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Do More With Less: A Surgery Directed Institutional Model for Resident Central Line Training David Leshikar, M.D. Jonathan Pierce, M.D. Edgardo Salcedo, M.D. Gurpreet Bola, B.S. Joseph Galante, M.D. April 23, 2013
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“See One, Do One, Teach One” Apprenticeship model Little to no supervision Bedside teaching
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Simulation Training Background Uses Procedural training CPR/ACLS Endoscopy Laparoscopy Endovascular Fundamentals of Laparoscopic Surgery
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Central Venous Catheters (CVC) Common bedside procedure Performed by many specialties Complications
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Central Line Simulation CVC Simulation: Decreases complications Improves comfort level Widespread adoption Barsuk, et al, Crit Care Med, 2009. Barsuk, et al, Arch Intern Med, 2009 Burden, et al, J Clin Anesth, 2012.
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Procedural Simulation Expensive Equipment costs Faculty time No standardized assessment metrics Redundant within institutions Duncan, et al, J Grad Med Educ, 2010
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Hypothesis A curriculum centralized in the department of surgery Single faculty trainer Maintain quality of training Institution wide Efficient resource utilization
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Curriculum Web-based module Covered all aspects of central line placement Pre/Post testing Hands-on simulation training Technical training – all components Video assessment
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Resource Utilization Equipment costs CVC simulator Simulator supplies Staff productivity Number of faculty involved Preparation time Compared pre vs post implementation
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Pre-Implementation Individual departments Inconsistent simulator use No standardization
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Post-Implementation Study Period: July 2010-June 2012 Departments involved: Surgery Internal Medicine Emergency Medicine Family Practice Pediatrics Anesthesia Standardized evaluation Single faculty trainer
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Online Module July 2010 – June 2011July 2011 – June 2012 N= 132N = 126 Pre-Test Mean 7.07.1 Post-Test Mean 8.4 Difference +1.4+1.3 P value < 0.0001
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Video Assessments PGY-1PGY-2PGY-3PGY-4+ N=26N=9N=5N=1 Pre-Test Mean14.215.012.815.0 Post-Test Mean17.515.414.817.0 Difference+3.3+0.4+2.0 P value0.00010.4260.0217
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Central Line Infections Mean before, 3.8 infections per 1000 catheter days Mean after, 2.3 infections per 1000 catheter days
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Resource Utilization Pre-ImplementationPost-Implementation Residents Per Session1-53-5 Simulators Used5 (4 manufacturers)2 (single manufacturer) CVC Kits1 per session1 per 10 sessions Attending ParticipationVariableStandardized Attending PreparationVariableStandardized Facility PreparationNot standardizedStandardized
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Estimated Program Costs Pre-ImplementationPost-Implementation Supply Costs CVC Simulator 5 models ($1500)$7,500 2 models ($1500)$3,000 Maintenance 4 manufacturers Single manufacturer CVC Kits 1 per session ($100)$2600 1 per 10 sessions ($100)$260 Staff Productivity Attending Physicians 10 1 Preparation Time 30 min x 26 sessions 13 hours None Sim Lab Staff Setup 4 manufacturers Single manufacturer Faculty Familiarity 10 different attendings Single attending
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Summary Streamlined development Effective instruction Improved efficiency
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Conclusion Standardization of simulation Maintained quality of teaching Decrease resource utilization
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Questions?
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