Development and Videographic Evaluation of a Vascular Access Simulation-Based Curriculum for Surgical and Medical Trainees

Alaska Pendleton, Tiffany R. Bellomo, Srihari K. Lella, Kristen Jogerst, Ada Stefanescu, Douglas Drachman, Nikolaos Zacharias, A. Dua
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Abstract

There is a paucity of data evaluating femoral arterial access training, despite significant morbidity/mortality associated with incorrect femoral arterial access. The aim of this study was to develop and evaluate a novel 2-component simulation-based curriculum to address a lack of standardized access training and identify the most frequent errors in access. The femoral arterial access curriculum was developed through a multi-disciplinary collaboration and utilized in-person simulation sessions in conjunction with online and in-person didactic training. Access errors and curriculum efficacy were assessed using mixed-methodology evaluation of video recordings of trainee arterial access pre- and postcurriculum. All recordings were reviewed and scored by 2 blinded, independent investigators. Twenty-six participants completed the curriculum with pre- and postcurriculum recordings. Sixteen participants (62%) were in their first year of residency training. Fifteen participants (58%) belonged to general surgery residency, 9 (35%) to emergency medicine, 1 to vascular surgery, and 1 to interventional radiology residency programs. The global rating for the overall ability to obtain femoral arterial access under ultrasound guidance (0 = fail, 4 = excellent) improved following the curriculum (0.87 ± 0.15, 2.79 ± 1.26, P < 0.0001). Fourteen participants (54%) were unable to independently complete the procedure before training, compared to only 2 participants (8%) following the curriculum. Procedural completion time decreased from 7.14 ± 4.26 to 3.81 ± 2.53 minutes (P < 0.001). Most frequent errors, determined through qualitative analysis, included difficulty using the ultrasound and unsafe maneuvers. Before the curriculum, there were significant frequent errors in junior resident femoral arterial access with major patient safety concerns. A novel simulation-based femoral arterial access curriculum resulted in improved procedural skills across all metrics.
为外科和内科受训人员开发血管通路模拟课程并进行视频评估
尽管股动脉通路错误会导致严重的发病率/死亡率,但评估股动脉通路培训的数据却很少。本研究旨在开发和评估一种由两部分组成的新型模拟课程,以解决缺乏标准化入路培训的问题,并找出入路中最常见的错误。 股动脉通路课程是通过多学科合作开发的,采用了现场模拟课程与在线和现场教学培训相结合的方式。通过对课程前后受训者动脉通路的视频录像进行混合方法评估,对通路错误和课程效果进行了评估。所有录像均由两名独立的盲人调查员进行审查和评分。 26 名学员完成了课程,并进行了课程前后的录像。16名参与者(62%)是住院医师培训的第一年。其中 15 人(58%)属于普外科住院医师培训,9 人(35%)属于急诊医学,1 人属于血管外科,1 人属于介入放射学住院医师培训。课程结束后,在超声引导下获取股动脉通路的整体能力评分(0 = 不及格,4 = 优秀)有所提高(0.87 ± 0.15,2.79 ± 1.26,P < 0.0001)。培训前,14 名学员(54%)无法独立完成手术,而课程结束后,只有 2 名学员(8%)能够独立完成手术。程序完成时间从 7.14 ± 4.26 分钟减少到 3.81 ± 2.53 分钟(P < 0.001)。通过定性分析发现,最常见的错误包括难以使用超声波和不安全的操作。 在开设该课程之前,初级住院医师股动脉通路经常出现严重错误,给患者安全带来了重大隐患。新颖的模拟股动脉通路课程提高了所有指标的操作技能。
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