Simulation Training for Ultrasound Guided Central Venous Catheter Insertion

描述（由申请人提供）：住院医师教育传统上致力于知识获取，而不是临床能力的定义水平。目前，缺乏经验的医生接受的是基于床边、学徒模式的有创手术，如中心静脉导管（CVC）插入，在真实患者身上获得的专业知识既不严谨也不规范。模拟器可以缓解学员与实际病人的过渡，避免不良事件的发生。本项目旨在探讨结构化模拟训练方案在超声引导下住院医师CVC插入中的效果。具体目的是比较：(1)CVC插入失败率；(2)完成结构化、实践模拟培训方案的住院医生（干预组）和按照传统的、病床边学徒模式培训的住院医生（对照组）在实际患者上静脉插管的尝试次数、CVC插入的技术错误和并发症发生率以及CVC插入的时间。我们假设，与对照组相比，干预组在实际患者的CVC插入方面将获得更好的技能，其衡量标准如下：（1)CVC插入失败率降低，(2)a）静脉插管尝试次数减少，b)技术错误和并发症发生率降低，以及c)根据独立评估者使用程序清单的评估，插入时间缩短。这项前瞻性、随机观察性研究将包括在三级护理教学医院的一年级和二年级住院医师，为期21个月，他们在急诊科、内科重症监护病房和/或外科重症监护病房轮转。干预组将在部分任务训练模拟器上完成超声引导的实际模拟训练方案，直到达到以下能力：（1)知识-在培训后的书面考试中获得bb0 - 90%的分数；(2)表现- a）在连续4/5次尝试中第一次通过超声引导下插管模拟静脉的能力。b)在部分任务训练模拟器上正确插入CVC，并且没有独立评估员观察到的技术错误。本研究项目的潜在长期效益是为住院医师建立超声引导CVC插入的结构化模拟培训方案，提高患者的安全性，并适用于国家级教学医院。

DESCRIPTION (PROVIDED BY APPLICANT): Resident education has traditionally devoted itself to knowledge acquisition rather than defined levels of clinical competence. Currently, inexperienced physicians are trained to perform invasive procedures such as central venous catheter (CVC) insertion according to the bedside, apprenticeship model, gaining expertise on real patients in neither a rigorous nor standardized manner. Simulators may ease trainees' transition to actual patients and avoid adverse events. The proposed project aims to investigate the efficacy of a structured simulation training protocol in ultrasound guided CVC insertion for resident physicians. The specific aims are to compare: (1) the failure rate of CVC insertion, and (2) the number of attempts at venous cannulation, rates of technical errors and complications of CVC insertion, and time to CVC insertion on actual patients between residents who have completed a structured, hands-on simulation training protocol (intervention group) and those who are trained according to the traditional, bedside apprenticeship model (control group). We hypothesize that the intervention group will obtain superior skills at CVC insertion on actual patients as compared to the control group as measured by: (1) a reduced failure rate at CVC insertion, (2) a) a reduced number of attempts at venous cannulation b) a decreased rate of technical errors and complications and c) a decreased time to insertion based on an independent rater's evaluation using a procedure checklist. This prospective, randomized observational study will include 1st and 2nd postgraduate year residents over a 21 month period at a tertiary care teaching hospital who rotate through the Emergency Department, Medical Intensive Care Unit and/or Surgical Intensive Care Unit. The intervention group will complete a hands-on ultrasound guided simulation training protocol on a partial task training simulator until competence is achieved as measured by (1) knowledge - a score of > 90% on a written post-training exam, (2) performance - a) the ability to cannulate a simulated vein under ultrasound guidance on first pass in 4/5 consecutive attempts, and b) correct insertion of a CVC on a partial task training simulator with no technical errors as observed by an independent rater. The potential long-term benefit of this research project is the establishment of a structured simulation training protocol for ultrasound guided CVC insertion by resident physicians which will improve patient safety and be applicable to teaching hospitals at a national level.