1. in first year residents of different specialties.
Research Abstract
ID# 24465
Performance assessment during jugular central venous catheter placement after simulation training with deliberate practice,
in first year residents of different specialties.
Corvetto M, Pedemonte JC, Varas D, Fuentes C, Altermatt F
Division of Anestesiologia, Escuela de Medicina, Pontificia Universidad Católica de Chile.
BACKGROUND
MATERIALS AND METHODS
RESULTS
Central venous catheter (CVC) placement is a basic requirement for many medical specialties.
A recent meta-analysis supports the clinical utility of adopting simulation training for CVC insertion.
However, a standardized methodology to teach procedural skills has not been determined yet.
Before and after intervention study.
42 PGY-1 residents from anesthesiology, emergency medicine, cardiology, ICU and nephrology specialties were trained.
35 subjects completed successfully the program.
15 anesthesiology, 7 emergency medicine, 6 cardiology, 5 ICU and 2 nephrology residents.
Pre-training (n=35)
Post-training (n=35)
P value
GRS scores (7-47)
19 (16-27)
45 (40-45)
p < 0.001
Procedural Time (s)
387 ( )
200 ( )
0.029
Number of movements
215 ( )
115 (73-208)
 0.48
Total Path Length (m)
45.91 ( )
30.38 ( )
0.008
Participants were trained in 4 deliberated practice sessions.
Learning objectives included: principles of US, preparation, procedural skill I (US scanning and puncture under US guidance), and procedural skill II (correct intra vascular insertion of the catheter).
PURPOSE AND HYPOTHESIS
This study aims to determine if a simulation-training program with deliberated practice improves resident’s performance during internal jugular CVC placement, using a validated global rating scale (GRS) and a tracking motion device ICSAD (Imperial College Surgical Assessment Device).
As secondary outcome, we pretend to establish the construct and concurrent validity of the ICSAD in this simulated model.
PGY-1 resident’s GRS scores improved significantly after the training (p < 0.001).
Total path length decreased significantly after the training (p = 0.008).
Procedural time decreased significantly after training 387 sec vs 200 sec (p = 0.029).
CVC technical proficiency was tested pre and post training using hand motion analysis with the Imperial College Surgical Assessment Device (ICSAD) and a global rating scale (GRS).
The inter-rater reliability between GRS scores was calculated using the Cohen kappa coefficient.
GRS and ICSAD values are expressed in median and range. Wilcoxon test and Kruskall Wallis test were used when comparing 2 or 3 groups respectively.
Novices (n=8)
Intermediates (n=8)
Experts (n=8)
P value
Procedural Time (s)
442.5
( )
142.7
( )
114.2 ( )
p < 0.001 
Number of movements
325
( )
271.5
( ) 93
(78-109,25)
 0.004
Total Path Length (m)
59.8
( )
31.96
( )
( )
 0.003
CONCLUSIONS
This simulation-training program based on deliberate practice significantly increased the technical skills of residents in US guided CVC placement, with a level of performance comparable to intermediate third year residents.
Our results confirm the validity of ICSAD as an assessment tool for ultrasound guided internal jugular CVC placement.
Construct and concurrent validation of the assessment tool ICSAD. Spearman correlation coefficient of –0.684 (p < 0.001) between TPL and GRS scores.