Barsuk Jeffrey H, Cohen Elaine R, Nguyen Duyhuu, Mitra Debi, O'Hara Kelly, Okuda Yasuharu, Feinglass Joe, Cameron Kenzie A, McGaghie William C, Wayne Diane B
1Department of Medicine, Northwestern University Feinberg School of Medicine; Chicago, IL.2Department of Medical Education, Northwestern University Feinberg School of Medicine, Chicago, IL.3The Simulation Learning, Education and Research Network (SimLEARN), Veterans Health Administration, Orlando, FL.4Department of Medical Education, University of Central Florida College of Medicine, Orlando, FL.
Crit Care Med. 2016 Oct;44(10):1871-81. doi: 10.1097/CCM.0000000000001831.
Central venous catheter insertions may lead to preventable adverse events. Attending physicians' central venous catheter insertion skills are not assessed routinely. We aimed to compare attending physicians' simulated central venous catheterinsertion performance to published competency standards.
Prospective cohort study of attending physicians' simulated internal jugular and subclavian central venous catheter insertion skills versus a historical comparison group of residents who participated in simulation training.
Fifty-eight Veterans Affairs Medical Centers from February 2014 to December 2014 during a 2-day simulation-based education curriculum and two academic medical centers in Chicago.
A total of 108 experienced attending physicians and 143 internal medicine and emergency medicine residents.
None.
Using a previously published central venous catheter insertion skills checklist, we compared Veterans Affairs Medical Centers attending physicians' simulated central venous catheter insertion performance to the same simulated performance by internal medicine and emergency medicine residents from two academic centers. Attending physician performance was compared to residents' baseline and posttest (after simulation training) performance. Minimum passing scores were set previously by an expert panel. Attending physicians performed higher on the internal jugular (median, 75.86% items correct; interquartile range, 68.97-86.21) and subclavian (median, 83.00%; interquartile range, 59.00-86.21) assessments compared to residents' internal jugular (median, 37.04% items correct; interquartile range, 22.22-68.97) and subclavian (median, 33.33%; interquartile range, 0.00-70.37; both p < 0.001) baseline assessments. Overall simulated performance was poor because only 12 of 67 attending physicians (17.9%) met or exceeded the minimum passing score for internal jugular central venous catheter insertion and only 11 of 47 (23.4%) met or exceeded the minimum passing score for subclavian central venous catheter insertion. Resident posttest performance after simulation training was significantly higher than attending physician performance (internal jugular: median, 96%; interquartile range, 93.10-100.00; subclavian: median, 100%; interquartile range, 96.00-100.00; both p < 0.001).
This study demonstrates highly variable simulated central venous catheter insertion performance among a national cohort of experienced attending physicians. Hospitals, healthcare systems, and governing bodies should recognize that even experienced physicians require periodic clinical skill assessment and retraining.
中心静脉导管插入术可能导致可预防的不良事件。主治医师的中心静脉导管插入技能未进行常规评估。我们旨在将主治医师模拟中心静脉导管插入操作的表现与已公布的能力标准进行比较。
对主治医师模拟颈内静脉和锁骨下中心静脉导管插入技能进行前瞻性队列研究，并与参与模拟培训的住院医师历史对照组进行比较。
2014年2月至2014年12月期间，在为期2天的基于模拟的教育课程中，选取了58家退伍军人事务医疗中心以及芝加哥的两家学术医疗中心。
总共108名经验丰富的主治医师以及143名内科和急诊科住院医师。
无。
使用先前公布的中心静脉导管插入技能检查表，我们将退伍军人事务医疗中心主治医师模拟中心静脉导管插入操作的表现与来自两个学术中心的内科和急诊科住院医师的相同模拟操作表现进行比较。将主治医师的表现与住院医师的基线表现和测试后（模拟培训后）表现进行比较。最低及格分数先前由一个专家小组设定。与住院医师颈内静脉（中位数，正确项目为37.04%；四分位间距，22.22 - 68.97）和锁骨下（中位数，33.33%；四分位间距，0.00 - 70.37；两者p < 0.001）的基线评估相比，主治医师在颈内静脉（中位数，正确项目为75.86%；四分位间距，68.97 - 86.21）和锁骨下（中位数，83.00%；四分位间距，59.00 - 86.21）评估中的表现更高。总体模拟表现较差，因为67名主治医师中只有12名（17.9%）达到或超过颈内中心静脉导管插入的最低及格分数，47名中只有11名（23.4%）达到或超过锁骨下中心静脉导管插入的最低及格分数。模拟培训后住院医师的测试后表现显著高于主治医师的表现（颈内静脉：中位数，96%；四分位间距，93.10 - 100.00；锁骨下：中位数，100%；四分位间距，96.00 - 100.00；两者p < 0.001）。
本研究表明，在全国一组经验丰富的主治医师中，模拟中心静脉导管插入操作的表现差异很大。医院、医疗保健系统和管理机构应认识到，即使是经验丰富的医生也需要定期进行临床技能评估和再培训。
