Procedural Competence in Internal Medicine Residents: Validity of a Central Venous Catheter Insertion Assessment Instrument

Huang, Grace C.; Newman, Lori R.; Schwartzstein, Richard M.; Clardy, Peter; Feller‐Kopman, David; Irish, Julie T.; Smith, Carol

doi:10.1097/acm.0b013e3181acf491

Cited by 87 publications

(74 citation statements)

References 25 publications

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“…In general, these educational interventions showed improvements in CLABSI rates; however, more study is needed to clearly understand the most effective teaching strategies, content taught, length of presentation, and frequency for repeating the program. 220,221 Both extraluminal and intraluminal avenues for CVC infection should be addressed in the educational plan.…”

Section: Educatementioning

confidence: 99%

Strategies to Prevent Central Line-Associated Bloodstream Infections in Acute Care Hospitals: 2014 Update

Marschall

Mermel

Fakih

et al. 2014

Infect. Control Hosp. Epidemiol.

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Previously published guidelines are available that provide comprehensive recommendations for detecting and preventing healthcare-associated infections (HAIs). The intent of this document is to highlight practical recommendations in a concise format designed to assist acute care hospitals in implementing and prioritizing their central line-associated bloodstream infection (CLABSI) prevention efforts. This document updates “Strategies to Prevent Central Line-Associated Bloodstream Infections in Acute Care Hospitals,” published in 2008. This expert guidance document is sponsored by the Society for Healthcare Epidemiology of America (SHEA) and is the product of a collaborative effort led by SHEA, the Infectious Diseases Society of America (IDSA), the American Hospital Association (AHA), the Association for Professionals in Infection Control and Epidemiology (APIC), and The Joint Commission, with major contributions from representatives of a number of organizations and societies with content expertise. The list of endorsing and supporting organizations is presented in the introduction to the 2014 updates.

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Section: Educatementioning

confidence: 99%

Strategies to Prevent Central Line-Associated Bloodstream Infections in Acute Care Hospitals: 2014 Update

Marschall

Mermel

Fakih

et al. 2014

Infect. Control Hosp. Epidemiol.

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“…[1][2][3] Studies confirm that simulation-based training, 4,5 use of ultrasound, 6,7 adherence to a checklist, 8 team training, 9 and direct observation 10 decrease complication rates, thereby improving safe practices.…”

Section: Introductionmentioning

confidence: 84%

“…3,[18][19][20] The approach we developed combines objective assessments of knowledge and skill with subjective assessments of attitude, ultimately linking them to procedural outcomes. While others have reported the utility of a similar assessment instrument, 8 historically, self-assessments of performance have been challenged. 21,22 Our project builds on prior work that called for clearer standards to define competency.…”

Section: Discussionmentioning

confidence: 99%

“…The content of the skills checklist was created by local experts but included information similar to that in previously published checklists, 2,8 as well as national infection control standards and the Institute for Healthcare Improvement Central Line Bundle for prevention of central line-associated bloodstream infections. 15 In contrast to other studies, 2,8 there was consistent application of the checklist in the simulation laboratory and at the patient's bedside. Those residents who did not score 100% on the checklist were offered remediation in the simulation laboratory and were prevented from performing the procedure independently and without supervision until their score improved.…”

Section: Interventionmentioning

confidence: 99%

“…Smith et al 3 created a medical procedure service and evaluated patient outcomes but did not specifically define a competency threshold. Dong et al 2 and Huang et al 8 provided validity evidence for a central line checklist by using a task trainer but did not link the learner's skill to patient outcomes. Studies suggest that to provide a comprehensive assessment of trainees' abilities, a range of tools should be used.…”

Section: Introductionmentioning

confidence: 99%

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Filling the Void: Defining Invasive Bedside Procedural Competency for Internal Medicine Residents

Lenchus

Carvalho²,

Ferreri³

et al. 2013

Journal of Graduate Medical Education

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Background Residents perform invasive bedside procedures in most training programs. To date, there is no universal approach for determining competency and ensuring quality and safety of care. Objective We developed and implemented an assessment of central venous catheter insertion competency for internal medicine and internal medicine–pediatrics residents, using measurements for knowledge, skill, and attitude and linking them to procedural outcomes. Methods We conducted a cohort study of a 4-week, resident-run procedure service from July 2007 through June 2011 at a large academic medical center. Knowledge was assessed by using a written test, technical skill by using a checklist, and attitude by self- and supervisor assessments of residents' confidence and capability. Competence was defined as (1) a minimum written test score (70%); (2) a perfect checklist score; (3) a resident's self-assessed confidence and capability scores of 4 or 5 of 5; and (4) faculty rating of the resident's confidence and capability as 5 of 5. A composite success rate was based on procedural outcomes (eg, completed procedures, less than 3 forward needle passes, and complication rate) and was compared to the checklist scores. Results A total of 148 internal medicine and medicine–pediatrics residents inserted 639 catheters, and 53 (36%) achieved competence by the end of 4 weeks. Residents judged to be competent by checklist scores had a higher composite success rate than those deemed not competent. Conclusions Our multi-factorial criteria used to define central venous catheter insertion competency effectively discriminated between residents judged to be competent and those judged not competent, using data from procedural outcomes.

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Consensus Core Point‐of‐care Ultrasound Applications for Pediatric Emergency Medicine Training

Shefrin

Warkentine

Constantine

et al. 2019

AEM Education and Training

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Background: Pediatric emergency medicine (PEM) physicians have variably incorporated point-of-care ultrasound (POCUS) into their practice. Prior guidelines describe the scope of POCUS practice for PEM physicians; however, consensus does not yet exist about which applications should be prioritized and taught as fundamental skills for PEM trainees. Members of the PEM POCUS Network (P2Network) conducted a consensusbuilding process to determine which applications to incorporate into PEM fellowship training.Methods: A multinational group of experts in PEM POCUS was recruited from the P2Network and greater PEM POCUS community if they met the following criteria: performed over 1,000 POCUS scans and had at least 3 years of experience teaching POCUS to PEM fellows, were a local academic POCUS leader, or completed a formal PEM POCUS fellowship. Experts rated 60 possible PEM POCUS applications for their importance to include as part of a PEM fellowship curriculum using a modified Delphi consensus-building technique.Results: In round 1, 66 of 92 (72%) participants responded to an e-mail survey of which 48 met expert criteria and completed the survey. Consensus was reached to include 18 items in a PEM fellowship curriculum and to exclude two items. The 40 remaining items and seven additional items were considered in round 2. Thirty-seven of 48 (77%) experts completed round 2 reaching consensus to include three more items and exclude five. The remaining 39 items did not reach consensus for inclusion or exclusion.Conclusion: Experts reached consensus on 21 core POCUS applications to include in PEM fellowship curricula. P oint-of-care ultrasound (POCUS) has been established in the practice of emergency medicine for over two decades. 1,2 More recently, its use has expanded into the practice of pediatric emergency medicine (PEM). 3 Most PEM fellowship programs now offer formal ultrasound training to their fellows and incorporate POCUS into the care of the pediatric patient. 4,5 In

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Procedural Competence in Internal Medicine Residents: Validity of a Central Venous Catheter Insertion Assessment Instrument

Abstract: The authors were able to create and validate a consensus-driven procedural assessment tool with data-driven standards for basic proficiency and competence that faculty can use to assess residents as they perform CVC insertion.

Cited by 87 publications

References 25 publications

Strategies to Prevent Central Line-Associated Bloodstream Infections in Acute Care Hospitals: 2014 Update

Strategies to Prevent Central Line-Associated Bloodstream Infections in Acute Care Hospitals: 2014 Update

Filling the Void: Defining Invasive Bedside Procedural Competency for Internal Medicine Residents

Consensus Core Point‐of‐care Ultrasound Applications for Pediatric Emergency Medicine Training

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