Investigating the Effect of Simulator Functional Fidelity and Personalized Feedback on Central Venous Catheterization Training

Abstract

OBJECTIVE To compare the effect of simulator functional fidelity (manikin vs a Dynamic Haptic Robotic Trainer [DHRT]) and personalized feedback on surgical resident self-efficacy and self-ratings of performance during ultrasound-guided internal jugular central venous catheterization (IJ CVC) training. In addition, we seek to explore how self-ratings of performance compare to objective performance scores generated by the DHRT system. DESIGN Participants were randomly assigned to either manikin or DHRT IJ CVC training over a 6-month period. Self-efficacy surveys were distributed before and following training. Training consisted of a pretest, 22 practice IJ CVC needle insertion attempts, 2 full-line practice attempts, and a posttest. Participants provided self-ratings of performance for each needle insertion and were presented with feedback from either an upper level resident (manikin) or a personalized learning system (DHRT). SETTING A study was conducted from July 2016 to February 2017 through a surgical skills training program at Hershey Medical Center in Hershey, Pennsylvania. PARTICIPANTS Twenty-six first-year surgical residents were recruited for the study. Individuals were informed that IJ CVC training procedures would be consistent regardless of participation in the study and that participation was optional. All recruited residents opted to participate in the study. RESULTS Residents in both groups significantly improved their self-efficacy scores from pretest to posttest (p < 0.01). Residents in the manikin group consistently provided higher self-ratings of performance (p < 0.001). Residents in the DHRT group recorded more feedback on errors (228 instances) than the manikin group (144 instances). Self-ratings of performance on the DHRT system were able to significantly predict the objective score of the DHRT system (R2 = 0.223, p < 0.001). CONCLUSION Simulation training with the DHRT system and the personalized learning feedback can improve resident self-efficacy with IJ CVC procedures and provide sufficient feedback to allow residents to accurately assess their own performance.

Evaluating Surgical Resident Needle Insertion Skill Gains in Central Venous Catheterization Training

“…During the pre-test, a trained senior surgical resident observed each participant and evaluated them using a modified Internal Jugular Catheterization (IJ CVC) evaluation form. The IJ CVC evaluation form used during the pre-test is a modified checklist (http://www.engr.psu.edu/britelab/resources/IJCVC_Checklist.pdf) focusing exclusively on the needle insertion portion of the procedure such as “selecting the appropriate site for venipuncture” and “locating the needle position on the ultrasound image.” 32 Total time to complete the 10-items during the pre-test was timed by the observer. There was a 5-minute time limit for the pre-test and if the participant did not successfully stick a vessel during the 5-minute time period, the pre-test was terminated.…”

Auditory Stimulation Improves Gait and Posture in Cerebral Palsy: A Systematic Review with Between- and Within-Group Meta-Analysis

“…This approach, in theory, allows the AStim to be mapped on the movement characteristics of a person so that it adjusts according to the preferred pace of the gait or the personalized movement characteristics of the performer [ 53 ]. Moreover, this allows the AStim to be delivered according to a person’s choice (i.e., superimposed on the preferred type of music) and, therefore, could allow additional benefits such as active participation and higher motivation from the performer’s perspective [ 54 , 55 , 56 ]. These properties permit AStim to adhere to the best practice principles of motor rehabilitation, which suggest that interventions should be highly task-specific, intensive, challenging, repetitive, and intriguing to promote recovery [ 47 , 57 ].…”

Fun and Games: Designing a Gamified Central Venous Catheterization Training Simulator

“…The DHRT uses a combination of haptic forces and ultrasound images to mimic the anatomy of multiple patient profiles, allowing the medical resident to gain experience on a wider variety of patient anatomies (Pepley et al, 2017). This system has been proven to be as effective as a manikin trainer in both skills training and self-efficacy (Yovanoff et al, 2016;Yovanoff et al, 2018). The system focuses on minimizing errors associated with mechanical complications, and as such trains only the first step of the CVC procedure, needle insertion.…”