Development and Evaluation of a Simulation-based Curriculum for Ultrasound-guided Central Venous Catheterization

CJEM ◽  
2016 ◽  
Vol 18 (6) ◽  
pp. 405-413 ◽  
Author(s):  
Robert McGraw ◽  
Tim Chaplin ◽  
Conor McKaigney ◽  
Louise Rang ◽  
Melanie Jaeger ◽  
...  
Keyword(s):  
Rating Scale ◽  
Deliberate Practice ◽  
Venous Catheter ◽  
Global Rating Scale ◽  
Global Rating ◽  
Ultrasound Guided ◽  
Central Venous ◽  
Simulation Based ◽  
Technical Proficiency ◽  
The Mean

AbstractObjectiveTo develop a simulation-based curriculum for residents to learn ultrasound-guided (USG) central venous catheter (CVC) insertion, and to study the volume and type of practice that leads to technical proficiency.MethodsTen post-graduate year two residents from the Departments of Emergency Medicine and Anesthesiology completed four training sessions of two hours each, at two week intervals, where they engaged in a structured program of deliberate practice of the fundamental skills of USG CVC insertion on a simulator. Progress during training was monitored using regular hand motion analysis (HMA) and performance benchmarks were determined by HMA of local experts. Blinded assessment of video recordings was done at the end of training to assess technical competence using a global rating scale.ResultsNone of the residents met any of the expert benchmarks at baseline. Over the course of training, the HMA metrics of the residents revealed steady and significant improvement in technical proficiency. By the end of the fourth session six of 10 residents had faster procedure times than the mean expert benchmark, and nine of 10 residents had more efficient left and right hand motions than the mean expert benchmarks. Nine residents achieved mean GRS scores rating them competent to perform independently.ConclusionWe successfully developed a simulation-based curriculum for residents learning the skills of USG CVC insertion. Our results suggest that engaging residents in three to four distributed sessions of deliberate practice of the fundamental skills of USG CVC insertion leads to steady and marked improvement in technical proficiency with individuals approaching or exceeding expert level benchmarks.

Ultrasound-guided regional anesthesia: feasibility and effectiveness of teaching via telesimulation in Ethiopia

2021 ◽  
pp. rapm-2020-102394
Author(s):  
Monica Liu ◽  
Margaret Salmon ◽  
Rene Zaidi ◽  
Arun Nagdev ◽  
Finot Debebe ◽  
...  
Keyword(s):  
Regional Anesthesia ◽  
Nerve Block ◽  
Rating Scale ◽  
Femoral Nerve Block ◽  
Femoral Nerve ◽  
House Staff ◽  
Global Rating Scale ◽  
Global Rating ◽  
Ultrasound Guided ◽  
Post Test

BackgroundAcute pain management in resource-poor countries remains a challenge. Ultrasound-guided regional anesthesia is a cost-effective way of delivering analgesia in these settings. However, for financial and logistical reasons, educational workshops are inaccessible to many physicians in these environments. Telesimulation provides a way of teaching across distance by using simulators and video-conferencing software to connect instructors and students worldwide. We conducted a prospective study to determine the feasibility of ultrasound-guided regional anesthesia teaching via telesimulation in Ethiopia.MethodsEighteen Ethiopian orthopedic and emergency medicine house staff participated in telesimulation teaching of ultrasound-guided femoral nerve block. This consisted of four 90-min sessions, once per week. Week 1 consisted of a precourse test and a presentation on aspects of performing a femoral nerve block, weeks 2 and 3 were live teaching sessions on scanning and needling techniques, and in week 4, the house staff undertook a postcourse test. All participants were assessed using a validated Global Rating Scale and Checklist.ResultsParticipants were provided with a validated checklist and global rating scale as a pretest and post-test. The participants showed significant improvement in their test scores, from a total mean of 51% in the pretest to 84% in their post-test.ConclusionsTeaching ultrasound-guided regional anesthesia of the femoral nerve remotely via telesimulation is feasible. Telesimulation can greatly improve the accessibility of ultrasound-guided regional anesthesia teaching to physicians in remote areas.

Pre- and post-review of a standardized ultrasound-guided central venous catheterization curriculum evaluating procedural skills acquisition and clinician confidence

2019 ◽  
Vol 21 (4) ◽  
pp. 440-448 ◽  
Author(s):  
Timothy R Spencer ◽  
Amy J Bardin-Spencer
Keyword(s):  
Central Venous Catheter ◽  
Central Venous Catheterization ◽  
Venous Catheter ◽  
Catheter Insertion ◽  
Central Venous Catheter Insertion ◽  
Ultrasound Guided ◽  
Central Venous ◽  
Clinical Simulation ◽  
Venous Catheterization ◽  
Simulation Based

Background: To evaluate novice and expert clinicians’ procedural confidence utilizing a blended learning mixed fidelity simulation model when applying a standardized ultrasound-guided central venous catheterization curriculum. Methods: Simulation-based education and ultrasound-guided central venous catheter insertion aims to provide facility-wide efficiencies and improves patient safety through interdisciplinary collaboration. The objective of this quality improvement research was to evaluate both novice (<50) and expert (>50) clinicians’ confidence across 100 ultrasound-guided central venous catheter insertion courses were performed at a mixture of teaching and non-teaching hospitals across 26 states within the United States between April 2015 and April 2016. A total of 1238 attendees completed a pre- and post-survey after attending a mixed method clinical simulation course. Attendees completed a 4-h online didactic education module followed by 4 h of hands-on clinical simulation stations (compliance/sterile technique, needling techniques, vascular ultrasound assessment, and experiential complication management). Results: The use of a standardized evidence-based ultrasound-guided central venous catheter curriculum improved confidence and application to required clinical tasks and knowledge across all interdisciplinary specialties, regardless of level of experience. Both physician and non-physician groups resulted in statistically significant results in both procedural compliance ( p < 0.001) and ultrasound skills ( p < 0.001). Conclusion: The use of a standardized clinical simulation curriculum enhanced all aspects of ultrasound-guided central venous catheter insertion skills, knowledge, and improved confidence for all clinician types. Self-reported complications were reported at significantly higher rates than previously published evidence, demonstrating the need for ongoing procedural competencies. While there are growing benefits for the role of simulation-based programs, further evaluation is needed to explore its effectiveness in changing the quality of clinical outcomes within the healthcare setting.

scholarly journals Visuospatial Ability as a Predictor of Novice Performance in Ultrasound-guided Regional Anesthesia

2015 ◽  
Vol 123 (5) ◽  
pp. 1188-1197 ◽  
Author(s):  
Atif Shafqat ◽  
Eamonn Ferguson ◽  
Vishal Thanawala ◽  
Nigel M. Bedforth ◽  
Jonathan G. Hardman ◽  
...  
Keyword(s):  
Regional Anesthesia ◽  
Rating Scale ◽  
Emotional State ◽  
Fear Of Failure ◽  
Global Rating Scale ◽  
Instructional Video ◽  
Global Rating ◽  
Ultrasound Guided ◽  
Visuospatial Ability ◽  
Ability Test

Abstract Background Visuospatial ability correlates positively with novice performance of simple laparoscopic tasks. The aims of this study were to identify whether visuospatial ability could predict technical performance of an ultrasound-guided needle task by novice operators and to describe how emotional state, intelligence, and fear of failure impact on this. Methods Sixty medical student volunteers enrolled in this observational study. The authors used an instructional video to standardize training for ultrasound-guided needle advancement in a turkey breast model and assessed volunteers’ performance independently by two assessors using composite error score (CES) and global rating scale (GRS). The authors assessed their “visuospatial ability” with mental rotation test (MRT), group embedded figures test, and Alice Heim group ability test. Emotional state was judged with UWIST Mood Adjective Checklist (UMACL), and fear of failure and general cognitive ability were judged with numerical reasoning test. Results High CES scores (high error rate) were associated with low MRT scores (ρ = −0.54; P &lt; 0.001). Better GRS scores were associated with better MRT scores (ρ = 0.47; P &lt; 0.001). Regarding emotions, GRS scores were low when anxiety levels were high (ρ = −0.35; P = 0.005) and CES scores (errors) were low when individuals reported feeling vigorous and active (ρ = −0.30; P = 0.01). Conclusions An MRT predicts novice performance of an ultrasound-guided needling task on a turkey model and as a trait measure could be used as a tool to focus training resources on less-able individuals. Anxiety adversely affects performance. Therefore, both may prove useful in directing targeted training in ultrasound-guided regional anesthesia.

scholarly journals Simulation-based Training Improves Physicians' Performance in Patient Care in High-stakes Clinical Setting of Cardiac Surgery

2010 ◽  
Vol 112 (4) ◽  
pp. 985-992 ◽  
Author(s):  
Heinz R. Bruppacher ◽  
Syed K. Alam ◽  
Vicki R. LeBlanc ◽  
David Latter ◽  
Viren N. Naik ◽  
...  
Keyword(s):  
Patient Care ◽  
Clinical Setting ◽  
Retention Test ◽  
Rating Scale ◽  
Training Session ◽  
Global Rating Scale ◽  
Global Rating ◽  
High Stakes ◽  
Randomized Controlled ◽  
Simulation Based

Background Simulation-based training is useful in improving physicians' skills. However, no randomized controlled trials have been able to demonstrate the effects of simulation teaching in real-life patient care. This study aimed to determine whether simulation-based training or an interactive seminar resulted in better patient care during weaning from cardiopulmonary bypass (CPB)-a high stakes clinical setting. Methods This study was conducted as a prospective, single-blinded, randomized controlled trial. After institutional research board approval, 20 anesthesiology trainees, postgraduate year 4 or higher, inexperienced in CPB weaning, and 60 patients scheduled for elective coronary artery bypass grafting were recruited. Each trainee received a teaching syllabus for CPB weaning 1 week before attempting to wean a patient from CPB (pretest). One week later, each trainee received a 2-h training session with either high-fidelity simulation-based training or a 2-h interactive seminar. Each trainee then weaned patients from CPB within 2 weeks (posttest) and 5 weeks (retention test) from the intervention. Clinical performance was measured using the validated Anesthesiologists' Nontechnical Skills Global Rating Scale and a checklist of expected clinical actions. Results Pretest Global Rating Scale and checklist performances were similar. The simulation group scored significantly higher than the seminar group at both posttest (Global Rating Scale [mean +/- standard error]: 14.3 +/- 0.41 vs. 11.8 +/- 0.41, P &lt; 0.001; checklist: 89.9 +/- 3.0% vs. 75.4 +/- 3.0%, P = 0.003) and retention test (Global Rating Scale: 14.1 +/- 0.41 vs. 11.7 +/- 0.41, P &lt; 0.001; checklist: 93.2 +/- 2.4% vs. 77.0 +/- 2.4%, P &lt; 0.001). Conclusion Skills required to wean a patient from CPB can be acquired through simulation-based training. Compared with traditional interactive seminars, simulation-based training leads to improved performance in patient care by senior trainees in anesthesiology.

Evaluation of a Task-Specific Checklist and Global Rating Scale for Ultrasound-Guided Regional Anesthesia

2014 ◽  
Vol 39 (5) ◽  
pp. 399-408 ◽  
Author(s):  
Daniel M. Wong ◽  
Mathew J. Watson ◽  
Roman Kluger ◽  
Alwin Chuan ◽  
Michael D. Herrick ◽  
...  
Keyword(s):  
Regional Anesthesia ◽  
Rating Scale ◽  
Global Rating Scale ◽  
Global Rating ◽  
Ultrasound Guided

scholarly journals P.181 High-Fidelity Simulation-Based Microsurgical Training for Neurosurgical Residents

2021 ◽  
Vol 48 (s3) ◽  
pp. S72-S72
Author(s):  
B Santyr ◽  
M Abbass ◽  
A Chalil ◽  
D Krivosheya ◽  
LM Denning ◽  
...  
Keyword(s):  
Rating Scale ◽  
Global Rating Scale ◽  
High Fidelity ◽  
Global Rating ◽  
High Fidelity Simulation ◽  
Femoral Vessel ◽  
Simulation Based ◽  
Microsurgical Techniques ◽  
One Year ◽  
Training Modules

Background: Microsurgical techniques remain a cornerstone of neurosurgical training. Despite this, neurosurgical microvascular case volumes are decreasing as endovascular and minimally invasive options expand. As such, educators are looking towards simulation to supplement operative exposure. We review a single institution’s experience with a comprehensive, longitudinal microsurgical simulation training program, and evaluate its effectiveness. Methods: Consecutive postgraduate year 2 (PGY-2) neurosurgery residents completed a one-year curriculum spanning 17 training sessions divided into 5 modules of increasing fidelity. Both perfused duck wing and live rat femoral vessel training modules were used. Trainee performance was video recorded and blindly graded using the Objective Structured Assessment of Technical Skills Global Rating Scale. Results: Eighteen participants completed 107 microvascular anastomoses during the study. There was significant improvement in six measurable skills during the curriculum. Mean overall score was significantly higher on the fifth attempt compared to the first attempt for all 3 live anastomotic modules (p<0.001). Each module had a different improvement profile across the skills assessed. The greatest improvement was observed during artery-to-artery anastomosis. Conclusions: This high-fidelity microsurgical simulation curriculum demonstrated a significant improvement in the six microneurosurgical skills assessed, supporting its use as an effective teaching model. Transferability to the operative environment is actively being investigated.

scholarly journals LO088: Development of a simulation-based curriculum for ultrasound-guided internal jugular central venous catheterization

CJEM ◽  
2016 ◽  
Vol 18 (S1) ◽  
pp. S60-S60
Author(s):  
M. Woodcroft ◽  
M. Holden ◽  
T. Chaplin ◽  
L. Rang ◽  
M. Jaeger ◽  
...  
Keyword(s):  
Performance Metrics ◽  
Deliberate Practice ◽  
Venous Catheter ◽  
High Volume ◽  
Careful Consideration ◽  
Learning Curves ◽  
Central Venous ◽  
Real Patient ◽  
Hand Motion ◽  
Simulation Based

Introduction / Innovation Concept: Insertion of an internal jugular (IJ) central venous catheter (CVC) under ultrasound guidance (USG) is a complex skill that requires considerable practice in order to achieve technical proficiency. Simulation allows novices to engage in structured and high volume repetitive practice of USG IJ CVC insertion and to work through a predictable pattern of errors prior to real patient encounters. Based on earlier work on learning curves for CVC insertion, this curriculum uses a model of simulation-based high volume deliberate practice of the fundamental skills of USG CVC insertion, and was designed with careful consideration of the conditions associated with optimal learning and improvement of performance. Methods: Eight residents (post graduate year 2) from the Departments of Emergency Medicine and Anesthesiology engaged in deliberate practice of USG CVC insertion during three two-hour sessions, at 2-week intervals. Progress of the residents was monitored with direct observation and regular hand motion analysis (HMA), which was compared to performance metrics set by a local expert. Curriculum, Tool, or Material: Students reviewed online introductory ultrasound video and articles outlining internal jugular (IJ) and femoral CVC insertion prior to the first session. Session 1 focused on ultrasound skills including knobology, transducer movement, and needle tracking. This was followed by 60 minutes of deliberate practice of the skills of USG CVC insertion on both femoral and IJ models. During sessions 2/3, students practiced complete gowning and draping using sterile technique. This was followed again by deliberate practice of the skills of USG CVC insertion on both femoral and IJ models. Students received coaching and feedback throughout all sessions, with HMA assessment of USG IJ CVC insertion at the beginning and end of each session. After three training sessions, consisting of 85 total attempts, 5/8 residents surpassed the expert benchmark for probe hand motion, 6/8 for needle hand motion, and 1/8 for total procedure time, with the remaining residents approaching the expert benchmark for each metric. Conclusion: We have successfully developed a simulation-based curriculum for USG IJ CVC placement. Residents demonstrated continuous improvement in each session, approaching or exceeding the expert benchmarks by the end of the third session.

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