Ballard Heather A, Tsao Michelle, Robles Alison, Phillips Mitch, Hajduk John, Feinglass Joseph, Barsuk Jeffrey H
Department of Pediatric Anesthesiology, Ann & Robert H. Lurie Children's Hospital of Chicago, IL, USA.
Northwestern University, Feinberg School of Medicine, Chicago, IL, USA.
Paediatr Anaesth. 2020 Nov;30(11):1204-1210. doi: 10.1111/pan.13953. Epub 2020 Sep 27.
Pediatric vascular access is inherently challenging due to the small caliber of children's vessels. Ultrasound-guided intravenous catheter insertion has been shown to increase success rates and decrease time to cannulation in patients with difficult intravenous access. Although proficiency in ultrasound-guided intravenous catheter insertion is a critical skill in pediatric anesthesia, there are no published competency-based training curricula.
The objective of this study was to evaluate the performance of pediatric anesthesiologists who participated in a novel ultrasound-guided intravenous catheter insertion simulation-based mastery learning curriculum.
Pediatric anesthesia attendings, fellows, and rotating residents participated in the ultrasound-guided intravenous catheter insertion simulation-based mastery learning curriculum from August 2019 to February 2020. The 2-hour curriculum consisted of participants first undergoing a simulated skills pretest followed by watching a video on ultrasound-guided intravenous catheter insertion and deliberate practice on a simulator. Subsequently, all participants took a post-test and were required to meet or exceed a minimum passing standard. Those who were unable to meet the minimum passing standard participated in further practice until they could be retested and met this standard. We compared pre to post-test ultrasound-guided intravenous catheter insertion skills and self-confidence before and after participation in the curriculum.
Twenty-six pediatric anesthesia attendings, 12 fellows, and 38 residents participated in the curriculum. At pretest, 16/76 (21%) participants were able to meet or exceed the minimum passing standard. The median score on the pretest was 21/25 skills checklist items correct and improved to 24/25 at post-test (95% CI 3.0-4.0, P < .01). Self-confidence significantly improved after the course from an average of 3.2 before the course to a postcourse score of 3.9 (95% CI 0.5-0.9, P < .01; 1 = Not all confident, 5 = Very confident).
Simulation-based mastery learning significantly improved anesthesiologists' ultrasound-guided intravenous catheter insertion performance in a simulated setting.
由于儿童血管管径小，儿科血管通路建立具有内在挑战性。超声引导下静脉置管已被证明可提高静脉通路困难患者的成功率并缩短置管时间。尽管熟练掌握超声引导下静脉置管是儿科麻醉中的一项关键技能，但尚无基于能力的培训课程发表。
本研究的目的是评估参与新型基于模拟掌握学习的超声引导下静脉置管课程的儿科麻醉医生的表现。
2019年8月至2020年2月，儿科麻醉主治医师、住院医师和轮转住院医生参加了基于模拟掌握学习的超声引导下静脉置管课程。这一2小时的课程包括参与者首先进行模拟技能预测试，然后观看超声引导下静脉置管视频并在模拟器上进行刻意练习。随后，所有参与者进行后测，并要求达到或超过最低及格标准。那些未达到最低及格标准的人参加进一步练习，直到他们可以重新测试并达到该标准。我们比较了课程前后超声引导下静脉置管技能以及参与课程前后的自信心。
26名儿科麻醉主治医师、12名住院医师和38名住院医生参加了该课程。预测试时，16/76（21%）名参与者能够达到或超过最低及格标准。预测试中技能检查表项目的中位数得分是21/25正确，后测时提高到24/25（95%CI 3.0-4.0，P<.01）。课程结束后，自信心显著提高，从课程前的平均3.2分提高到课程后的3.9分（95%CI 0.5-0.9，P<.01；1=不太自信，5=非常自信）。
基于模拟的掌握学习在模拟环境中显著提高了麻醉医生超声引导下静脉置管的表现。
