Objective Assessment of Skill Retention 7 Months Post-Training: Motion Analysis of Central Venous Catheter Placement.

Abstract

Background: Central venous catheter (CVC) placement is a technically challenging skill. Routine assessment tools, including checklists and global rating scales, require subjective expert evaluation. We hypothesized that motion analysis could be used to objectively assess skill retention in CVC placement by comparing the performance of anesthesiology residents immediately after training and 7 months later.

Methods: After learning to perform CVC placement on a mannikin, 12 first-year anesthesiology residents each performed a "baseline" trial with electromagnetic motion sensors on the dorsum of their dominant hand and base of their ultrasound probe. Seven months later, they each performed a "follow-up" mannikin trial with an identical setup. For each trial, sensors recorded participants' path length, translational motions, and rotational sum. Time was recorded for each trial as well. We defined skill retention as performance within 1 standard deviation or less of the entire cohort's average at baseline (threshold). We compared the number of residents who met the threshold, which indicated less excessive motion and therefore better performance, at baseline with the number at follow-up using McNemar's test across each metric for each sensor.

Results: For path length, translational motions, and rotational sum of the probe, significantly more residents met the threshold at baseline than at follow-up (P < .04). No significant differences were detected for any metrics of the dorsum or time.

Conclusions: Motion analysis can objectively assess skill decay in anesthesiology residents performing CVC placement. Residents exhibited skill retention in tasks involving their dominant hand and skill decay in tasks involving the ultrasound probe (nondominant hand).