Original Research

Improving internal medicine residents' performance, knowledge, and confidence in central venous catheterization using simulators†‡

  1. Scott J. Millington MD1,
  2. Roger Y. Wong MD2,
  3. Barry O. Kassen MD2,
  4. James M. Roberts MD2,
  5. Irene W.Y. Ma MD2,3,§,*

Article first published online: 14 SEP 2009

DOI: 10.1002/jhm.570

Issue

Journal of Hospital Medicine

Journal of Hospital Medicine

Volume 4, Issue 7, pages 410–416, September 2009

Additional Information

How to Cite

Millington, S. J., Wong, R. Y., Kassen, B. O., Roberts, J. M. and Ma, I. W. (2009), Improving internal medicine residents' performance, knowledge, and confidence in central venous catheterization using simulators. Journal of Hospital Medicine, 4: 410–416. doi: 10.1002/jhm.570

Author Information

  1. 1

    Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada

  2. 2

    Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada

  3. 3

    Department of Medicine, University of Calgary, Calgary, Alberta, Canada

  1. §

    Telephone: 403-210-6826; Fax: 403-283-6151

*1443 Health Sciences Centre, 3330 Hospital Drive NW, Calgary, Alberta, Canada, T2N 4N1

  1. †

    Supported by the Department of Medicine, University of British Columbia.

  2. ‡

    Disclosure: There are no financial disclosures or conflicts of interest with any of the authors, relating to the design and conduct of the study, collection, management, analysis, and interpretation of the data, or preparation, review, or approval of this manuscript.

Publication History

  1. Issue published online: 15 SEP 2009
  2. Article first published online: 14 SEP 2009
  3. Manuscript Accepted: 31 MAY 2009
  4. Manuscript Revised: 26 MAY 2009
  5. Manuscript Received: 25 JUL 2008

Funded by

  • Department of Medicine, University of British Columbia

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Keywords:

  • central venous catheterization;
  • competency;
  • education;
  • patient simulation;
  • procedural skills

Abstract

BACKGROUND:

Efficacy of simulators in teaching central venous catheterization (CVC) in an internal medicine residency program is unknown.

OBJECTIVE:

To determine whether or not learning CVC on simulators is associated with improvement in performance of CVC, knowledge about the procedure, and self-reported confidence.

METHODS:

All consenting first-year internal medicine residents who completed training in CVC on simulators were included. Participants were evaluated pre- and post-training by video-recorded CVC insertion and multiple-choice knowledge assessments. Procedural technique was rated in a blinded fashion by two independent adjudicators. Knowledge retention and self-reported confidence were reassessed at 18 months.

MEASUREMENTS:

Primary outcome of CVC performance was assessed based on global rating score (minimum 1, maximum 5). Secondary measures include checklist score (out of ten), knowledge score and self-reported confidence (6-point Likert scale ranging from “none” to “complete”).

RESULTS:

Median global rating scores in 30 participants increased from 3.5 (IQR = 3-4) to 4.5 (IQR = 4-4.5) (P < 0.001). Checklist score increased from 9 (IQR = 6-9.5) to 9.5 (IQR = 9-9.5) (P < 0.001). Knowledge score increased from 65.7 ± 11.9% to 81.2 ± 10.7% (P < 0.001). Confidence increased from 3 (“moderate”, IQR = 2-3) to 4 (“good”, IQR=3-4) (P < 0.001). Sixteen participants completed the retention tests. Improvement in knowledge score and confidence at 18 months was retained compared with baseline (P = 0.002 and P < 0.0001 respectively).

CONCLUSIONS:

Use of simulators in teaching CVC in an internal medicine residency program results in improved procedural performance, knowledge, and self-reported confidence. Improvement in knowledge and confidence was retained at 18 months. Journal of Hospital Medicine 2009;4:410–416. © 2009 Society of Hospital Medicine.

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