Improving Internal Medicine Residents' Performance, Knowledge, and Confidence in Central Venous Catheterization Using Simulators

被引:35
作者
Millington, Scott J. [1 ]
Wong, Roger Y. [2 ]
Kassen, Barry O. [2 ]
Roberts, James M. [2 ]
Ma, Irene W. Y. [2 ,3 ]
机构
[1] Univ Ottawa, Dept Med, Ottawa, ON, Canada
[2] Univ British Columbia, Dept Med, Vancouver, BC, Canada
[3] Univ Calgary, Dept Med, Calgary, AB, Canada
关键词
central venous catheterization; competency; education; patient simulation; procedural skills; COMPLICATION RATES; GENERAL INTERNISTS; TECHNICAL SKILLS; SURGICAL SKILLS; PHYSICIANS; EDUCATION; COMPETENCE; SURGERY;
D O I
10.1002/jhm.570
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
BACKGROUND: Efficacy of simulators in teaching central venous catheterization (CVC) in an internal medicine residency program is unknown. OBJECTIVE: To determine whether or not learning CVC on simulators is associated with improvement in performance of CVC, knowledge about the procedure, and self-reported confidence. METHODS: All consenting first-year internal medicine residents who completed training in CVC on simulators were included. Participants were evaluated pre- and post-training by video-recorded CVC insertion and multiple-choice knowledge assessments. Procedural technique was rated in a blinded fashion by two independent adjudicators. Knowledge retention and self-reported confidence were reassessed at 18 months. MEASUREMENTS: Primary outcome of CVC performance was assessed based on global rating score (minimum 1, maximum 5). Secondary measures include checklist score (Out of ten), knowledge score and self-reported confidence (6-point Likert scale ranging from "none" to "complete"). RESULTS: Median global rating scores in 30 participants increased from 3.5 (IQR = 3-4) to 4.5 (IQR = 4-4.5) (P < 0.001). Checklist score increased from 9 (IQR = 6-9.5) to 9.5 (IQR = 9-9.5) (P < 0.001). Knowledge score increased from 65.7 +/- 11.9% to 81.2 +/- 10.7% (P < 0.001). Confidence increased from 3 ("moderate", IQR = 2-3) to 4 ("good", IQR=3-4) (P < 0.001). Sixteen participants completed the retention tests. Improvement in knowledge score and confidence at 18 months was retained compared with baseline (P = 0.002 and P < 0.0001 respectively). CONCLUSIONS: Use of simulators in teaching CVC in an internal medicine residency program results in improved procedural performance, knowledge, and self-reported confidence. Improvement in knowledge and confidence was retained at 18 months. Journal of Hospital Medicine 2009;4:410-416. (C) 2009 Society of Hospital Medicine.
引用
收藏
页码:410 / 416
页数:7
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