Abstract:
Background: Pediatric vascular access is inherently challenging due to the small caliber of children’s vessels. Ultrasound-guided intravenouscatheter insertion has been shown to increase success rates and decrease time to cannulation in patients with difficult intravenous access. Although proficiency inultrasound-guided intravenous catheter insertion is a critical skill in pediatric anesthesia, there are no published competency-based training curricula.
Aims: The objective of this study was to evaluate the performance of pediatric anesthesiologists who participated in a novel ultrasound-guided intravenous catheter insertion simulation-based mastery learning curriculum.
Methods: Pediatric anesthesia attendings, fellows, and rotating residents participated in the ultrasound-guided intravenous catheter insertion simulation-based mastery learningcurriculum from August 2019 to February 2020. The two-hour curriculum consisted of participants first undergoing a simulated skills pretest followed by watching a video on ultrasound-guided intravenous catheter insertion and deliberate practice on a simulator. Subsequently, all participants took a posttest and were required to meet or exceed a minimum passing standard. Those who were unable to meet theminimum passing standard participated in further practice until they could be retested and met this standard. We compared pre- to posttestultrasound-guided intravenous catheter insertion skills and self-confidence before and after participation in the curriculum.
Results: Twenty-six pediatric anesthesia attendings, 12 fellows, and 38 residents participated in the curriculum. At pretest, 16/76 (21%) participants were able to meet or exceed the minimum passing standard. The median score on the pretest was 21/25 skills checklist items correct and improved to 24/25 at posttest (95% CI 3.0-4.0,p<0.01). Self-confidence significantly improved after the course from an average of 3.2 before the course to a post-course score of 3.9 (95% CI 0.5-0.9,p<0.01; 1=Not all confident, 5=Very confident) CONCLUSIONS: Simulation-based mastery learning significantly improved anesthesiologists' ultrasound-guided intravenous catheterinsertion performance in a simulated setting.
Reference:
Ballard, H. A., Tsao, M., Robles, A., Phillips, M., Hajduk, J., Feinglass, J. and Barsuk, J. H. (2020) Use of a Simulation-based Mastery Learning Curriculum to Improve Ultrasound-guided Vascular Access Skills of Pediatric Anesthesiologists. Paediatric Anaesthesia. June 27th. https://doi.org/10.1111/pan.13953 (epub ahead of print).