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Broch Porcar MJ, Castellanos-Ortega Á. Patient safety, what does clinical simulation and teaching innovation contribute? Med Intensiva 2024:S2173-5727(24)00101-2. [PMID: 38797620 DOI: 10.1016/j.medine.2024.04.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2023] [Accepted: 03/24/2024] [Indexed: 05/29/2024]
Abstract
Clinical simulation in Intensive Care Medicine is a crucial tool to strengthen patient safety. It focuses on the complexity of the Intensive Care Unit, where challenging clinical situations require rapid decision making and the use of invasive techniques that can increase the risk of errors and compromise safety. Clinical simulation, by mimicking clinical contexts, is presented as essential for developing technical and non-technical skills and enhancing teamwork in a safe environment, without harm to the patient. in situ simulation is a valuable approach to practice in realistic environments and to address latent security threats. Other simulation methods as virtual reality and tele-simulation are gaining more and more acceptance. Herein, we provide current data on the clinical utility of clinical simulation related to improved safety in the practice of techniques and procedures, as well as improvements of teamwork performance and outcomes. Finally, we propose the needs for future research.
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Burnett G, Goldhaber-Fiebert S. The role of simulation training in patients' safety in anaesthesia and perioperative medicine. BJA Educ 2024; 24:7-12. [PMID: 38495746 PMCID: PMC10941098 DOI: 10.1016/j.bjae.2023.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/10/2023] [Indexed: 03/19/2024] Open
Affiliation(s)
- G.W. Burnett
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Buchanan C, Burt A, Moureau N, Murray D, Nizum N. Registered Nurses' Association of Ontario (RNAO) best practice guideline on the assessment and management of vascular access devices. J Vasc Access 2023:11297298231169468. [PMID: 37125815 DOI: 10.1177/11297298231169468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023] Open
Abstract
INTRODUCTION Vascular access is the most common invasive procedure performed in health care. This fundamental procedure must be performed in a safe and effective manner. Vascular access devices (VADs) are often the source of infections and other complications, yet there is a lack of clear guidance on VADs for health providers across different settings. A Best Practice Guideline (BPG) was developed by the Registered Nurses' Association of Ontario (RNAO) to provide evidence-based recommendations on the assessment and management of VADs. METHODS RNAO BPGs are based on systematic reviews of the literature following the GRADE approach. Experts on the topic of vascular access were selected to form a panel. Systematic reviews were conducted on six research areas: education, vascular access specialists, blood draws, daily review of peripheral VADs, visualization technologies, and pain management. A search for relevant research studies published in English limited to January 2013 was applied to eight databases. All studies were independently assessed for eligibility and risk of bias by two reviewers based on predetermined inclusion and exclusion criteria. The GRADE approach was used to determine certainty of the evidence. RESULTS Over 65,000 articles were screened related to the six priority research questions. Of these, 876 full-text publications were examined for relevance, with 174 articles designated to inform nine recommendations in the BPG on the subject areas of: comprehensive health teaching, practical education for health providers, blood draws, daily review of peripheral VADs, visualization technologies, and pain management. In June 2021, the RNAO published the BPG on vascular access, which included the recommendations and other supporting resources. CONCLUSION The vascular access BPG provides high quality guidance and updated recommendations, and can serve as a primary resource for health providers assessing and managing VADs.
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Affiliation(s)
| | - Amy Burt
- Registered Nurses' Association of Ontario, Toronto, ON, Canada
| | - Nancy Moureau
- PICC Excellence, Hartwell, GA, USA; Griffith University, Brisbane, QLD
| | | | - Nafsin Nizum
- Registered Nurses' Association of Ontario, Toronto, ON, Canada
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Hildreth AF, Maggio LA, Iteen A, Wojahn AL, Cook DA, Battista A. Technology-enhanced simulation in emergency medicine: Updated systematic review and meta-analysis 1991-2021. AEM EDUCATION AND TRAINING 2023; 7:e10848. [PMID: 36936085 PMCID: PMC10014971 DOI: 10.1002/aet2.10848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 01/14/2023] [Accepted: 01/21/2023] [Indexed: 06/18/2023]
Abstract
Background Over the past decade, the use of technology-enhanced simulation in emergency medicine (EM) education has grown, yet we still lack a clear understanding of its effectiveness. This systematic review aims to identify and synthesize studies evaluating the comparative effectiveness of technology-enhanced simulation in EM. Methods We searched MEDLINE, EMBASE, PsycINFO, CINAHL, ERIC, Web of Science, and Scopus to identify EM simulation research that compares technology-enhanced simulation with other instructional modalities. Two reviewers screened articles for inclusion and abstracted information on learners, clinical topics, instructional design features, outcomes, cost, and study quality. Standardized mean difference (SMD) effect sizes were pooled using random effects. Results We identified 60 studies, enrolling at least 5279 learners. Of these, 23 compared technology-enhanced simulation with another instructional modality (e.g., living humans, lecture, small group), and 37 compared two forms of technology-enhanced simulation. Compared to lecture or small groups, we found simulation to have nonsignificant differences for time skills (SMD 0.33, 95% confidence interval [CI] -0.23 to 0.89, n = 3), but a large, significant effect for non-time skills (SMD 0.82, 95% CI 0.18 to 1.46, n = 8). Comparison of alternative types of technology-enhanced simulation found favorable associations with skills acquisition, of moderate magnitude, for computer-assisted guidance (compared to no computer-assisted guidance), for time skills (SMD 0.50, 95% CI -1.66 to 2.65, n = 2) and non-time skills (SMD 0.57, 95% CI 0.33 to 0.80, n = 6), and for more task repetitions (time skills SMD 1.01, 95% CI 0.16 to 1.86, n = 2) and active participation (compared to observation) for time skills (SMD 0.85, 95% CI 0.25 to 1.45, n = 2) and non-time skills (SMD 0.33 95% CI 0.08 to 0.58, n = 3). Conclusions Technology-enhanced simulation is effective for EM learners for skills acquisition. Features such as computer-assisted guidance, repetition, and active learning are associated with greater effectiveness.
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Affiliation(s)
- Amy F. Hildreth
- Walter Reed National Military Medical CenterBethesdaMarylandUSA
- Uniformed Services University of the Health SciencesBethesdaMarylandUSA
| | - Lauren A. Maggio
- Uniformed Services University of the Health SciencesBethesdaMarylandUSA
| | - Alex Iteen
- Uniformed Services University of the Health SciencesBethesdaMarylandUSA
- 3rd Medical Battalion, 3rd Marine Logistics GroupOkinawaJapan
| | - Amanda L. Wojahn
- Uniformed Services University of the Health SciencesBethesdaMarylandUSA
- Naval Medical Center San DiegoSan DiegoCaliforniaUSA
| | - David A. Cook
- Office of Applied Scholarship and Education ScienceMayo Clinic College of Medicine and ScienceRochesterMinnesotaUSA
| | - Alexis Battista
- Uniformed Services University of the Health SciencesBethesdaMarylandUSA
- The Henry M. Jackson Foundation for the Advancement of Military MedicineBethesdaMarylandUSA
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Sugiki D, Matsushima H, Asao T, Tokumine J, Lefor AK, Kamisasanuki T, Suzuki M, Gomei S. A web-based self-learning system for ultrasound-guided vascular access. Medicine (Baltimore) 2022; 101:e31292. [PMID: 36316890 PMCID: PMC9622633 DOI: 10.1097/md.0000000000031292] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Ultrasound-guided vascular access is practiced widely. Optimal educational methods have not yet been established. We hypothesized that a step-by-step web-based learning system is effective for self-learning. In this study, we examined the potential of this system as a self-learning tool. This was an observational study at a single institution. Participants included residents, who were self-educated through the web-based system. Skill proficiency was measured after self-learning. The primary outcome was the extent to which self-learning enabled residents to acquire proficiency in the basic skills of ultrasound-guided vascular access: needle visualization, hand-eye coordination, and avoiding posterior wall penetration. A secondary outcome was the time required to achieve proficiency. Thirty-nine residents were enrolled in this study. Eleven residents (28%) passed the first skill assessment test. There was no significant difference in the number of days that the web-based system was accessed, the total number of screen views, or the total learning time between participants who passed and those who failed the first test. Skill assessment scores between those who passed and those who failed the first test were different, especially the score for hand-eye coordination, and the number of posterior wall penetrations. Self-learning with a web-based system enabled 28% of residents to pass the first skill assessment test. The remaining 72% failed the first skill assessment test but continued to learn using the web-based system and eventually passed the test. Hence, the web-based system needed formative testing to function as a self-learning system. Simulation education for vascular access is expected to increase in educational content and methods. Self-learning through a web-based learning system is a leading candidate for this growth.
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Affiliation(s)
- Daisuke Sugiki
- Emergency and Critical Care Center, Dokkyo Medical University Saitama Medical Center, Saitama, Japan
| | - Hisao Matsushima
- Emergency and Critical Care Center, Dokkyo Medical University Saitama Medical Center, Saitama, Japan
| | - Takayuki Asao
- Gunma University Center for Mathematics and Data Science, Gunma, Japan
| | - Joho Tokumine
- Department of Anesthesiology, Kyorin University School of Medicine, Tokyo, Japan
- *Correspondence: Joho Tokumine, Department of Anesthesiology, Kyorin University School of Medicine, 6-20-2 Sinkawa, Mitaka, Tokyo, Japan (e-mail: )
| | | | - Toshirou Kamisasanuki
- Emergency and Critical Care Center, Dokkyo Medical University Saitama Medical Center, Saitama, Japan
| | - Mitsuhiro Suzuki
- Emergency and Critical Care Center, Dokkyo Medical University Saitama Medical Center, Saitama, Japan
| | - Sayaka Gomei
- Emergency and Critical Care Center, Dokkyo Medical University Saitama Medical Center, Saitama, Japan
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Blanie A, Shoaleh C, Marquion F, Benhamou D. Comparison of multimodal active learning and single-modality procedural simulation for central venous catheter insertion for incoming residents in anesthesiology: a prospective and randomized study. BMC MEDICAL EDUCATION 2022; 22:357. [PMID: 35538481 PMCID: PMC9092872 DOI: 10.1186/s12909-022-03437-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 05/03/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND Active learning methods, including low-fidelity simulation, are useful but the incremental learning effect of each method is however limited. We designed this study to assess if combining flipped classroom and the modified Peyton's « 4-steps» method during procedural simulation (intervention group [IG]) would provide better learning results than simulation alone (control group [CG]) in the context of central venous catheter insertion training. METHODS This prospective, single-center, and randomized study took place in 2017 in a single simulation center. All first year Anesthesiology residents of Ile de France area at the start of their residency were randomly included either in the IG or CG during a seminar aimed at providing initial procedural skills with low-fidelity simulation. A composite learning score which included knowledge MCQ and a questionnaire assessing satisfaction and value of the training session was recorded after training (primary outcome, /100). A randomized sub-group of learners of each group were video-recorded during central venous catheter insertion at the end of training and their skills were evaluated with validated tools, including a specific checklist and a global rating scale (GRS). RESULTS Among 89 anesthesiology residents, 48 and 41 learners were randomized in the intervention and control groups respectively. Of the IG residents, 40/48 (83%) had read the learning material prior to the session. There was no significant difference regarding the composite outcome ([IG]= 81.1 vs [CG] = 80.5 /100 (p = 0.68)). Results of the post-session MCQ knowledge questionnaire were also non-significantly different. Residents were similarly satisfied and described a significant improvement of their knowledge and skills after training. Learners highly valued the training session as a mean to improve their future practice. No significant differences regarding checklist and GRS scores were observed. CONCLUSIONS A multimodal active learning strategy of procedural learning did not provide better learning outcomes when compared to a traditional simulation method. In both groups, satisfaction was high and perception of the acquired theoretical and practical knowledge was improved after training.
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Affiliation(s)
- Antonia Blanie
- Centre de simulation LabForSIMS, Faculté de médecine Université Paris Saclay, 94275, Le Kremlin-Bicêtre, France.
- Département d'Anesthésie-Réanimation, CHU Bicêtre, 94275, Le Kremlin Bicêtre, France.
- CIAMS, Univ. Paris-Saclay, Université Paris-Saclay, 91405, Orsay Cedex, France.
- Université d'Orléans, 45067, Orléans, France.
| | - Cécile Shoaleh
- Centre de simulation LabForSIMS, Faculté de médecine Université Paris Saclay, 94275, Le Kremlin-Bicêtre, France
| | - Fabien Marquion
- Centre de simulation LabForSIMS, Faculté de médecine Université Paris Saclay, 94275, Le Kremlin-Bicêtre, France
| | - Dan Benhamou
- Centre de simulation LabForSIMS, Faculté de médecine Université Paris Saclay, 94275, Le Kremlin-Bicêtre, France
- Département d'Anesthésie-Réanimation, CHU Bicêtre, 94275, Le Kremlin Bicêtre, France
- CIAMS, Univ. Paris-Saclay, Université Paris-Saclay, 91405, Orsay Cedex, France
- Université d'Orléans, 45067, Orléans, France
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L’Her E, Geeraerts T, Desclefs JP, Benhamou D, Blanie A, Cerf C, Delmas V, Jourdain M, Lecomte F, Ouanes I, Garnier M, Mossadegh C. Recommandations de pratiques professionnelles : Intérêts de l’apprentissage par simulation en soins critiques. ANNALES FRANCAISES DE MEDECINE D URGENCE 2022. [DOI: 10.3166/afmu-2022-0411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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8
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Umei N, Nishimura M, Ichiba S, Sakamoto A, Worth Berg B. The need for an adult intensive care unit boot camp for residents and fellows: a cross-sectional survey among intensive care unit directors. J NIPPON MED SCH 2022; 89:443-453. [DOI: 10.1272/jnms.jnms.2022_89-412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Nao Umei
- Department of Anesthesiology, Nippon Medical School
| | | | | | | | - Benjamin Worth Berg
- SimTiki Simulation Center, John A Burns School of Medicine, University of Hawaii
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An Innovative Biological Model for Ultrasound-Guided Central Venous Access Simulation. Simul Healthc 2021; 16:362-366. [PMID: 33196608 DOI: 10.1097/sih.0000000000000520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Simulation training is an increasingly used method to train medical students in the use of ultrasound guidance for vascular access positioning. Although very efficient for basic training, commercial simulators for vascular access do not reproduce real-life conditions. We developed a biological training model, using porcine liver, and compared it with an existing commercial model. METHODS Whole porcine livers were used by perfusing the portal vein system after inferior vena cava clamping. Thirty-three practitioners accustomed to ultrasound-guided procedure were enrolled to perform an ultrasound-guided vascular procedure on both biological and commercial models. Procedure duration was recorded and 10-point scales were used to compare the 2 models regarding image quality, procedure feeling, and similarity with the real-life procedure. RESULTS Participants reported a better image quality with the biological model (8.8 ± 1 vs. 7.7 ± 2, P = 0.007) as well as a significant difference in the procedure feeling (8.0 ± 1 vs. 6.9 ± 1.9, P = 0.002). Real-life likeness was significantly better for the biological model (8.4 ± 1.1 vs. 4.5 ± 6, P < 0.0001). Procedure duration was almost 3 times longer using the biological model than the commercial model (209.6 ± 189.0 vs. 59.8 ± 50.1, P < 0.0001). CONCLUSIONS This study validates our biological model of porcine's liver as an interesting training model, allowing closer real-life perception than its commercial counterpart. This model could complement and enhance simulation learning.
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Jagneaux T, Caffery TS, Musso MW, Long AC, Zatarain L, Stopa E, Freeman N, Quin CC, Jones GN. Simulation-Based Education Enhances Patient Safety Behaviors During Central Venous Catheter Placement. J Patient Saf 2021; 17:425-429. [PMID: 28984729 DOI: 10.1097/pts.0000000000000425] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE We describe the effect of simulation-based education on residents' adherence to protocols for and performance of central venous access. METHODS Internal medicine and emergency medicine residents underwent a central venous access course that included a lecture, video presentation, readings, and simulation demonstrations presented by faculty. Baseline data were collected before the course was initiated. After a skills session where they rehearsed their ultrasound-guided central venous access skills, residents were evaluated using a procedural checklist and written knowledge exam. Residents also completed questionnaires regarding confidence in performing ultrasound-guided central venous access and opinions about the training course. RESULTS Residents demonstrated significant improvement on the written knowledge exam (P < 0.0001) and Standard Protocol Checklist (P < 0.0001) after the training course. Training improved a number of patient safety elements, including adherence to sterile technique, transparent dressing, discarding sharps, and ordering postprocedure x-rays. However, a number of residents failed to wash their hands, prepare with chlorhexidine, drape the patient using a sterile technique, anesthetize the site, and perform a preprocedure time-out. Significant improvement in procedural skills was also noted for reduction in skin-to-vein time (P < 0.003) as well as a reduction in number of residents who punctured the carotid artery (P < 0.02). CONCLUSIONS Simulation-based education significantly improved residents' knowledge and procedural skills along with their confidence. Adherence to the protocol also improved. This study illustrates that simulation-based education can improve patient safety through training and protocols.
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Affiliation(s)
| | | | | | - Ann C Long
- Division of Pulmonary and Critical Care Medicine, Harborview Medical Center, University of Washington, Seattle, Washington
| | - Lauren Zatarain
- From the Internal Medicine Residency Program-Baton Rouge Campus, Louisiana State University Health Sciences Center School of Medicine in New Orleans
| | - Erik Stopa
- Emergency Medicine Residency Program-Baton Rouge Campus
| | | | | | - Glenn N Jones
- Family Medicine, Louisiana State University Health Sciences Center, School of Medicine in New Orleans, New Orleans, Louisiana, Baton Rouge, Louisiana
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Okano H, Mayumi T, Kataoka Y, Banno M, Tsujimoto Y, Shiroshita A, Taito S, Tokumine J. Outcomes of Simulation-Based Education for Vascular Access: A Systematic Review and Meta-Analysis. Cureus 2021; 13:e17188. [PMID: 17243645 PMCID: PMC8365863 DOI: 10.7759/cureus.17188] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/15/2021] [Indexed: 11/12/2022] Open
Abstract
Simulation training is key to developing skills for vascular access. However, the efficacy of simulation-based education remains unclear. We conducted a well-designed and updated systematic review to investigate the efficacy of these programs. Randomized controlled trials (RCTs) were researched using the following databases from inception until July 26, 2020: MEDLINE, Embase, the Cochrane Central Register of Controlled Trials (CENTRAL), Education Resources Information Center (ERIC), Cumulative Index to Nursing and Allied Health Literature (CINAHL), ClinicalTrials.gov, and International Clinical Trials Registry Platform (ICTRP). RCTs included patients undergoing insertion of central venous catheters (CVCs), peripherally inserted central catheters (PICCs), and radial arterial catheters. We compared the group that received simulation training with the group that received traditional training. We also assessed the success rate, adverse events, and first-attempt success using a random-effects meta-analysis. The protocol was registered at Protocols.io (dx.doi.org/10.17504/protocols.io.biu6keze). Seven RCTs (n=866) were evaluated. The meta-analysis showed that simulation-based education increased the overall success rate compared with traditional education (risk ratio: 1.08, 95% CI: 1.03 to 1.13; six RCTs; 840 participants; I2=0%; moderate certainty of evidence). However, it was unclear whether or not simulation-based education had an effect on reducing adverse events when compared with traditional education (risk ratio: 1.00, 95% CI: 0.63 to 1.58; five studies; 750 participants; I2=37%; very low certainty of evidence) or on raising first-attempt success rates (risk ratio: 1.34, 95% CI: 0.93 to 1.94; three studies; 244 participants; I2=59%; very low certainty of evidence). Simulation-based education may help develop skills for successful vascular access. However, it is unclear whether simulation-based education actually reduces the incidence of adverse events. Fine control of the needle tip is probably necessary to prevent adverse events. Simulation-based education might be required in the future for outcome-based task training.
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Affiliation(s)
- Hiromu Okano
- Department of Critical Care and Emergency Medicine, National Hospital Organization Yokohama Medical Center, Yokohama, JPN
| | - Takuya Mayumi
- Department of Cardiovascular Medicine, Kanazawa University, Kanazawa, JPN
| | - Yuki Kataoka
- Department of Internal Medicine, Kyoto Min-Iren Asukai Hospital, Kyoto, JPN
| | - Masahiro Banno
- Department of Systematic Reviewers, Systematic Review Workshop Peer Support Group (SRWS-PSG), Osaka, JPN
- Department of Psychiatry, Nagoya University Graduate School of Medicine, Nagoya, JPN
- Department of Psychiatry, Seichiryo Hospital, Nagoya, JPN
| | - Yasushi Tsujimoto
- Department of Healthcare Epidemiology, Graduate School of Medicine and Public Health, Kyoto University, Kyoto, JPN
| | - Akihiro Shiroshita
- Department of Respiratory Medicine, Ichinomiyanishi Hospital, Ichinomiya, JPN
| | - Shunsuke Taito
- Division of Rehabilitation, Hiroshima University Hospital, Hiroshima, JPN
| | - Joho Tokumine
- Department of Anesthesiology, Kyorin University School of Medicine, Tokyo, JPN
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Lee SU, Joo YH, Chang I, Kim DK, Lee JC, Jung JY, Park JW, Kwak YH. Novel Simulation Model That Realizes Arterial and Venous Blood Flow for Ultrasound-Guided Central Venous Catheter Insertion in Children. IEEE JOURNAL OF TRANSLATIONAL ENGINEERING IN HEALTH AND MEDICINE-JTEHM 2021; 9:1800305. [PMID: 34350069 PMCID: PMC8313016 DOI: 10.1109/jtehm.2021.3093203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 04/22/2021] [Accepted: 06/07/2021] [Indexed: 11/11/2022]
Abstract
Objective: We developed and validated a realistic simulation model for
ultrasound-guided central venous catheter insertion in children that is easy to
build and inexpensive and can automatically reproduce arterial and venous blood
flow. Methods: The simulation model was constructed with a chicken breast, two
DWP-385 water pumps, two types of tubes and a controller. An elastic rubber
tourniquet and a silicone tube were connected to each water pump, which
generated different continuous flows mimicking those of the pediatric internal
carotid artery and internal jugular vein, respectively. Both tubes were inserted
into a piece of chicken breast and connected to the controller. Then, we
provided a simulation program of ultrasound-guided central venous catheter
insertion using our novel model to resident emergency medicine physicians. We
also collected data on their knowledge and confidence levels regarding the
procedure before and after the simulation via questionnaires utilizing a 5-point
Likert scale. Results: The flow patterns of the artery and vein were well
demonstrated with our model. A total of 11 resident physicians were enrolled.
The knowledge and confidence regarding the discrimination of arteries and veins
were significantly improved after training with our simulation model (p-value
< 0.01). The subjective similarity and usefulness of our model also
scored high on the questionnaire (median: 4; interquartile range in both
categories: 4–5). Conclusion: Our novel simulation model is useful and
realistic for ultrasound-guided central venous catheter insertion training.
Clinical impact: This controlled motor system can be applied to many simulation
models of artery and vein circulation.
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Affiliation(s)
- Se Uk Lee
- Department of Emergency MedicineSamsung Medical CenterSeoul06351Republic of Korea
| | - Yoon Ha Joo
- Interdisciplinary Program in BioengineeringSeoul National University Graduate SchoolSeoul03080Republic of Korea
| | - Ikwan Chang
- Department of Emergency MedicineKangwon National University College of MedicineChuncheon24289Republic of Korea
| | - Do Kyun Kim
- Department of Emergency MedicineSeoul National University HospitalSeoul03080Republic of Korea
| | - Jung Chan Lee
- Department of Biomedical EngineeringSeoul National University College of MedicineSeoul03080Republic of Korea
| | - Jae Yun Jung
- Department of Emergency MedicineSeoul National University HospitalSeoul03080Republic of Korea
| | - Joong Wan Park
- Department of Emergency MedicineSeoul National University HospitalSeoul03080Republic of Korea
| | - Young Ho Kwak
- Department of Emergency MedicineSeoul National University HospitalSeoul03080Republic of Korea
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13
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Jørgensen R, Laursen CB, Konge L, Pietersen PI. Education in the placement of ultrasound-guided peripheral venous catheters: a systematic review. Scand J Trauma Resusc Emerg Med 2021; 29:83. [PMID: 34176508 PMCID: PMC8237454 DOI: 10.1186/s13049-021-00897-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 05/31/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Placing a peripheral vein catheter can be challenging due to several factors, but using ultrasound as guidance increases the success rate. The purpose of this review is to investigate the knowledge already existing within the field of education in ultrasound-guided peripheral vein catheter placement and explore the efficacy and clinical impact of different types of education. METHODS In accordance with PRISMA-guidelines, a systematic search was performed using three databases (PubMed, EMBASE, CINAHL). Two reviewers screened titles and abstracts, subsequently full-text of the relevant articles. The risk of bias was assessed using the Cochrane Collaboration risk of bias assessment tool and the New Ottawa scale. RESULTS Of 3409 identified publications, 64 were included. The studies were different in target learners, study design, assessment tools, and outcome measures, which made direct comparison difficult. The studies addressed a possible effect of mastery learning and found e-learning and didactic classroom teaching to be equally effective. CONCLUSION Current studies suggest a potential benefit of ultrasound guided USG-PVC training on success rate, procedure time, cannulation attempts, and reducing the need for subsequent CVC or PICC in adult patients. An assessment tool with proven validity of evidence to ensure competence exists and education strategies like mastery learning, e-learning, and the usage of color Doppler show promising results, but an evidence-based USG-PVC-placement training program using these strategies combined is still warranted.
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Affiliation(s)
- Rasmus Jørgensen
- Department of Respiratory Medicine, Odense University Hospital, Sdr. Boulevard 29, 5000, Odense, Denmark. .,Regional Center for Technical Simulation, Region of Southern Denmark, 5000, Odense, Denmark.
| | - Christian B Laursen
- Department of Respiratory Medicine, Odense University Hospital, Sdr. Boulevard 29, 5000, Odense, Denmark.,Department of Clinical Research, Faculty of Health Science, University of Southern Denmark, Odense, Denmark
| | - Lars Konge
- Regional Center for Technical Simulation, Region of Southern Denmark, 5000, Odense, Denmark.,Copenhagen Academy for Medical Education and Simulation, University of Copenhagen and the Capital Region of Denmark, Copenhagen, Denmark
| | - Pia Iben Pietersen
- Department of Respiratory Medicine, Odense University Hospital, Sdr. Boulevard 29, 5000, Odense, Denmark.,Regional Center for Technical Simulation, Region of Southern Denmark, 5000, Odense, Denmark
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14
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The Impact of a Comprehensive Simulation-Based Training and Certification Program on Resident Central Venous Catheter Complication Rates. Simul Healthc 2020; 16:92-97. [PMID: 32910104 DOI: 10.1097/sih.0000000000000500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Millions of central venous catheters (CVCs) are placed annually in the United States, many by resident physicians. Simulation training has been proposed as a means to increase resident physician competence with CVC placement and decrease the incidence of line-associated mechanical complications. We aimed to evaluate the impact of a novel simulation-based CVC training program for resident physicians on CVC-associated mechanical complication rates. We hypothesized that the CVC-related mechanical complication rates would be lower among simulation-trained residents (STRs) compared with nonsimulation, traditionally trained residents (TTRs). METHODS A retrospective chart review was performed of patients with a CVC placed by a resident physician between October 2014 and January 2017 at MedStar Georgetown University Hospital in Washington, DC. Incidence of CVC mechanical complications, including pneumothorax, hemothorax, arterial injury, or retained guidewire, were extracted from the electronic medical record and compared between STR and TTR cohorts. In contrast to TTRs who were trained to place CVCs in a supervised clinical setting, STRs underwent a CVC training program using online modules, a hands-on simulation training and testing checklist, and a series of successful supervised insertions before being credentialed to place lines independently. RESULTS Nine hundred twenty-four CVCs placed by resident physicians during the study period were analyzed. There was no statistically significant difference in total mechanical complication rates between the STRs and TTRs in this study period (2.4% vs. 2.2%, P = 1). Simulation-trained residents were more likely to use ultrasound guidance when indicated during CVC insertion compared with TTRs (94.8% vs. 70.5%, P < 0.001). CONCLUSIONS Mechanical complication rates associated with CVC insertion were similar between the simulation and TTRs and were consistent with previously published literature. These findings suggest that residents who underwent simulation training and certification demonstrated performance on par with more experienced TTRs. In addition, they were more likely to use best practices including ultrasound guidance in line placement.
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de la Fuente R, Fuentes R, Munoz-Gama J, Dagnino J, Sepúlveda M. Delphi Method to Achieve Clinical Consensus for a BPMN Representation of the Central Venous Access Placement for Training Purposes. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17113889. [PMID: 32486300 PMCID: PMC7312914 DOI: 10.3390/ijerph17113889] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 05/25/2020] [Accepted: 05/26/2020] [Indexed: 12/31/2022]
Abstract
Proper teaching of the technical skills necessary to perform a medical procedure begins with its breakdown into its constituent steps. Currently available methodologies require substantial resources and their results may be biased. Therefore, it is difficult to generate the necessary breakdown capable of supporting a procedural curriculum. The aim of our work was to breakdown the steps required for ultrasound guided Central Venous Catheter (CVC) placement and represent this procedure graphically using the standard BPMN notation. Methods: We performed the first breakdown based on the activities defined in validated evaluation checklists, which were then graphically represented in BPMN. In order to establish clinical consensus, we used the Delphi method by conducting an online survey in which experts were asked to score the suitability of the proposed activities and eventually propose new activities. Results: Surveys were answered by 13 experts from three medical specialties and eight different institutions in two rounds. The final model included 28 activities proposed in the initial model and four new activities proposed by the experts; seven activities from the initial model were excluded. Conclusions: The proposed methodology proved to be simple and effective, generating a graphic representation to represent activities, decision points, and alternative paths. This approach is complementary to more classical representations for the development of a solid knowledge base that allows the standardization of medical procedures for teaching purposes.
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Affiliation(s)
- Rene de la Fuente
- Department of Anesthesiology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago 8331150, Chile; (R.d.l.F.); (J.D.)
| | - Ricardo Fuentes
- Department of Anesthesiology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago 8331150, Chile; (R.d.l.F.); (J.D.)
- Correspondence:
| | - Jorge Munoz-Gama
- Department of Computer Science, School of Engineering, Pontificia Universidad Católica de Chile, Santiago 7820436, Chile; (J.M.-G.); (M.S.)
| | - Jorge Dagnino
- Department of Anesthesiology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago 8331150, Chile; (R.d.l.F.); (J.D.)
| | - Marcos Sepúlveda
- Department of Computer Science, School of Engineering, Pontificia Universidad Católica de Chile, Santiago 7820436, Chile; (J.M.-G.); (M.S.)
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Design and Evaluation of a Low-Cost Bronchoscopy-Guided Percutaneous Dilatational Tracheostomy Simulator. Simul Healthc 2020; 14:415-419. [PMID: 31804426 PMCID: PMC6903325 DOI: 10.1097/sih.0000000000000399] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Supplemental digital content is available in the text. Introduction Bronchoscopy-guided percutaneous dilatational tracheostomy (BG-PDT) is an invasive procedure regularly performed in the intensive care unit. Risk of serious complications have been estimated in up to 5%, focused during the learning phase. We have not found any published formal training protocols, and commercial simulators are costly and not widely available in some countries. The objective of this study was to present the design and simulator performance of a low-cost BG-PDT simulator. Methods A simulator was designed with materials available in a hardware store, synthetic skin pads, ex vivo bovine tracheas, and a pipe inspection camera. The simulator was tested in 8 experts and 9 novices. Sessions were video recorded, and participants were equipped with the Imperial College Surgical Device, a hand motion–tracking device. Performance was evaluated with a multimodal approach, including first attempt success rate, global success rate, total procedural time, Imperial College Surgical Device–derived proficiency parameters, and global rating scale applied blindly by 2 expert observers. A satisfaction survey was applied after the procedure. Results A simulator was successfully constructed, allowing multiple iterations per assembly, with a fixed cost of US $30 and $4 per use. Experts had greater global and first attempt success rate, performed the procedure faster, and with greater proficiency. It presented high user satisfaction and fidelity. Conclusions A low-cost BG-PDT simulator was successfully constructed, with the ability to discriminate between experts and novices, and with high fidelity. Considering its ease of construction and cost, it can be replicated in almost any intensive care unit.
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L'Her E, Geeraerts T, Desclefs JP, Benhamou D, Blanié A, Cerf C, Delmas V, Jourdain M, Lecomte F, Ouanes I, Garnier M, Mossadegh C. Simulation-based teaching in critical care, anaesthesia and emergency medicine. Anaesth Crit Care Pain Med 2020; 39:311-326. [PMID: 32223994 DOI: 10.1016/j.accpm.2020.03.010] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Erwan L'Her
- Centre Hospitalier Régional Universitaire de Brest, La Cavale-Blanche, Médecine Intensive et Réanimation, LATIM, INSERM, UMR 1101, boulevard Tanguy-Prigent, 29609 Brest cedex, France.
| | - Thomas Geeraerts
- Anesthésie-Réanimation, CHU de Toulouse, Hôpital Pierre-Paul-Riquet, Institut Toulousain de Simulation en Santé (ItSimS), Université Toulouse 3-Paul-Sabatier, place du Docteur-Baylac, TSA 40031, 31059 Toulouse cedex 9, France
| | - Jean-Philippe Desclefs
- Samu 91, Smur de Corbeil-Essonnes, Centre Hospitalier Sud-Francilien, 91100 Corbeil-Essonnes, France
| | - Dan Benhamou
- Service d'Anesthésie-Réanimation, Hôpitaux Universitaires Paris-Sud, AP-HP, Hôpital Bicêtre, 78, rue du Général-Leclerc, 94275 Le Kremlin-Bicêtre, France
| | - Antonia Blanié
- Département d'anesthésie-réanimation-médecine périopératoire, groupe hospitalo-universitaire, Paris-Saclay, AP-HP, Paris, France; Centre de simulation LabForSIMS, faculté de médecine Paris-Sud, unité de recherche CIAMS, EA4532, UFR STAPS Paris-Sud, Orsay, France
| | - Charles Cerf
- Réanimation Polyvalente, Hôpital Foch, 40, rue Worth, 92150 Suresnes, France
| | - Véronique Delmas
- Urgences, CHU Le Mans, 194, avenue Rubillard, 72000 Le Mans, France
| | - Mercedes Jourdain
- Réanimation médicale, Hôpital Salengro, rue Émile-Laine, 59037 Lille, France
| | - François Lecomte
- Urgences, Hôpital Cochin, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France
| | - Islem Ouanes
- Réanimation Médicale, Hôpital Fattouma-Bourguiba, avenue Farhat-Hached, Monastir, Tunisia
| | - Marc Garnier
- Département d'anesthésie et réanimation, Pôle Thorax-Voies Aériennes-Anesthésie-Réanimation, Hôpital Tenon, 4, rue de la Chine, 75020 Paris, France; INSERM, UMR1152, Faculté de médecine X.-Bichat, 16, rue Henri-Huchard, 75018 Paris, France
| | - Chirine Mossadegh
- Hôpital Universitaire La Pitié-Salpêtrière, Service de Réanimation Médicale, 47-83, boulevard de l'Hôpital, 75651 Paris cedex 13, France
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Learners and Luddites in the Twenty-first Century: Bringing Evidence-based Education to Anesthesiology. Anesthesiology 2020; 131:908-928. [PMID: 31365369 DOI: 10.1097/aln.0000000000002827] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Anesthesiologists are both teachers and learners and alternate between these roles throughout their careers. However, few anesthesiologists have formal training in the methodologies and theories of education. Many anesthesiology educators often teach as they were taught and may not be taking advantage of current evidence in education to guide and optimize the way they teach and learn. This review describes the most up-to-date evidence in education for teaching knowledge, procedural skills, and professionalism. Methods such as active learning, spaced learning, interleaving, retrieval practice, e-learning, experiential learning, and the use of cognitive aids will be described. We made an effort to illustrate the best available evidence supporting educational practices while recognizing the inherent challenges in medical education research. Similar to implementing evidence in clinical practice in an attempt to improve patient outcomes, implementing an evidence-based approach to anesthesiology education may improve learning outcomes.
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Lira R, Salas-Morales J, Leiva L, Fuente RDL, Fuentes R, Delfino A, Nazal CH, Sepúlveda M, Arias M, Herskovic V, Munoz-Gama J. Process-Oriented Feedback through Process Mining for Surgical Procedures in Medical Training: The Ultrasound-Guided Central Venous Catheter Placement Case. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16111877. [PMID: 31141904 PMCID: PMC6603675 DOI: 10.3390/ijerph16111877] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/13/2019] [Revised: 05/16/2019] [Accepted: 05/22/2019] [Indexed: 12/31/2022]
Abstract
Developing high levels of competence in the execution of surgical procedures through training is a key factor for obtaining good clinical results in healthcare. To improve the effectiveness of the training, it is advisable to provide feedback to each student tailored to how the student has performed the procedure on each occasion. Current state-of-the-art feedback is based on Checklists and Global Rating Scales, which indicate whether all process steps have been carried out and the quality of each execution step. However, there is a process perspective that is not captured successfully by these instruments, e.g., steps performed, but in an undesired order, group of activities that are repeated an unnecessary number of times, or an excessive transition time between two consecutive steps. In this research, we propose a novel use of process mining techniques to effectively identify desired and undesired process patterns regarding rework, the order in which activities are performed, and time performance, in order to complement the tailored feedback for surgical procedures using a process perspective. The proposed approach was applied to analyze a real case of ultrasound-guided Central Venous Catheter placement training. It was quantitatively and qualitatively validated that the students who participated in the training program perceived the process-oriented feedback they received as favorable for their learning.
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Affiliation(s)
- Ricardo Lira
- Department of Computer Science, School of Engineering, Pontificia Universidad Católica de Chile, Santiago 7820436, Chile.
| | - Juan Salas-Morales
- Department of Computer Science, School of Engineering, Pontificia Universidad Católica de Chile, Santiago 7820436, Chile.
| | - Luis Leiva
- Department of Computer Science, School of Engineering, Pontificia Universidad Católica de Chile, Santiago 7820436, Chile.
| | - Rene de la Fuente
- Department of Anesthesiology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago 8331150, Chile.
| | - Ricardo Fuentes
- Department of Anesthesiology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago 8331150, Chile.
| | - Alejandro Delfino
- Department of Anesthesiology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago 8331150, Chile.
| | - Claudia Hurtado Nazal
- Department of Anesthesiology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago 8331150, Chile.
| | - Marcos Sepúlveda
- Department of Computer Science, School of Engineering, Pontificia Universidad Católica de Chile, Santiago 7820436, Chile.
| | - Michael Arias
- Department of Business Computer Science, Universidad de Costa Rica, San Ramón 111-4250, Costa Rica.
| | - Valeria Herskovic
- Department of Computer Science, School of Engineering, Pontificia Universidad Católica de Chile, Santiago 7820436, Chile.
| | - Jorge Munoz-Gama
- Department of Computer Science, School of Engineering, Pontificia Universidad Católica de Chile, Santiago 7820436, Chile.
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Good RJ, Rothman KK, Ackil DJ, Kim JS, Orsborn J, Kendall JL. Hand motion analysis for assessment of nursing competence in ultrasound-guided peripheral intravenous catheter placement. J Vasc Access 2018; 20:301-306. [DOI: 10.1177/1129729818804997] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Introduction: Objective measures such as hand motion analysis are needed to assess competency in technical skills, including ultrasound-guided procedures. Ultrasound-guided peripheral intravenous catheter placement has many potential benefits and is a viable skill for nurses to learn. The objective of this study was to demonstrate the feasibility and validity of hand motion analysis for assessment of nursing competence in ultrasound-guided peripheral intravenous placement. Methods: We conducted a prospective cohort study at a tertiary children’s hospital. Participants included a convenience sample of nurses with no ultrasound-guided peripheral intravenous experience and experts in ultrasound-guided peripheral intravenous placement. Nurses completed hand motion analysis before and after participating in a simulation-based ultrasound-guided peripheral intravenous placement training program. Experts also completed hand motion analysis to provide benchmark measurements. After training, nurses performed ultrasound-guided peripheral intravenous placement in clinical practice and self-reported details of attempts. Results: A total of 21 nurses and 6 experts participated. Prior to the hands-on training session, experts performed significantly better in all hand motion analysis metrics and procedure time. After completion of the hands-on training session, the nurses showed significant improvement in all hand motion analysis metrics and procedure time. Few nurses achieved hand motion analysis metrics within the expert benchmark after completing the hands-on training session with the exception of angiocatheter motion smoothness. In total, 12 nurses self-reported 38 ultrasound-guided peripheral intravenous placement attempts in clinical practice with a success rate of 60.5%. Discussion: We demonstrated the feasibility and construct validity of hand motion analysis as an objective assessment of nurse competence in ultrasound-guided peripheral intravenous placement. Nurses demonstrated rapid skill acquisition but did not achieve expert-level proficiency.
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Affiliation(s)
- Ryan J Good
- Department of Pediatrics, Section of Critical Care, University of Colorado Denver, Anschutz Medical Campus, Aurora, CO, USA
| | | | - Daniel J Ackil
- Department of Emergency Medicine, Denver Health Medical Center, Denver, CO, USA
| | - John S Kim
- Department of Pediatrics, Section of Cardiology, University of Colorado Denver, Anschutz Medical Campus, Aurora, CO, USA
| | - Jonathan Orsborn
- Department of Pediatrics, Section of Emergency Medicine, University of Colorado Denver, Anschutz Medical Campus, Aurora, CO, USA
| | - John L Kendall
- Department of Emergency Medicine, Denver Health Medical Center, Denver, CO, USA
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Bohnen JD, Demetri L, Fuentes E, Butler K, Askari R, Anand RJ, Petrusa E, Kaafarani HMA, Yeh DD, Saillant N, King D, Briggs S, Velmahos GC, Moya MD. High-Fidelity Emergency Department Thoracotomy Simulator With Beating-Heart Technology and OSATS Tool Improves Trainee Confidence and Distinguishes Level of Skill. JOURNAL OF SURGICAL EDUCATION 2018; 75:1357-1366. [PMID: 29496361 DOI: 10.1016/j.jsurg.2018.02.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Revised: 12/23/2017] [Accepted: 02/01/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE Resuscitative Thoracotomy or Emergency Department Thoracotomy (EDT) is a time-sensitive and potentially life-saving procedure. Yet, trainee experience with this procedure is often limited in both clinical and simulation settings. We sought to develop a high-fidelity EDT simulation module and assessment tool to facilitate trainee education. DESIGN Using the Kern model for curricular development, a group of expert trauma surgeons identified EDT as a high-stakes, low-frequency procedure. Task analysis identified 5 key steps of EDT: (1) opening chest/rib spreader utilization; (2) pericardiotomy/cardiac repair; (3) open cardiac massage; (4) clamping aorta; and (5) control of pulmonary hilum. A high-fidelity simulator with beating-heart technology was built. The previously validated Objective Structured Assessment of Technical Skills (OSATS) was adapted to create the "EDT-OSATS" which assessed performance along several domains: (1) Surgical technique (key steps); (2) general skills; and (3) global rating. A pilot test was performed to compare board-certified trauma surgeons (i.e., Experts) with categorical general surgery interns (i.e., Novices). Each subject received preparatory materials, completed a presimulation quiz, performed a videotaped procedure on the EDT simulator, and completed a postmodule survey. Two independent raters scored performances using the EDT-OSATS. Groups were compared in descriptive and unadjusted analyses. We hypothesized that our EDT simulation module would distinguish between expert vs novice performance and improve trainee confidence. SETTING Simulation laboratory at Massachusetts General Hospital in Boston, MA. PARTICIPANTS Trauma surgeons (Experts, n = 6) and categorical general surgery interns (Novices, n = 8). RESULTS Experts scored significantly higher than Novices on nearly all components of the EDT-OSATS, including: (1) surgical technique: pericardiotomy (4.2 vs 3.4, p = 0.040), cardiac massage (3.6 vs 2.4, p = 0.028), clamping aorta (4.1 vs 3.3, p = 0.035), control of pulmonary hilum (4.8 vs 3.4, p < 0.001); (2) general skills: time/motion (4.1 vs 2.9, p = 0.011), knowledge and handling of instruments (4.3 vs 3.1, p = 0.004), and (3) global rating (3.9 vs 2.9, p = 0.026). There was no statistical difference between groups on opening chest/rib spreader utilization (3.8 vs 3.3, p = 0.352) or procedure time (204sec vs 227sec, p = 0.401), though Experts scored numerically higher than Novices on every measure. Novices reported significantly increased confidence after the simulation (3.1 vs 1.4, p = 0.001). Ninety-three percent (13/14) of participants found the simulator realistic. CONCLUSIONS Our novel high-fidelity beating-heart EDT simulator is realistic and improves trainee confidence in this low-frequency, high-stakes emergency procedure. The EDT-OSATS tool differentiates between performances of experienced surgeons vs novice trainees on the beating-heart simulator. This training module and accompanying assessment instrument hold promise as a learning tool for clinicians who may perform emergency department thoracotomy.
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Affiliation(s)
- Jordan D Bohnen
- Department of Surgery, Massachusetts General Hospital & Harvard Medical School, Boston, Massachusetts
| | - Leah Demetri
- Department of Surgery, Massachusetts General Hospital & Harvard Medical School, Boston, Massachusetts
| | - Eva Fuentes
- Department of Surgery, Massachusetts General Hospital & Harvard Medical School, Boston, Massachusetts
| | - Kathryn Butler
- Division of Trauma, Emergency Surgery, and Surgical Critical Care, Massachusetts General Hospital & Harvard Medical School, Boston, Massachusetts
| | - Reza Askari
- Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts
| | - Rahul J Anand
- Department of Surgery, Virginia Commonwealth University School of Medicine, Richmond, Virginia
| | - Emil Petrusa
- Department of Surgery, Massachusetts General Hospital & Harvard Medical School, Boston, Massachusetts; Learning Laboratory, Massachusetts General Hospital, Boston, Massachusetts
| | - Haytham M A Kaafarani
- Division of Trauma, Emergency Surgery, and Surgical Critical Care, Massachusetts General Hospital & Harvard Medical School, Boston, Massachusetts
| | - D Dante Yeh
- Division of Trauma, Emergency Surgery, and Surgical Critical Care, Massachusetts General Hospital & Harvard Medical School, Boston, Massachusetts
| | - Noelle Saillant
- Division of Trauma, Emergency Surgery, and Surgical Critical Care, Massachusetts General Hospital & Harvard Medical School, Boston, Massachusetts
| | - David King
- Division of Trauma, Emergency Surgery, and Surgical Critical Care, Massachusetts General Hospital & Harvard Medical School, Boston, Massachusetts
| | - Susan Briggs
- Division of Trauma, Emergency Surgery, and Surgical Critical Care, Massachusetts General Hospital & Harvard Medical School, Boston, Massachusetts
| | - George C Velmahos
- Division of Trauma, Emergency Surgery, and Surgical Critical Care, Massachusetts General Hospital & Harvard Medical School, Boston, Massachusetts
| | - Marc de Moya
- Division of Trauma and Acute Care Surgery, Medical College of Wisconsin-Froedtert Trauma Center, Milwaukee, Wisconsin.
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Improved Retention of Chest Compression Psychomotor Skills With Brief "Rolling Refresher" Training. Simul Healthc 2018; 12:213-219. [PMID: 28368963 DOI: 10.1097/sih.0000000000000228] [Citation(s) in RCA: 67] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION High-quality cardiopulmonary resuscitation (CPR) is critical to improve survival from cardiac arrest. However, cardiopulmonary resuscitation knowledge and psychomotor skill proficiency are transient. We hypothesized that brief, in situ refresher training will improve chest compression (CC) psychomotor skill retention for bedside providers. METHODS Nurses completed a baseline skill evaluation of CC quality 6 months after traditional basic life support recertification. Data collected using ResusciAnne with SkillReporter included the following: CC depth, rate, complete release, and correct hand position. Total compliance was defined as 100% CC with depth of 50 mm or greater, rate of 100/min or greater, and more than 90% complete release. After the baseline evaluation, the subjects completed "Rolling Refresher" (RR) CC psychomotor training using audiovisual feedback every 2 to 3 months for 12 months until 30 seconds of CCs fulfilling total compliance criteria was achieved. Chest compression quality evaluations were repeated twice ("RR 6 month" and "RR 12 month" evaluation) after implementation of RR program. RESULTS Thirty-seven providers enrolled and completed the baseline evaluation. Mean depth was 36.3 (9.7) mm, and 8% met criteria for depth, 35% for rate, and 5% for total compliance. After RRs were implemented, CC quality improved significantly at RR 6-month evaluation: odds ratio for meeting criteria were the following: depth of 35.1 (95% confidence interval = 2.5496, P = 0.009) and total compliance of 22.3 (95% confidence interval = 2.1239, P = 0.010). There was no difference in CC quality at RR 12-month versus RR 6-month evaluation. CONCLUSIONS Retention of CC psychomotor skill quality is limited to 6 months after traditional basic life support recertification. Rolling Refresher CC training can significantly improve retention of CC psychomotor skills. Whether CC skills are improved, maintained, or deteriorate after 12 months of Refresher training and optimal frequency of Refreshers is unknown.
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Blum RH, Muret-Wagstaff SL, Boulet JR, Cooper JB, Petrusa ER. Simulation-based Assessment to Reliably Identify Key Resident Performance Attributes. Anesthesiology 2018; 128:821-831. [DOI: 10.1097/aln.0000000000002091] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Abstract
Background
Obtaining reliable and valid information on resident performance is critical to patient safety and training program improvement. The goals were to characterize important anesthesia resident performance gaps that are not typically evaluated, and to further validate scores from a multiscenario simulation-based assessment.
Methods
Seven high-fidelity scenarios reflecting core anesthesiology skills were administered to 51 first-year residents (CA-1s) and 16 third-year residents (CA-3s) from three residency programs. Twenty trained attending anesthesiologists rated resident performances using a seven-point behaviorally anchored rating scale for five domains: (1) formulate a clear plan, (2) modify the plan under changing conditions, (3) communicate effectively, (4) identify performance improvement opportunities, and (5) recognize limits. A second rater assessed 10% of encounters. Scores and variances for each domain, each scenario, and the total were compared. Low domain ratings (1, 2) were examined in detail.
Results
Interrater agreement was 0.76; reliability of the seven-scenario assessment was r = 0.70. CA-3s had a significantly higher average total score (4.9 ± 1.1 vs. 4.6 ± 1.1, P = 0.01, effect size = 0.33). CA-3s significantly outscored CA-1s for five of seven scenarios and domains 1, 2, and 3. CA-1s had a significantly higher proportion of worrisome ratings than CA-3s (chi-square = 24.1, P < 0.01, effect size = 1.50). Ninety-eight percent of residents rated the simulations more educational than an average day in the operating room.
Conclusions
Sensitivity of the assessment to CA-1 versus CA-3 performance differences for most scenarios and domains supports validity. No differences, by experience level, were detected for two domains associated with reflective practice. Smaller score variances for CA-3s likely reflect a training effect; however, worrisome performance scores for both CA-1s and CA-3s suggest room for improvement.
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Affiliation(s)
- Richard H. Blum
- Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children’s Hospital and Harvard Medical School, Boston, Massachusetts
- Center for Medical Simulation, Charlestown, Massachusetts
| | | | - John R. Boulet
- Foundation for Advancement of International Medical Education and Research, Philadelphia, Pennsylvania
| | - Jeffrey B. Cooper
- Center for Medical Simulation, Charlestown, Massachusetts
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Emil R. Petrusa
- Department of Surgery and Massachusetts General Hospital Learning Laboratory, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
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Singleton MN, Allen KF, Li Z, McNerney K, Naber UH, Braga MS. Rolling-refresher simulation improves performance and retention of paediatric intensive care unit nurse code cart management. BMJ SIMULATION & TECHNOLOGY ENHANCED LEARNING 2018; 4:77-82. [PMID: 29670762 PMCID: PMC5890621 DOI: 10.1136/bmjstel-2017-000243] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Revised: 08/16/2017] [Accepted: 09/02/2017] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Paediatric Intensive Care Unit Nurses (PICU RNs) manage the code cart during paediatric emergencies at the Children's Hospital at Dartmouth-Hitchcock. These are low -frequency, high-stakes events. METHODS An uncontrolled intervention study with 6-month follow-up. A collaboration of physician and nursing experts developed a rolling-refresher training programme consisting of five simulated scenarios, including 22 code cart skills, to establish nursing code cart competency. The cohort of PICU RNs underwent a competency assessment in training 1. To achieve competence, the participating RN received immediate feedback and instruction and repeated each task until mastery during training 1. The competencies were repeated 6 months later, designated training 2. RESULTS Thirty-two RNs participated in training 1. Sixteen RNs (50%) completed the second training. Our rolling-refresher training programme resulted in a 43% reduction in the odds of first attempt failures between training 1 and training 2 (p=0.01). Multivariate linear regression evaluating the difference in first attempt failure between training 1 and training 2 revealed that the following covariates were not significantly associated with this improvement: interval Paediatric Advanced Life Support training, interval use of the code cart or defibrillator (either real or simulated) and time between training sessions. Univariate analysis between the two trainings revealed a statistically significant reduction in first attempt failures for: preparing an epinephrine infusion (72% vs 41%, p=0.04) and providing bag-mask ventilation (28% vs 0%, p=0.02). CONCLUSIONS Our rolling-refresher training programme demonstrated significant improvement in performance for low-frequency, high-risk skills required to manage a paediatric code cart with retention after initial training.
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Affiliation(s)
- Marcy N Singleton
- Pediatric Critical Care Medicine, Geisel School of Medicine at Dartmouth, Children's Hospital at Dartmouth-Hitchcock, Lebanon, New Hampshire
| | - Kimberly F Allen
- Pediatric Critical Care Medicine, Geisel School of Medicine at Dartmouth, Children's Hospital at Dartmouth-Hitchcock, Lebanon, New Hampshire
| | - Zhongze Li
- Norris Cotton Cancer Center, Biostatistics Shared Resource, Dartmouth College, Hanover, New Hampshire
| | - Kevin McNerney
- Department of Pediatrics, Yale School of Medicine, New Haven, Connecticut, USA
| | - Urs H Naber
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California, USA
| | - Matthew S Braga
- Pediatric Critical Care Medicine, Geisel School of Medicine at Dartmouth, Children's Hospital at Dartmouth-Hitchcock, Lebanon, New Hampshire
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Brydges R, Stroud L, Wong BM, Holmboe ES, Imrie K, Hatala R. Core Competencies or a Competent Core? A Scoping Review and Realist Synthesis of Invasive Bedside Procedural Skills Training in Internal Medicine. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2017; 92:1632-1643. [PMID: 28489618 DOI: 10.1097/acm.0000000000001726] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
PURPOSE Invasive bedside procedures are core competencies for internal medicine, yet no formal training guidelines exist. The authors conducted a scoping review and realist synthesis to characterize current training for lumbar puncture, arthrocentesis, paracentesis, thoracentesis, and central venous catheterization. They aimed to collate how educators justify using specific interventions, establish which interventions have the best evidence, and offer directions for future research and training. METHOD The authors systematically searched Medline, Embase, the Cochrane Library, and ERIC through April 2015. Studies were screened in three phases; all reviews were performed independently and in duplicate. The authors extracted information on learner and patient demographics, study design and methodological quality, and details of training interventions and measured outcomes. A three-step realist synthesis was performed to synthesize findings on each study's context, mechanism, and outcome, and to identify a foundational training model. RESULTS From an initial 6,671 studies, 149 studies were further reduced to 67 (45%) reporting sufficient information for realist synthesis. Analysis yielded four types of procedural skills training interventions. There was relative consistency across contexts and significant differences in mechanisms and outcomes across the four intervention types. The medical procedural service was identified as an adaptable foundational training model. CONCLUSIONS The observed heterogeneity in procedural skills training implies that programs are not consistently developing residents who are competent in core procedures. The findings suggest that researchers in education and quality improvement will need to collaborate to design training that develops a "competent core" of proceduralists using simulation and clinical rotations.
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Affiliation(s)
- Ryan Brydges
- R. Brydges is assistant professor, Department of Medicine, University of Toronto, and scientist, Wilson Centre, University Health Network, Toronto, Ontario, Canada. L. Stroud is assistant professor, Department of Medicine, University of Toronto, Toronto, Ontario, Canada. B.M. Wong is associate professor, Department of Medicine, University of Toronto, Toronto, Ontario, Canada. E.S. Holmboe is senior vice president for milestones development and evaluation, Accreditation Council for Graduate Medical Education, Chicago, Illinois. K. Imrie is immediate past president, Royal College of Physicians and Surgeons of Canada, Ottawa, Ontario, Canada. R. Hatala is associate professor, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
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Slomer A, Chenkin J. Does Test-enhanced Learning Improve Success Rates of Ultrasound-guided Peripheral Intravenous Insertion? A Randomized Controlled Trial. AEM EDUCATION AND TRAINING 2017; 1:310-315. [PMID: 30051049 PMCID: PMC6001601 DOI: 10.1002/aet2.10044] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Revised: 04/25/2017] [Accepted: 05/16/2017] [Indexed: 05/05/2023]
Abstract
INTRODUCTION Teaching procedural skills in medicine is time- and resource-intensive, and it is therefore important to determine which educational strategies are most effective. Test-enhanced learning (TEL) has been demonstrated to be effective in improving learner retention; however, there is little research evaluating the testing effect on the acquisition of procedural skills in medicine. The objective of this study was to examine the impact of TEL on learning ultrasound-guided intravenous (USG IV) insertion on a simulated model. METHODS We conducted a prospective randomized controlled trial of medical students at a single tertiary care academic hospital. Participants were randomized to either the TEL group (TEG) or control group (CG). Each group received an USG peripheral IV teaching session that included a didactic portion and hands-on skills training. The training sessions were identical except that the TEG was informed at the outset that there would be an assessment at the end of the session. The TEG then received a formal assessment of the skill during the last 15 minutes of the session, whereas the CG had continued practice time. Subjects in both groups were evaluated 10-14 days later to compare skill performance using a simulation-based assessment tool consisting of a global rating scale (GRS) and checklist items. RESULTS Thirty medical students completed the study, 15 in the TEG and 15 in the CG. There were no significant differences between the two groups at baseline based on year of medical training or prior IV or ultrasound experience. The overall procedural success rate was 93.3% (95% CI = 79.0%-100.0%) in the TEG and 80.0% (95% CI = 57.1%-100%) in the CG (p = 0.60). The first-attempt failure rate was 13.3% (95% CI = 0.0%-32.8%) in the TEG and 33.3% (95% CI = 6.3%-60.4%) in the CG (p = 0.39). There were no statistically significant differences between the means of the GRS (TEG = 4.7, CG = 4.2; p = 0.53, r = 0.11) or checklist scores (TEG = 78.6%, CG = 75.3%; p = 0.20, r = 0.24). CONCLUSIONS In this study of novice learners, both TEL with structured practice and structured practice alone lead to high success rates performing USG IV insertion on a simulated model. While we noted a trend toward higher procedural success rates and lower first-attempt failure rates in the TEG, these did not meet statistical significance. Further studies with larger sample sizes are required to determine whether the beneficial effects of TEL can be transferred to procedural skills teaching.
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Affiliation(s)
- Adam Slomer
- Division of Emergency MedicineDepartment of MedicineUniversity of TorontoTorontoOntarioCanada
| | - Jordan Chenkin
- Division of Emergency MedicineDepartment of MedicineUniversity of TorontoTorontoOntarioCanada
- University of TorontoSunnybrook Health Sciences CentreTorontoOntarioCanada
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Corvetto MA, Pedemonte JC, Varas D, Fuentes C, Altermatt FR. Simulation-based training program with deliberate practice for ultrasound-guided jugular central venous catheter placement. Acta Anaesthesiol Scand 2017; 61:1184-1191. [PMID: 28685812 DOI: 10.1111/aas.12937] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2016] [Revised: 06/06/2017] [Accepted: 06/17/2017] [Indexed: 12/20/2022]
Abstract
BACKGROUND Current evidence supports the utility of simulation training for bedside procedures such as ultrasound-guided jugular central venous catheter (CVC) insertion. However, a standardized methodology to teach procedural skills has not been determined yet. The aim of this study was to evaluate the effectiveness of a simulation-based training program for improving novice technical performance during ultrasound-guided internal jugular CVC placement. METHODS Postgraduate year 1 (PGY-1) residents from anesthesiology, emergency medicine, cardiology, ICU, and nephrology specialties were trained in four deliberate practice sessions. Learning objectives included principles of ultrasound (US), preparation (gown, glove, draping), procedural skills I (US scanning and puncture), and procedural skills II (catheter insertion). 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). RESULTS Thirty-five PGY-1 residents successfully completed the program. These novices' GRS scores improved significantly after the training (P < 0.001). Total path length measured with the ICSAD decreased significantly after the training (P = 0.008). Procedural time decreased significantly after training from 387 (310-501) seconds to 200 (157-261) seconds (median and interquartile range) (P = 0.029). CONCLUSION This simulation-training program based on deliberate practice significantly increased the technical skills of residents in US-guided short-axis, out-of-plane internal jugular CVC placement. Data also confirm the validity of the ICSAD as an assessment tool for ultrasound-guided internal jugular CVC placement learning.
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Affiliation(s)
- M. A. Corvetto
- Department of Anesthesiology; School of Medicine; Pontificia Universidad Catolica de Chile; Santiago Chile
| | - J. C. Pedemonte
- Department of Anesthesiology; School of Medicine; Pontificia Universidad Catolica de Chile; Santiago Chile
| | - D. Varas
- Department of Anesthesiology; School of Medicine; Pontificia Universidad Catolica de Chile; Santiago Chile
| | - C. Fuentes
- Department of Anesthesiology; School of Medicine; Pontificia Universidad Catolica de Chile; Santiago Chile
| | - F. R. Altermatt
- Department of Anesthesiology; School of Medicine; Pontificia Universidad Catolica de Chile; Santiago Chile
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Amini R, Stolz LA, Breshears E, Patanwala AE, Stea N, Hawbaker N, Thompson M, Sanders AB, Adhikari S. Assessment of ultrasound-guided procedures in preclinical years. Intern Emerg Med 2017; 12:1025-1031. [PMID: 27565985 DOI: 10.1007/s11739-016-1525-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Accepted: 08/12/2016] [Indexed: 10/21/2022]
Abstract
Medical graduates entering residency often lack confidence and competence in procedural skills. Implementation of ultrasound (US)-guided procedures into undergraduate medical education is a logical step to addressing medical student procedural competency. The objective of our study was to determine the impact of an US teaching workshop geared toward training medical students in how to perform three distinct US-guided procedures. Cross-sectional study at an urban academic medical center. Following a 1-h didactic session, a sample of 11 students out of 105 (10.5 %) were asked to perform three procedures each (total 33 procedures) to establish a baseline of procedural proficiency. Following a 1-h didactic session, students were asked to perform 33 procedures using needle guidance with ultrasound to establish a baseline of student proficiency. Also, a baseline survey regarding student opinions, self-assessment of skills, and US procedure knowledge was administered before and after the educational intervention. After the educational workshop, students' procedural competency was assessed by trained ultrasound clinicians. One-hundred-and-five third-year medical students participated in this study. The average score for the knowledge-based test improved from 46 % (SD 16 %) to 74 % (SD 14 %) (p < 0.05). Students' overall confidence in needle guidance improved from 3.1 (SD 2.4) to 7.8 (SD 1.5) (p < 0.05). Student assessment of procedural competency using an objective and validated assessment tool demonstrated statistically significant (p < 0.05) improvement in all procedures. The one-day US education workshop employed in this study was effective at immediately increasing third-year medical students' confidence and technical skill at performing US-guided procedures.
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Affiliation(s)
- Richard Amini
- Department of Emergency Medicine, University of Arizona, Tucson, AZ, USA.
| | - Lori Ann Stolz
- Department of Emergency Medicine, University of Arizona, Tucson, AZ, USA
| | | | - Asad E Patanwala
- Department of Pharmacy Practice and Science, University of Arizona, Tucson, AZ, USA
| | - Nicholas Stea
- Department of Emergency Medicine, University of Arizona, Tucson, AZ, USA
| | - Nicolaus Hawbaker
- Department of Emergency Medicine, University of Arizona, Tucson, AZ, USA
| | - Matthew Thompson
- Department of Emergency Medicine, University of Arizona, Tucson, AZ, USA
| | | | - Srikar Adhikari
- Department of Emergency Medicine, University of Arizona, Tucson, AZ, USA
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Brunette V, Thibodeau-Jarry N. Simulation as a Tool to Ensure Competency and Quality of Care in the Cardiac Critical Care Unit. Can J Cardiol 2016; 33:119-127. [PMID: 28024550 DOI: 10.1016/j.cjca.2016.10.015] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Revised: 10/17/2016] [Accepted: 10/19/2016] [Indexed: 02/03/2023] Open
Abstract
Cardiac critical care units are high-risk clinical environments. Medical emergencies are frequent and require the intervention of a cohesive, efficient, and well trained interprofessional team. In modern clinical practice there is increased emphasis on safety but also increased lack of acceptance of medical errors and as a consequence, increased litigation. In the past decade, simulation-based learning has arisen as an effective and safe means to learn and practice acute care setting skills. It has been used and studied in different contexts including procedural skills training, crisis resource management and team training, patient and family member communication skills, and health care system quality improvement. Simulation-based education is a relatively recent teaching strategy and evidence of its efficacy continues to grow. Nevertheless, many influential medical societies are now promoting a simulation-based approach for cardiovascular training and continuing medical education. In this article we review the simulation literature in the intensive care unit and evaluate its integration in coronary care units and postoperative cardiovascular intensive care units. We also provide resources for educators and clinicians who wish to implement simulation workshops in these settings.
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Affiliation(s)
- Véronique Brunette
- Critical Care Department, Hôpital du Sacré-Cœur de Montréal, University de Montréal, Montreal, Québec, Canada; Surgical Department, Montreal Heart Institute, Université de Montréal, Montreal, Québec, Canada.
| | - Nicolas Thibodeau-Jarry
- Masters of Medical Sciences in Medical Education Program, Harvard Medical School, Boston, Massachusetts, USA
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Komasawa N, Mihara R, Minami T. Central venous access training simulator that enables dilator or catheter insertion. Acute Med Surg 2016; 3:424-425. [DOI: 10.1002/ams2.169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Affiliation(s)
| | - Ryosuke Mihara
- Department of AnesthesiologyOsaka Medical College Takatsuki Japan
| | - Toshiaki Minami
- Department of AnesthesiologyOsaka Medical College Takatsuki Japan
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Dietrich CF, Horn R, Morf S, Chiorean L, Dong Y, Cui XW, Atkinson NSS, Jenssen C. Ultrasound-guided central vascular interventions, comments on the European Federation of Societies for Ultrasound in Medicine and Biology guidelines on interventional ultrasound. J Thorac Dis 2016; 8:E851-E868. [PMID: 27747022 DOI: 10.21037/jtd.2016.08.49] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Central venous access has traditionally been performed on the basis of designated anatomical landmarks. However, due to patients' individual anatomy and vessel pathology and depending on individual operators' skill, this landmark approach is associated with a significant failure rate and complication risk. There is substantial evidence demonstrating significant improvement in effectiveness and safety of vascular access by realtime ultrasound (US)-guidance, as compared to the anatomical landmark-guided approach. This review comments on the evidence-based recommendations on US-guided vascular access which have been published recently within the framework of Guidelines on Interventional Ultrasound (InVUS) of the European Federation of Societies for Ultrasound in Medicine and Biology (EFSUMB) from a clinical practice point of view.
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Affiliation(s)
- Christoph F Dietrich
- Medical Department, Caritas-Krankenhaus Bad Mergentheim, Academic Teaching Hospital of the University of Würzburg, Würzburg, Germany;; Sino-German Research Center of Ultrasound in Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450000, China
| | - Rudolf Horn
- Notfallstation, Kantonsspital Glarus, Glarus, Switzerland
| | - Susanne Morf
- Intensivmedizin Kantonsspital Graubünden, Chur, Switzerland
| | - Liliana Chiorean
- Department of Medical Imaging, des Cévennes Clinic, Annonay, France
| | - Yi Dong
- Translational Gastroenterology Unit, John Radcliffe Hospital, Oxford University Hospitals NHS Trust, Oxford, UK
| | - Xin-Wu Cui
- Medical Department, Caritas-Krankenhaus Bad Mergentheim, Academic Teaching Hospital of the University of Würzburg, Würzburg, Germany;; Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430074, China
| | - Nathan S S Atkinson
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Christian Jenssen
- Department of Internal Medicine, Krankenhaus Märkisch Oderland Strausberg, Wriezen, Germany
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Ullman E, Kennedy M, Di Delupis FD, Pisanelli P, Burbui AG, Cussen M, Galli L, Pini R, Gensini GF. The Tuscan Mobile Simulation Program: a description of a program for the delivery of in situ simulation training. Intern Emerg Med 2016; 11:837-41. [PMID: 26861702 DOI: 10.1007/s11739-016-1401-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Accepted: 01/24/2016] [Indexed: 11/26/2022]
Abstract
Simulation has become a critical aspect of medical education. It allows health care providers the opportunity to focus on safety and high-risk situations in a protected environment. Recently, in situ simulation, which is performed in the actual clinical setting, has been used to recreate a more realistic work environment. This form of simulation allows for better team evaluation as the workers are in their traditional roles, and can reveal latent safety errors that often are not seen in typical simulation scenarios. We discuss the creation and implementation of a mobile in situ simulation program in emergency departments of three hospitals in Tuscany, Italy, including equipment, staffing, and start-up costs for this program. We also describe latent safety threats identified in the pilot in situ simulations. This novel approach has the potential to both reduce the costs of simulation compared to traditional simulation centers, and to expand medical simulation experiences to providers and healthcare organizations that do not have access to a large simulation center.
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Affiliation(s)
- Edward Ullman
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, 1 Deaconess Road, WCC2, Boston, MA, 02215, USA.
| | - Maura Kennedy
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, 1 Deaconess Road, WCC2, Boston, MA, 02215, USA
| | - Francesco Dojmi Di Delupis
- Inter-institutional Integrated Department, University of Florence and Careggi University Hospital, Florence, Italy
- Local Healthcare Authority, ASL 10, Florence, Tuscany, Italy
| | - Paolo Pisanelli
- Inter-institutional Integrated Department, University of Florence and Careggi University Hospital, Florence, Italy
- Department of Emergency Medicine, Grosseto Hospital, ASL 9, Grosseto, Italy
| | | | - Meaghan Cussen
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, 1 Deaconess Road, WCC2, Boston, MA, 02215, USA
| | - Laura Galli
- Inter-institutional Integrated Department, University of Florence and Careggi University Hospital, Florence, Italy
| | - Riccardo Pini
- Department of Emergency Medicine, Careggi University Hospital, Florence, Italy
| | - Gian Franco Gensini
- Department of Clinical and Experimental Medicine, University of Florence and Don Carlo Gnocchi Foundation, Florence, Italy
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Simulation Improves Procedural Protocol Adherence During Central Venous Catheter Placement: A Randomized Controlled Trial. Simul Healthc 2016; 10:270-6. [PMID: 26154250 DOI: 10.1097/sih.0000000000000096] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND Simulation training may improve proficiency at and reduce complications from central venous catheter (CVC) placement, but the scope of simulation's effect remains unclear. This randomized controlled trial evaluated the effects of a pragmatic CVC simulation program on procedural protocol adherence, technical skill, and patient outcomes. METHODS Internal medicine interns were randomized to standard training for CVC insertion or standard training plus simulation-based mastery training. Standard training involved a lecture, a video-based online module, and instruction by the supervising physician during actual CVC insertions. Intervention-group subjects additionally underwent supervised training on a venous access simulator until they demonstrated procedural competence. Raters evaluated interns' performance during internal jugular CVC placement on actual patients in the medical intensive care unit. Generalized estimating equations were used to account for outcome clustering within trainees. RESULTS We observed 52 interns placing 87 CVCs. Simulation-trained interns exhibited better adherence to prescribed procedural technique than interns who received only standard training (P = 0.024). There were no significant differences detected in first-attempt or overall cannulation success rates, mean needle passes, global assessment scores, or complication rates. CONCLUSIONS Simulation training added to standard training improved protocol adherence during CVC insertion by novice practitioners. This study may have been too small to detect meaningful differences in venous cannulation proficiency and other clinical outcomes, highlighting the difficulty of patient-centered simulation research in settings where poor outcomes are rare. For high-performing systems, where protocol deviations may provide an important proxy for rare procedural complications, simulation may improve CVC insertion quality and safety.
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King N, Kunac A, Johnsen E, Gallina G, Merchant AM. Design and validation of a cost-effective physical endoscopic simulator for fundamentals of endoscopic surgery training. Surg Endosc 2016; 30:4871-4879. [PMID: 26905575 DOI: 10.1007/s00464-016-4824-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2015] [Accepted: 02/06/2016] [Indexed: 01/13/2023]
Abstract
BACKGROUND The American Board of Surgery will require graduating surgical residents to achieve proficiency in endoscopy. Surgical simulation can help residents to prepare for this proficiency test, accelerate skill acquisition, shorten the learning, and improve patient safety. Currently, endoscopic simulators are extremely cost-prohibitive. We therefore designed an inexpensive physical endoscopic simulator to (1) facilitate Fundamentals of Endoscopic Surgery skills training and (2) teach basic colonoscopy skills, for <$200.00. METHODS We constructed the Rutgers Open Source Colonoscopy Simulator (ROSCO) from easily acquired commercial materials. For construct validation, we compared novices to experts in a two-arm non-randomized study. Each participant performed the five tasks and a full cecal intubation on the simulator. Face and content validity surveys were taken by the experts, after the construct validity study to determine the simulator's ability to achieve the intended task with "realism." Data were collected on (1) cost and construction, (2) time to completion of individual tasks, (3) percentage of task completion, and (4) survey statistics. RESULTS Our simulator requires no advanced expertise, costs $62.77 US, and weighs 8.5 pounds. The ROSCO simulator was clearly able to distinguish expert from novice. Expert task times for completing all five tasks, performing the loop reduction, and reaching the splenic and hepatic flexures on the simulator were significantly better than novice times (p < 0.05). All participants were able to complete all five tasks on the simulator 100 % of the time. Three out of five experts "Agreed" or "Strongly Agreed" with five out of the six statements regarding the simulator's teaching ability. Four out of five experts rated each of the five specific aspects of the simulator as "Realistic" or "Very Realistic." CONCLUSIONS We have designed a low-cost colonoscopy simulator with easily available materials and which requires very little advanced construction expertise and have demonstrated construct, face, and content validity. We believe this will have broad impact for endoscopic simulation, surgical education, and health education cost.
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Affiliation(s)
- Neil King
- Division of General Surgery, Rutgers-New Jersey Medical School, Newark, NJ, 07103, USA
| | - Anastasia Kunac
- Division of Trauma and Critical Care, Rutgers-New Jersey Medical School, Newark, NJ, 07103, USA
| | - Erik Johnsen
- Department of Surgery, Rutgers-New Jersey Medical School, 185 So. Orange Ave., MSB G-506, Newark, NJ, 07103, USA
| | - Gregory Gallina
- Division of Surgery, Hackensack University Medical Center, Hackensack, NJ, 07601, USA
| | - Aziz M Merchant
- Division of General Surgery, Rutgers-New Jersey Medical School, Newark, NJ, 07103, USA. .,Department of Surgery, Rutgers-New Jersey Medical School, 185 So. Orange Ave., MSB G-506, Newark, NJ, 07103, USA.
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Gardner AK, Abdelfattah K, Wiersch J, Ahmed RA, Willis RE. Embracing Errors in Simulation-Based Training: The Effect of Error Training on Retention and Transfer of Central Venous Catheter Skills. JOURNAL OF SURGICAL EDUCATION 2015; 72:e158-62. [PMID: 26362712 DOI: 10.1016/j.jsurg.2015.08.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/07/2015] [Revised: 07/30/2015] [Accepted: 08/05/2015] [Indexed: 05/11/2023]
Abstract
INTRODUCTION Error management training is an approach that encourages exposure to errors during initial skill acquisition so that learners can be equipped with important error identification, management, and metacognitive skills. The purpose of this study was to determine how an error-focused training program affected performance, retention, and transfer of central venous catheter (CVC) placement skills when compared with traditional training methodologies. METHODS Surgical interns (N = 30) participated in a 1-hour session featuring an instructional video and practice performing internal jugular (IJ) and subclavian (SC) CVC placement with guided instruction. All interns underwent baseline knowledge and skill assessment for IJ and SC (pretest) CVC placement; watched a "correct-only" (CO) or "correct + error" (CE) instructional video; practiced for 30 minutes; and were posttested on knowledge and IJ and SC CVC placement. Skill retention and transfer (femoral CVC placement) were assessed 30 days later. All skills tests (pretest, posttest, and transfer) were videorecorded and deidentified for evaluation by a single blinded instructor using a validated 17-item checklist. RESULTS Both the groups exhibited significant improvements (p < 0.001) in knowledge and skills after the 1-hour training program, but the increase of items achieved on the performance checklist did not differ between conditions (CO: IJ Δ = 35%, SC Δ = 29%; CE: IJ Δ = 36%, subclavian Δ = 33%). However, 1 month later, the CO group exhibited significant declines in skill retention on IJ CVC placement (from 68% at posttraining to 44% at day 30; p < 0.05) and SC CVC placement (from 63% at posttraining to 49% at day 30; p < 0.05), whereas the CE group did not have significant decreases in performance. The CE group performed significantly better on femoral CVC placement (i.e., transfer task; 62% vs 38%; p < 0.01) and on 2 of the 3 complication scenarios (p < 0.05) when compared with the CO group. CONCLUSIONS These data indicate that incorporating error-based activities and discussions into training programs can be beneficial for skill retention and transfer.
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Braga MS, Tyler MD, Rhoads JM, Cacchio MP, Auerbach M, Nishisaki A, Larson RJ. Effect of just-in-time simulation training on provider performance and patient outcomes for clinical procedures: a systematic review. BMJ SIMULATION & TECHNOLOGY ENHANCED LEARNING 2015; 1:94-102. [DOI: 10.1136/bmjstel-2015-000058] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Accepted: 09/16/2015] [Indexed: 12/12/2022]
Abstract
BackgroundProviding simulation training directly before an actual clinical procedure—or ‘just-in-time’ (JiT)—is resource intensive, but could improve both provider performance and patient outcomes.ObjectivesTo assess the effects of JiT simulation training versus no JiT training on provider performance and patient complications following clinical procedures on patients.Study selectionWe searched MEDLINE, Cochrane Library, CINAHL, PsycINFO, ERIC, ClinicalTrials.gov, simulation journals indexes and references of included studies during October 2014 for randomised trials, non-randomised trials and before-after studies comparing JiT simulation training versus no JiT training among providers performing clinical procedures. Findings were synthesised qualitatively.FindingsOf 1805 records screened, 8 studies comprising 3540 procedures and 1969 providers were eligible. 5 involved surgical procedures; the other 3 included paediatric endotracheal intubations, central venous catheter dressing changes, or infant lumbar puncture. Methodological quality was high. Of the 8 studies evaluating provider performance, 5 favoured JiT simulation training with 18–48% relative improvement on validated clinical performance scales, 16–20% relative reduction in surgical time and 12% absolute reduction in corrective prompts during central venous catheter dressing changes; 3 studies were equivocal with no improvement in intubation success, lumbar puncture success or urological surgery clinical performance scores. 3 studies evaluated patient complications; 1 favoured JiT simulation training with 45% relative reduction in central line-associated blood stream infections; 2 studies found no differences following intubation or laparoscopic nephrectomy.ConclusionsJiT simulation training improves provider performance, but currently available literature does not demonstrate a reduction in patient complications.
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Day J, Davis J, Riesenberg LA, Heil D, Berg K, Davis R, Berg D. Integrating Sonography Training Into Undergraduate Medical Education: A Study of the Previous Exposure of One Institution's Incoming Residents. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2015; 34:1253-7. [PMID: 26112628 DOI: 10.7863/ultra.34.7.1253] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
OBJECTIVES Sonography is a crucial and versatile tool within the field of medicine. Recent advancements in technology have led to increased use of point-of-care sonography. We designed a survey to assess prior point-of-care sonography training among incoming interns at an academic teaching hospital. METHODS In 2012 and 2013, we surveyed incoming interns (n = 154 and 145, respectively) regarding point-of-care sonography training received during medical school. The survey questions included formal didactic sessions, bedside instruction, and the use of simulation technology. RESULTS One-fourth (26.3% in 2012 and 23.4% in 2013) of responding interns reported having never done an ultrasound scan at the bedside. In 2012 and 2013, 55.0% and 55.6% of respondents reported never having done an ultrasound scan in a simulation center, respectively. Interns agreed that sonography education should be provided during medical school. On average, interns disagreed with the statement that sonography should be taught in residency only. There was no significant difference in the sex or general previous experience with sonography across both intern classes. CONCLUSIONS Point-of-care sonography is inconsistently taught in medical school. The interns in our study also thought that sonography education should begin in medical school, and sonography should be taught by using simulation and at the bedside.
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Affiliation(s)
- James Day
- Rector Clinical Skills and Simulation Center, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania USA (Ja.D., Jo.D., D.H., K.B., D.B.); and Medical Education Outcomes and Research, Department of Anesthesiology and Perioperative Medicine, University of Alabama at Birmingham, Birmingham, Alabama USA (L.A.R., R.D.)
| | - Joshua Davis
- Rector Clinical Skills and Simulation Center, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania USA (Ja.D., Jo.D., D.H., K.B., D.B.); and Medical Education Outcomes and Research, Department of Anesthesiology and Perioperative Medicine, University of Alabama at Birmingham, Birmingham, Alabama USA (L.A.R., R.D.)
| | - Lee Ann Riesenberg
- Rector Clinical Skills and Simulation Center, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania USA (Ja.D., Jo.D., D.H., K.B., D.B.); and Medical Education Outcomes and Research, Department of Anesthesiology and Perioperative Medicine, University of Alabama at Birmingham, Birmingham, Alabama USA (L.A.R., R.D.).
| | - Daniel Heil
- Rector Clinical Skills and Simulation Center, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania USA (Ja.D., Jo.D., D.H., K.B., D.B.); and Medical Education Outcomes and Research, Department of Anesthesiology and Perioperative Medicine, University of Alabama at Birmingham, Birmingham, Alabama USA (L.A.R., R.D.)
| | - Katherine Berg
- Rector Clinical Skills and Simulation Center, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania USA (Ja.D., Jo.D., D.H., K.B., D.B.); and Medical Education Outcomes and Research, Department of Anesthesiology and Perioperative Medicine, University of Alabama at Birmingham, Birmingham, Alabama USA (L.A.R., R.D.)
| | - Robyn Davis
- Rector Clinical Skills and Simulation Center, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania USA (Ja.D., Jo.D., D.H., K.B., D.B.); and Medical Education Outcomes and Research, Department of Anesthesiology and Perioperative Medicine, University of Alabama at Birmingham, Birmingham, Alabama USA (L.A.R., R.D.)
| | - Dale Berg
- Rector Clinical Skills and Simulation Center, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania USA (Ja.D., Jo.D., D.H., K.B., D.B.); and Medical Education Outcomes and Research, Department of Anesthesiology and Perioperative Medicine, University of Alabama at Birmingham, Birmingham, Alabama USA (L.A.R., R.D.)
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Tainter CR, Wong NL, Bittner EA. Innovative strategies in critical care education. J Crit Care 2015; 30:550-6. [PMID: 25702843 DOI: 10.1016/j.jcrc.2015.02.001] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2014] [Revised: 01/21/2015] [Accepted: 02/04/2015] [Indexed: 01/29/2023]
Abstract
The cadre of information pertinent to critical care medicine continues to expand at a tremendous pace, and we must adapt our strategies of medical education to keep up with the expansion. Differences in learners' characteristics can contribute to a mismatch with historical teaching strategies. Simulation is increasingly popular, but still far from universal. Emerging technology has the potential to improve our knowledge translation, but there is currently sparse literature describing these resources or their benefits and limitations. Directed strategies of assessment and feedback are often suboptimal. Even strategies of accreditation are evolving. This review attempts to summarize salient concepts, suggest resources, and highlight novel strategies to enhance practice and education in the challenging critical care environment.
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