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的获取，而不是临床能力的定义水平。目前，没有经验的医生被训练以根据床边学徒模式执行侵入性手术，例如中心静脉导管（CVC）插入，从而以既不严格也不标准化的方式获得对真实的患者的专业知识。模拟器可以使受训者更容易过渡到实际患者并避免不良事件。拟议的项目旨在研究住院医师超声引导CVC插入的结构化模拟培训方案的有效性。具体目的是比较：（1）CVC插入的失败率，和（2）已经完成结构化的、动手模拟训练方案的住院医师之间的静脉插管尝试的次数、CVC插入的技术错误和并发症的发生率，以及实际患者的CVC插入时间（干预组）和那些根据传统的床边学徒模式培训的人（对照组）。我们假设，与对照组相比，干预组将获得上级的CVC插入技能，通过以下指标衡量：（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）基于独立评估者使用手术检查表的评估，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进行为期21个月的第一和第二年研究生住院医师，他们在急诊科、内科重症监护室和/或外科重症监护室轮换。干预组将在部分任务训练模拟器上完成实践超声引导模拟训练方案，直到达到能力，如通过以下测量：（1）知识-书面训练后考试得分> 90%，（2）表现- a）在4/5次连续尝试中首次通过时在超声引导下对模拟静脉插管的能力，以及B）在部分任务训练模拟器上正确插入CVC，而没有独立评定者观察到的技术错误。本研究项目的潜在长期受益是建立住院医师超声引导CVC插入的结构化模拟培训方案，这将提高患者安全性，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.