRR). To examine the strength of the overall IRR, Randolph's free-marginal multi rater kappa was used.
  
  
  RESULTS
  A maximum score of 15 points was obtained by nine (60%) of the participants and two participants (13%) scored 13 points with all three raters. Only one participant failed more than one item on the checklist. The expert rater rated lower with a mean score of 14.2 versus the non-expert raters with mean 14.6 and 14.3. The overall IRR calculated with Randolph's free-marginal multi rater kappa was 0.71.
  
  
  CONCLUSIONS
  The essentials of the IO access procedure can be taught to medical students using a modified version of the Walker and Peyton's four-step approach and the checklist used was found reliable.
authors.affiliation: Department of Anaesthesiology, University Hospital of Copenhagen, Herlev, Denmark. monika.afzali@regionh.dk.|Cochrane Anaesthesia, Critical and Emergency Care, The Cochrane Collaboration, Herlev, Denmark. monika.afzali@regionh.dk.
authors.forename: Monika
authors.initials: M
authors.lastname: Afzali
authors.affiliation: Students' Society of Anaesthesiology & Traumatology, Faculty of Health and Medical Sciences, University of Copenhagen, Herlev, Denmark.
authors.forename: Ask Daffy
authors.initials: AD
authors.lastname: Kvisselgaard
authors.affiliation: Department of Anaesthesiology, Nordsjælland Hospital, Herlev, Denmark.
authors.forename: Tobias Stenbjerg
authors.initials: TS
authors.lastname: Lyngeraa
authors.affiliation: Copenhagen Academy for Medical Education and Simulation, Capital Region of Denmark, Herlev, Denmark.
authors.forename: Sandra
authors.initials: S
authors.lastname: Viggers
mesh_terms: D002102:Cadaver; D057189:Checklist / Q000592:standards; D002983:Clinical Competence / Q000592:standards*; D003718:Denmark; D004635:Emergency Medicine / Q000193:education* / Q000379:methods*; D006801:Humans; D017148:Infusions, Intraosseous / Q000379:methods*; D010865:Pilot Projects; D015203:Reproducibility of Results; D013337:Students, Medical
keywords: Anaesthesiology; Emergency medicine; Intraosseous access; Medical education; Medical students; OSCE and checklist validity; Resuscitation; Traumatology; Vascular access