McGraw Robert, Chaplin Tim, McKaigney Conor, Rang Louise, Jaeger Melanie, Redfearn Damian, Davison Colleen, Ungi Tamas, Holden Matthew, Yeo Caitlin, Keri Zsuzsanna, Fichtinger Gabor
*Department of Emergency Medicine,Kingston General Hospital,Kingston,ON.
†Department of Emergency Medicine,Queen's University,Kingston,ON.
CJEM. 2016 Nov;18(6):405-413. doi: 10.1017/cem.2016.329. Epub 2016 May 16.
To develop a simulation-based curriculum for residents to learn ultrasound-guided (USG) central venous catheter (CVC) insertion, and to study the volume and type of practice that leads to technical proficiency.
Ten post-graduate year two residents from the Departments of Emergency Medicine and Anesthesiology completed four training sessions of two hours each, at two week intervals, where they engaged in a structured program of deliberate practice of the fundamental skills of USG CVC insertion on a simulator. Progress during training was monitored using regular hand motion analysis (HMA) and performance benchmarks were determined by HMA of local experts. Blinded assessment of video recordings was done at the end of training to assess technical competence using a global rating scale.
None of the residents met any of the expert benchmarks at baseline. Over the course of training, the HMA metrics of the residents revealed steady and significant improvement in technical proficiency. By the end of the fourth session six of 10 residents had faster procedure times than the mean expert benchmark, and nine of 10 residents had more efficient left and right hand motions than the mean expert benchmarks. Nine residents achieved mean GRS scores rating them competent to perform independently.
We successfully developed a simulation-based curriculum for residents learning the skills of USG CVC insertion. Our results suggest that engaging residents in three to four distributed sessions of deliberate practice of the fundamental skills of USG CVC insertion leads to steady and marked improvement in technical proficiency with individuals approaching or exceeding expert level benchmarks.
为住院医师开发一个基于模拟的课程，以学习超声引导下（USG）中心静脉导管（CVC）置入术，并研究能达到技术熟练的练习量和类型。
来自急诊医学和麻醉学系的10名二年级住院医师，每隔两周完成四个每次两小时的培训课程，他们在模拟器上参与了一个关于USG CVC置入术基本技能的结构化刻意练习计划。培训期间的进展通过定期的手部动作分析（HMA）进行监测，表现基准由当地专家的HMA确定。培训结束时对录像进行盲法评估，使用整体评分量表评估技术能力。
在基线时，没有一名住院医师达到任何专家基准。在培训过程中，住院医师的HMA指标显示技术熟练程度稳步且显著提高。到第四节课结束时，10名住院医师中有6名的操作时间比专家基准平均值更快，10名住院医师中有9名的左右手动作比专家基准平均值更高效。9名住院医师的平均GRS分数表明他们有能力独立操作。
我们成功地为学习USG CVC置入术技能的住院医师开发了一个基于模拟的课程。我们的结果表明，让住院医师参与三到四次关于USG CVC置入术基本技能的分布式刻意练习课程，会使技术熟练程度稳步且显著提高，个人接近或超过专家水平基准。
