Improving internal medicine residents' performance, knowledge, and confidence in central venous catheterization using simulators.
J Hosp Med. 2009 Sep 14;4(7):410-416
Authors: Millington SJ, Wong RY, Kassen BO, Roberts JM, Ma IW
BACKGROUND:: Efficacy of simulators in teaching central venous catheterization (CVC) in an internal medicine residency program is unknown. OBJECTIVE:: To determine whether or not learning CVC on simulators is associated with improvement in performance of CVC, knowledge about the procedure, and self-reported confidence. METHODS:: All consenting first-year internal medicine residents who completed training in CVC on simulators were included. Participants were evaluated pre- and post-training by video-recorded CVC insertion and multiple-choice knowledge assessments. Procedural technique was rated in a blinded fashion by two independent adjudicators. Knowledge retention and self-reported confidence were reassessed at 18 months. MEASUREMENTS:: Primary outcome of CVC performance was assessed based on global rating score (minimum 1, maximum 5). Secondary measures include checklist score (out of ten), knowledge score and self-reported confidence (6-point Likert scale ranging from "none" to "complete"). RESULTS:: Median global rating scores in 30 participants increased from 3.5 (IQR = 3-4) to 4.5 (IQR = 4-4.5) (P < 0.001). Checklist score increased from 9 (IQR = 6-9.5) to 9.5 (IQR = 9-9.5) (P < 0.001). Knowledge score increased from 65.7 +/- 11.9% to 81.2 +/- 10.7% (P < 0.001). Confidence increased from 3 ("moderate", IQR = 2-3) to 4 ("good", IQR=3-4) (P < 0.001). Sixteen participants completed the retention tests. Improvement in knowledge score and confidence at 18 months was retained compared with baseline (P = 0.002 and P < 0.0001 respectively). CONCLUSIONS:: Use of simulators in teaching CVC in an internal medicine residency program results in improved procedural performance, knowledge, and self-reported confidence. Improvement in knowledge and confidence was retained at 18 months. Journal of Hospital Medicine 2009;4:410-416. (c) 2009 Society of Hospital Medicine.
PMID: 19753575 [PubMed - as supplied by publisher]