Simulation Training for Ultrasound Guided Central Venous Catheter Insertion

描述(由申请者提供)：住院医师教育传统上致力于知识获取，而不是确定的临床能力水平。目前，缺乏经验的医生接受的培训是根据床边、学徒模式进行中心静脉导管(CVC)插入等侵入性操作，以既不严格也不标准化的方式在真实患者身上获得专业知识。模拟器可能会使受训者更容易过渡到实际患者，并避免不良事件。这项拟议的项目旨在调查结构化模拟培训方案在超声引导下为住院医师进行CVC置入术的有效性。具体目的是比较：(1)CVC置入的失败率；(2)在实际患者上，完成结构化、动手操作的模拟培训方案的住院医师(干预组)和按照传统的床边见习模式进行培训的住院医师(对照组)之间的静脉插管次数、CVC置入的技术错误率和并发症以及CVC置入的时间。我们假设，与对照组相比，干预组在实际患者的CVC置入方面将获得更好的技能，其衡量标准是：(1)CVC置入失败率降低，(2)静脉插管尝试次数减少，b)技术错误和并发症发生率降低，c)基于独立评分者使用程序检查表的评估，置入时间缩短。这项前瞻性的随机观察性研究将包括在三级护理教学医院轮换急诊科、医疗重症监护病房和/或外科重症监护病房的第一年和第二年研究生住院医生，为期21个月。干预组将在部分任务训练模拟器上完成实际操作的超声引导模拟训练方案，直到达到以下测量能力为止：(1)知识--培训后笔试的分数为90%；(2)表现--a)在超声引导下在4/5连续尝试中首次通过模拟静脉插管的能力；以及b)根据独立评分员的观察，在部分任务训练模拟器上正确插入CVC而没有技术错误。这一研究项目的潜在长期好处是建立了住院医师超声引导下CVC置入的结构化模拟培训方案，这将提高患者的安全性，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.