Simulation-based medical education training improves short and long-term competency in, and knowledge of central venous catheter insertion A before and after intervention study

BACKGROUND Multimodal educational interventions have been shown to improve short-term competency in, and knowledge of central venous catheter (CVC) insertion. OBJECTIVE To evaluate the effectiveness of simulation-based medical education training in improving short and long-term competency in, and knowledge of CVC insertion. DESIGN Before and after intervention study. SETTING University Geneva Hospital, Geneva, Switzerland, between May 2008 and January 2012. PARTICIPANTS Residents in anaesthesiology aware of the Seldinger technique for vascular puncture. INTERVENTION Participants attended a half-day course on CVC insertion. Learning objectives included work organization, aseptic technique and prevention of CVC complications. CVC insertion competency was tested pretraining, posttraining and then more than 2 years after training (sustainability phase). MAIN OUTCOME MEASURES The primary study outcome was competency as measured by a global rating scale of technical skills, a hand hygiene compliance score and a checklist compliance score. Secondary outcome was knowledge as measured by a standardised pretraining and posttraining multiple-choice questionnaire. Statistical analyses were performed using paired Student's t test or Wilcoxon signed-rank test. RESULTS Thirty-seven residents were included; 18 were tested in the sustainability phase (on average 34 months after training). The average global rating of skills was 23.4 points (+/- SD 4.08) before training, 32.2 (+/- 4.51) after training (P<0.001 for comparison with pretraining scores) and 26.5 (+/- 5.34) in the sustainability phase (P = 0.040 for comparison with pretraining scores). The average hand hygiene compliance score was 2.8 (+/- 1.0) points before training, 5.0 (+/- 1.04) after training (P<0.001 for comparison with pretraining scores) and 3.7 (+/- 1.75) in the sustainability phase (P = 0.038 for comparison with pretraining scores). The average checklist compliance was 14.9 points (+/- 2.3) before training, 19.9 (+/- 1.06) after training (P<0.001 for comparison with pretraining scores) and 17.4 (+/- 1.41) (P = 0.002 for comparison with pretraining scores). The percentage of correct answers in the multiple-choice questionnaire increased from 76.0% (+/- 7.9) before training to 87.7% (+/- 4.4) after training (P<0.001). CONCLUSION Simulation-based medical education training was effective in improving short and long-term competency in, and knowledge of CVC insertion.