Does personalized vascular access training on a nonhuman tissue model allow for learning and retention of central line placement skills? Phase II of the procedural patient safety initiative (PPSI-II)

✍ Scribed by Bradley T. Rosen; Poulina Q. Uddin; Annie R. Harrington; Brian W. Ault; Mark J. Ault

• Publisher: John Wiley and Sons
• Year: 2009
• Tongue: English
• Weight: 204 KB
• Volume: 4
• Category: Article
• ISSN: 1553-5592
• DOI: 10.1002/jhm.571

✦ Synopsis

The Accreditation Counsel for Graduate Medical Education (ACGME) states in its Program Requirements for Residency Education in Internal Medicine that all residents must develop ''technical proficiency'' in several procedures, including central venous line placement. 1 Developing competency in common procedural skills has long been a part of medical training. The philosophy of ''see-1, do-1, teach-1'' is still the most common means by which most residents seek to obtain this proficiency, even though serious concerns have been raised about this approach. 2 A typical first experience in central line placement usually involves an eager (or terrified) trainee making several clumsy attempts on an actual patient, under the hurried guidance of a senior resident who themselves received an unknown degree of training. In this scenario, rarely does standardized instruction, formal evaluation, or structured follow-up occur.

A revitalized emphasis is now being placed on patient safety in healthcare, including an industry-wide commitment to minimizing procedural complications. The most common complications associated to central line placement include vascular damage and catheter-related bloodstream infections. A number of creative approaches are being developed to improve the quality of instruction on proper procedural techniques, all varying considerably in sophistication, scope, and rigor. Examples include the use of computer-assisted methods for training ultrasound-guided needle insertion techniques and ureteroscopy training, hands-on training with synthetic models for thoracentesis training, video training, and uterine aspiration using papayas. [3][4][5][6][7][8][9][10][11] Implicit in this trend is recognition that we, as educators, healthcare providers, and patient advocates, must design more cost effective and efficient ways to teach medical and surgical procedural techniques to clinicians.

Our approach was previously described in phase I of the Procedural Patient Safety Initiative (PPSI). 12 In PPSI-I, we introduced a nonhuman tissue model (NHTM; Figure 1) as the basis for teaching physicians a more rigorous curriculum of essential central line placement skills. By way of brief review, the NHTMs were constructed by tunneling 0.2-mmthick rubber tubing (vessels) lengthwise through raw, whole