High superficial resemblance versus high functional task alignment simulation for central venous catheterization training: A randomized crossover trial

Introduction

Fidelity in procedural skills simulation can be classified as superficial resemblance (simulator approximates real tissue appearance) or functional task alignment (key steps of simulation approximate those of real procedure). We hypothesized that resident physicians would prefer a simulation model with high functional task alignment over a model with higher superficial resemblance and lower functional task alignment in central venous catheter placement training.

Methods

We conducted a randomized crossover trial, enrolling residents from multiple specialties. We compared an Appearance-focused model with high superficial resemblance (head, neck, and upper torso) and low functional task alignment vs a function-focused model with high functional task alignment (replicates the process central venous catheter using ultrasound guidance including vascular identification, dilation, and catheter introduction in a single model) and lower superficial resemblance. Participants used each model once (crossover), with sequence randomly assigned. After using each model, they rated the superficial resemblance (ultrasonographic image, tissue feel, needle and transducer functionality, model as a whole) and functional task alignment (movements, steps sequence, continuity between steps, task as a whole) using a 5-point scale. Finally, participants rated their preference after using both simulators.

Results

Eighty residents were invited to participate, with 53 (66%) completing the study. Immediate post simulator assessments comparing Function-focused and Appearance-focused models demonstrated significantly higher mean scores for the Function-focused model across several domains, including tissue feels (2.9 ± 1.04 vs 2.4 ± 0.95, P = .027), needle and transducer functionality (3.3 ± 1.11 vs 2.8 ± 1.05, P = .007), model as a whole (3.4 ± 0.98 vs 2.6 ± 0.93, P < .001), and task continuity (4.0 ± 1.04 vs 2.7 ± 1.25, P < .001). Furthermore, the Function-focused model notably outperformed the Appearance-focused model regarding the overall task alignment (3.6 ± 0.95 vs 2.8 ± 1.0, P < .001). The overall preference for the simulators indicated a clear inclination toward the Function-focused model with participants preferring it for future training (87%, n = 46).

Conclusion

Resident physicians rated the function-focused simulator higher for both overall superficial resemblance and for all measures of functional task alignment, and preferred this model overall, in comparison with the appearance-focused simulator. Additionally, they demonstrated a strong preference for functional task alignment.