Simulation-based training in ultrasound-guided pediatric central venous catheterization for anesthesiology residents: transfer to the clinical setting.

Abstract

Introduction: Simulation-based training (SBT) for central venous catheter (CVC) placement has been shown to improve procedural performance, reduce the number of attempts, and increase success rates. However, training for specific populations, such as pediatric patients, remains challenging. Moreover, evidence regarding the transfer of simulation-acquired skills to real clinical practice is limited. The aim of this study was to evaluate the transfer of skills acquired by anesthesiology residents following SBT in ultrasound-guided pediatric CVC placement.

Methods: After institutional ethics committee approval, 21 anesthesiology residents were recruited to participate in an SBT program for ultrasound-guided pediatric CVC insertion. The training consisted of six individual one-hour weekly sessions with direct expert feedback, using a pediatric-specific Blue Phantom® simulation model. Pre-and post-training assessments (PRE and POST) were conducted using video-recorded procedures and evaluated by two blinded assessors using a validated Global Rating Scale (GRS). In addition, hand motion metrics were collected using the Imperial College Surgical Assessment Device (ICSAD), including total path length (TPL), number of movements (NM), and total procedure time (TPT). To assess skill transfer, the same evaluation protocol was applied during CVC insertion in pediatric patients undergoing elective cardiac surgery.

Results: Fifteen residents completed the training and both PRE and POST assessments. Median GRS scores improved significantly from 34 (interquartile range [IQR], 29.5-38.0) at PRE to 47 (IQR, 44.5-47.5) at POST. Total procedure time decreased significantly from 349.4 (IQR, 264-536) to 290.2 (IQR, 232-335) seconds. No significant differences were observed in total path length or number of movements. Regarding transfer to clinical practice, 13 of 15 residents successfully completed the procedure on their first attempt in real patients. Comparison between the POST simulation assessment and the real-patient assessment showed no significant differences in median GRS scores.

Conclusions: Simulation-based training significantly improved anesthesiology residents' performance in simulated ultrasound-guided pediatric CVC placement. Although not all residents were able to successfully complete the procedure in real patients, the findings suggest a potential transfer of skills acquired through simulation to clinical practice.