Resident perception of standardization and credentialing for high‐risk bedside procedures in cardiothoracic surgery: Results from an institutional pilot study

Abstract

Objectives: Though clear-guidelines are set by the American Board of Thoracic Surgery (ABTS) for the operative cases that cardiothoracic surgery residents must perform to be board-eligible, no such recommendations exist to assess competency for the wide range of high-risk bedside procedures. Our department created and implemented a multidisciplinary course designed to standardize common high-risk bedside procedures and credential our trainees. The aim of this study was to survey the attitudes of residents towards and query the efficacy of such a course. Methods: The course was designed with the goal of standardizing endotracheal intubation, arterial line insertion (radial and femoral), central venous line insertion, pigtail tube thoracostomy, thoracentesis and nasogastric tube placement. The course consisted of an online module followed by a 4-hour hands-on simulation session. Knowledge-based pre-and post-evaluations were administered as well as a Likert-based survey regarding multiple aspects of the residents′ perceptions of the course and the procedures. Results: Twenty-three (7 traditional and 16 integrated) cardiothoracic surgical residents participated in the course. Residents reported that 48% of the time, bedside procedures were historically taught by other trainees rather than by faculty. All residents endorsed increased standardization of all procedures after the course. Likewise, residents showed increased confidence in all procedures except for pigtail tube thoracostomy, thoracentesis as well as nasogastric tube placement. 43.5% of the participants demonstrated improvement in the pretest and posttest knowledgebased evaluations. Conclusion: Cardiothoracic residents have favorable attitudes towards standardization and credentialing for high-risk bedside procedures and utilizing such courses may help standardize procedural techniques.

Teaching and Assessing Bedside Procedures: A Standardized Cross-Disciplinary Framework for Graduate Medical Education

“…8,9 Additional topics, such as which educational tactics are effective for conveying basic knowledge, [10][11][12] which assessment tools accurately measure skills, 3 and how to track credentialing in the clinical arena, have all been explored. 13,14 Therefore, a central problem is that no single consensus on a specific, comprehensive strategy for bedside procedure training and implementation has been agreed on; however, a blended approach to teaching procedures improves trainees' technical skills, [15][16][17] and combining teaching modalities, such as didactics, simulation, supervised practice, and direct supervision, can increase trainees' comfort with procedure performance. 18 Another specific area of concern is a trend within teaching hospitals in which internal medicine residents, one of the largest groups of physicians who may perform bedside procedures, are performing fewer bedside procedures.…”

“…Indeed, even basic aspects of program implementation can be challenging, such as having a process for monitoring the physician who is authorized and competent to execute specific procedures 8,9 . Additional topics, such as which educational tactics are effective for conveying basic knowledge, 10–12 which assessment tools accurately measure skills, 3 and how to track credentialing in the clinical arena, have all been explored 13,14 . Therefore, a central problem is that no single consensus on a specific, comprehensive strategy for bedside procedure training and implementation has been agreed on; however, a blended approach to teaching procedures improves trainees’ technical skills, 15–17 and combining teaching modalities, such as didactics, simulation, supervised practice, and direct supervision, can increase trainees’ comfort with procedure performance 18 …”