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

Abstract

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.

A comparison of homemade vascular access ultrasound phantom models for peripheral intravenous catheter insertion

“…Standardized clinical simulations result in greatly improved ultrasound guided catheter insertion skills, knowledge, and confidence, yet barriers to implementing ultrasound education are an issue in many clinical settings. 12 In a survey of 82 curricular administrators at United States Doctor of Medicine (MD)-granting medical schools, a lack of financial support was cited as one of the most significant barriers to implementing ultrasound education at the undergraduate medical education level. 13 Commercial grade ultrasound phantoms are expensive and while reusable, their cost may pose a barrier to organizing simulation training.…”

PAs and point-of-care ultrasound

“…Types of educational intervention and their effect Eleven studies described various types of educational interventions and their effect (Table 4). [30][31][32][33][34][35][36][37][38][39][40] Studies were predominantly observational or mixed methodology and were conducted in a range of settings, including conference, undergraduate education, simulation laboratory, and academic institutional settings. Interventions ranged from 20 minutes to 4 weeks in length and predominantly used traditional or asynchronous didactic and hands-on training methods.…”

Impact of number of critical care procedural skill repetitions on supervision level and teaching style

“…Physicians experienced in thoracocentesis (>30 repetitions) may perform better than their inexperienced colleagues (<30 repetitions) [ 27 ]. However, self-assessed confidence may rise in both experienced and inexperienced trainees after training [ 28 ].…”