Simulation-based mastery learning reduces complications during central venous catheter insertion in a medical intensive care unit *

Abstract

Objective: To determine the effect of a simulation-based mastery learning model on central venous catheter insertion skill and the prevalence of procedure-related complications in a medical intensive care unit over a 1-yr period. Design: Observational cohort study of an educational intervention. Setting: Tertiary-care urban teaching hospital. Subjects: One hundred three internal medicine and emergency medicine residents. Interventions: Twenty-seven residents were traditionally trained and did not receive simulation-based education. These residents were surveyed regarding complications and procedural self-confidence on actual central venous catheters they inserted in the medical intensive care unit. Subsequently, 76 residents completed simulation-based training in internal jugular and subclavian central venous catheter insertions. Simulator-trained residents were expected to meet or exceed a minimum passing score set by an expert panel and measured by performance on a skills checklist (given both before and after the educational intervention), using a central venous catheter simulator. Simulator-trained residents also took a written pre- and posttest. Simulator-trained residents were surveyed regarding complications and procedural self-confidence on actual central venous catheters they inserted in the medical intensive care unit. Measurements and Main Results: Simulator-trained residents reported fewer needle passes (p< .0005), arterial punctures (p< .0005), catheter adjustments (p= .002), and higher success rates (p= .005) for actual central venous catheters inserted in the medical intensive care unit than traditionally trained residents. At clinical skills examination pretest, 12 (16%) of 76 simulator-trained residents met the minimum passing score for internal jugular central venous catheter insertion and 11 (14%) of 76 residents met the minimum passing score for subclavian central venous catheter insertion: mean (internal jugular) = 50.6%, sd = 23.4%; mean (subclavian) = 48.4%, sd = 26.8%. After simulation training, all residents met or exceeded the minimum passing score at posttest: mean (internal jugular) = 93.9%, sd = 10.2; mean (subclavian) = 91.5%, sd = 17.1 (p< .0005). Written examination performance improved from mean = 70.3%, sd = 7.7%, to 84.8%, sd = 4.8% (p< .0005). Conclusions: A simulation-based mastery learning program increased residents’ skills in simulated central venous catheter insertion and decreased complications related to central venous catheter insertions in actual patient care.