Outcomes of Simulation-Based Education for Vascular Access: A Systematic Review and Meta-Analysis

Simulation-based learning in nephrology

Simulation is a technique to replace and amplify real experiences with guided ones that evoke or replicate substantial aspects of the real world in a fully interactive fashion. In nephrology (a particularly complex specialty), simulation can be used by patients, nurses, residents, and attending physicians alike. It allows one to learn techniques outside the stressful environment of care such as central venous catheter placement, arteriovenous fistula management, learning about peritoneal dialysis, or performing a kidney biopsy. Serious games and virtual reality are emerging methods that show promise. Simulation could also be important in relational aspects of working in a team or with the patient. The development of simulation as a teaching tool in nephrology allows for maintaining high-quality training for residents, tailored to their future practice, and minimizing risks for patients. Additionally, this education helps nephrologists maintain mastery of technical procedures, making the specialty attractive to younger generations. Unfortunately, the inclusion of simulation training programmes faces occasional logistical or funding limitations that universities must overcome with the assistance and innovation of teaching nephrologists. The impact of simulation-based teaching on clinical outcomes needs to be investigated in clinical studies.

Near-infrared venous imaging may be more useful than ultrasound guidance for novices to obtain difficult peripheral venous access: A crossover simulation study

BACKGROUND

Difficult peripheral venous access, especially in obese people, is challenging for novices. We conducted a randomized cross-over study to examine whether near-infrared venous imaging or ultrasound guidance is more useful for novice operators to obtain difficult peripheral venous access.

METHODS

Medical students were recruited as participants. After receiving basic training using commercial simulators, participants were randomly assigned to obtain simulated venous access using a difficult venous access simulator with near-infrared venous imaging or ultrasound guidance in a randomized cross-over design. A difficult venous access simulator was newly developed with deep and narrow vessels to simulate an obese patient. The primary outcome measure of the study was the first-time success rate (%), and the secondary outcome measures included procedure time (seconds) and the number of 3 consecutive successful attempts, to represent proficiency with the procedure. Pearson chi-square test, the Wilcoxon signed-rank test, and generalized estimating equations were used for statistical analysis.

RESULTS

Forty-one medical students with no experience performing peripheral venous access were enrolled in this study. The rate of successful first attempts did not differ between the 2 groups (70% for near-infrared; 65% for ultrasound guidance; P = .64). The duration of the procedure for the first attempt was significantly shorter using near-infrared imaging (median: 14; interquartile range: 12-19) compared to ultrasound guidance (median 46; interquartile range: 26-52; P = .007). The number of attempts until 3 consecutive successes was not significantly different comparing the 2 approaches (near-infrared: 3 (3, 7.25), ultrasound guidance: 3 (3, 6.25), P = .63).

CONCLUSION

There was no difference in success rate of first-time attempts or acquiring proficiency for the 2 methods. However, duration of the first attempt was significantly shorter with near-infrared imaging than with ultrasound guidance. Near-infrared imaging may require less training than ultrasound guidance. Near-infrared venous imaging may be useful for novices to obtain difficult peripheral venous access in obese patients.

Simulation versus theoretical learning for the transradial approach: a randomized controlled trial in interventional cardiology

INTRODUCTION

Simulation-based education (SE) in interventional cardiology improves knowledge acquisition and mastery of procedures including the conventional radial access (CRA).

AIM

To evaluate the contribution of SE in CRA compared with theoretical learning alone.

METHODS

This is a prospective randomized controlled study including cardiology residents and patients with normal radial pulses. Experienced residents as well as patients with contraindications to CRA, requiring urgent intervention, or with hemodynamic instability were not included. Missing the teaching sessions was the exclusion criteria. Residents were randomized into two groups: simulation versus control. They attended a theory lecture explaining CRA and were evaluated Only the simulation group attended an SE session with measurement of heart rate (HR) and stress level. A real application was then performed with measurement of HR and stress level. The primary outcome was success puncture rate.

RESULTS

The success of the puncture was similar between the two groups (p=0.651). In the practical application, the stress level was significantly different before the procedure but similar after the end of the procedure. The stress level varied significantly within the same group before and after the procedure The simulation group was significantly less tachycardic both before and during the procedure with a significant difference between the two groups (p <10-3).

CONCLUSION

This study demonstrated the interest of SE in novice residents for CRA as a complement to theoretical learning upstream of the real-life procedure.