Kristen Campbell, MS
Research Instructor
University of Colorado, United States
Disclosure information not submitted.
John Kendall, MD
Professor
University of Colorado, United States
Disclosure information not submitted.
Angela Czaja, MD, MS
Associate Professor
University of Colorado At The Children's Hospital, United States
Disclosure information not submitted.
Title: Simulation-Based Training and Assessment for Pediatric Central Venous Catheter Placement
Introduction: Pediatric Critical Care Medicine (PCCM) providers must develop competence in central venous catheter (CVC) placement, but skill assessment is not standardized. We hypothesized that PCCM provider skill in CVC placement would improve after simulation-based training, and that PCCM fellows would demonstrate skill development through experiential learning during fellowship.
Methods: We recruited fellows, advanced practice providers (APPs) and attending physicians in PCCM at the University of Colorado between July 2019 and July 2021. Participant skill in CVC placement on a simulation task trainer was measured using hand motion analysis (HMA), a validated assessment tool for CVC placement. Fellows and APPs participated in simulation-based CVC training with HMA metrics collected before and after training. To evaluate for skill acquisition from experiential learning during PCCM fellowship, PCCM fellow HMA metrics were collected at 6-month intervals. Attending physician HMA metrics were collected to provide a benchmark for competence in CVC placement. Comparative analysis between HMA metrics before and after training was performed using the Wilcoxon signed-rank test.
Results: Seventeen fellows, 9 APPs and 6 attendings participated in the study. Participants in simulation-based CVC placement training (n = 20; 11 fellows, 9 APPs) demonstrated significant improvement in HMA metrics - median time: 264 s (IQR 182 - 398 s) vs. 146 s (IQR 134 - 205 s), p < 0.05, median motions: 6,216 (IQR 4,606 - 9,299) vs. 4,004 (IQR 3,612 - 5,312), p < 0.05. Attending (n = 6) benchmark HMA metrics included - median time: 81 s, (IQR 74 – 90 s), median motions: 2,308, (IQR 2,120 - 2,465). Among fellows who participated in the study at more than one time point (n = 13), CVC placement skill learning curves showed stability over time and few fellows achieved attending level HMA metric benchmarks even by the end of fellowship.
Conclusions: Simulation-based training improved PCCM provider skill in CVC placement but continued skill acquisition from experiential leaning by PCCM fellows was not appreciable through simulation-based assessment. Further study is necessary to determine if additional educational interventions for PCCM providers can enable development of attending level CVC placement skill.