Procedural skill retention in transvenous pacer placement among emergency medicine physician trainees

Background

Transvenous cardiac pacing (TVP) is a life-saving intervention that is infrequently performed in emergency medicine (EM). While competency can be achieved through dedicated procedural training, the longevity of skill retention in TVP placement has not been well demonstrated. Our study sought to assess retention of procedural skills among EM resident physicians following an immersive TVP training simulation.

Methods

EM residents at a single academic tertiary care center participated in an immersive TVP training session using a high-fidelity simulator. The paradigm of deliberate practice was used to establish competency in the procedure, which was defined by success on a previously published checklist. Immediately following the training, each resident was tested on the checklist and a Global Rating Scale (GRS; 0–100). Three faculty raters assessed resident performance on these instruments. Inter-rater reliability (IRR) was assessed using the intraclass correlation coefficient. Competency in TVP placement skill retention was then reassessed at 3 months. The paired-samples t-test was used to evaluate the difference in performance between the time intervals.

Results

Thirty-one EM resident physicians participated in the study, with 25 completing the 3-month follow-up assessment. Immediately following the workshop, the mean (±SD) score on the 0–30 checklist was 29.7 (±0.51), while the mean score on the GRS was 98.3 (±1.9). At 3-month follow-up, the mean (±SD) score on the checklist decreased to 21.6 (±5; p < 0.001), and GRS was 75.4 (±19.7; p < 0.001). IRR between raters was 0.81 for the GRS and 0.75 for the checklist score, indicating excellent agreement.

Conclusions

Decay of skills in transvenous pacemaker placement was apparent at 3 months following initial baseline competency demonstration after an immersive training session. These findings may help inform TVP procedural teaching frequency for EM resident trainees.