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Can J Kidney Health Dis. 2014 Oct 14;1:25. doi: 10.1186/s40697-014-0025-6. eCollection 2014.

Use of a national continuing medical education meeting to provide simulation-based training in temporary hemodialysis catheter insertion skills: a pre-test post-test study.

Author information

1
Department of Medicine, Division of Nephrology, The Ottawa Hospital, 1967 Riverside Drive, Ottawa, Ontario K1H 7 W9 Canada.
2
Department of Medicine, Division of Nephrology, Northwestern University Feinberg School of Medicine, 251 E Huron Street, Feinberg 16-738, Chicago, IL 60611 USA.
3
Department of Medicine and Department of Medical Education, Northwestern University Feinberg School of Medicine, 251 E Huron Street, Feinberg 16-738, Chicago, IL 60611 USA.
4
Department of Medicine, Division of Nephrology, The Toronto General Hospital, 8 N-840, 200 Elizabeth Street, Toronto, Ontario M5G 2C4 Canada.
5
Department of Medicine, Division of Nephrology, Royal Jubilee Hospital, 1952 Bay Street, Victoria, BC V8R 1 J8 Canada.
6
Department of Medicine, Northwestern University Feinberg School of Medicine, 251 E Huron Street, Feinberg 16-738, Chicago, IL 60611 USA.

Abstract

in English, French

BACKGROUND:

Simulation-based-mastery-learning (SBML) is an effective method to train nephrology fellows to competently insert temporary, non-tunneled hemodialysis catheters (NTHCs). Previous studies of SBML for NTHC-insertion have been conducted at a local level.

OBJECTIVES:

Determine if SBML for NTHC-insertion can be effective when provided at a national continuing medical education (CME) meeting. Describe the correlation of demographic factors, prior experience with NTHC-insertion and procedural self-confidence with simulated performance of the procedure.

DESIGN:

Pre-test - post-test study.

SETTING:

2014 Canadian Society of Nephrology annual meeting.

PARTICIPANTS:

Nephrology fellows, internal medicine residents and medical students.

MEASUREMENTS:

Participants were surveyed regarding demographics, prior NTHC-insertion experience, procedural self-confidence and attitudes regarding the training they received. NTHC-insertion skills were assessed using a 28-item checklist.

METHODS:

Participants underwent a pre-test of their NTHC-insertion skills at the internal jugular site using a realistic patient simulator and ultrasound machine. Participants then had a training session that included a didactic presentation and 2 hours of deliberate practice using the simulator. On the following day, trainees completed a post-test of their NTHC-insertion skills. All participants were required to meet or exceed a minimum passing score (MPS) previously set at 79%. Trainees who did not reach the MPS were required to perform more deliberate practice until the MPS was achieved.

RESULTS:

Twenty-two individuals participated in SBML training. None met or exceeded the MPS at baseline with a median checklist score of 20 (IQR, 7.25 to 21). Seventeen of 22 participants (77%) completed post-testing and improved their scores to a median of 27 (IQR, 26 to 28; p < 0.001). All met or exceeded the MPS on their first attempt. There were no significant correlations between demographics, prior experience or procedural self-confidence with pre-test performance.

LIMITATIONS:

Small sample-size and self-selection of participants. Costs could limit the long-term feasibility of providing this type of training at a CME conference.

CONCLUSIONS:

Despite most participants reporting having previously inserted NTHCs in clinical practice, none met the MPS at baseline; this suggests their prior training may have been inadequate.

KEYWORDS:

Central venous catheterization; Clinical competence; Mastery learning; Medical education; Non-tunneled hemodialysis catheter; Simulation-based education; Temporary hemodialysis catheter; Ultrasound; Vascular access

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