Mastery Learning of Temporary Hemodialysis Catheter Insertion by Nephrology Fellows Using Simulation Technology and Deliberate Practice

Background

Temporary hemodialysis catheter (THDC) insertion is a required skill for nephrology fellows. Traditional fellowship training may provide inadequate preparation to perform this procedure. Our aim was to use a central venous catheter (CVC) simulator to assess nephrology fellows' THDC insertion skills and evaluate the impact of an educational intervention on skill development to mastery standards.

Study Design

Prospective observational cohort study.

Setting & Participants

18 nephrology fellows from 3 academic centers in Chicago from May to August 2008. Six graduating fellows (traditionally-trained) underwent assessment of internal jugular THDC insertion skill using a CVC simulator. Subsequently, 12 first-year fellows (simulator-trained) underwent baseline testing and received a 2-hour education session featuring deliberate practice with the CVC simulator. Simulator-trained fellows were retested after the intervention and expected to meet or exceed a minimum passing score.

Predictor

Completion of CVC simulation education session.

Outcomes

THDC insertion skill performance.

Measurements

Skills examination was scored on a 27-item checklist. Minimum passing score was set by an expert panel.

Results

Performance of traditionally-trained graduating fellows in THDC insertion was poor (mean, 53.1%), and only 17% met the minimum passing score. Performance of simulator-trained first-year fellows improved from a mean of 29.5% to a mean of 88.6% after simulator training (P = 0.002). Simulator-trained fellows showed significantly higher THDC insertion performance than traditionally-trained graduating fellows (P = 0.001). The education program was rated highly.

Limitations

Although it represents fellows from 3 programs, sample size was small.

Conclusions

A curriculum featuring deliberate practice dramatically increased the skill of nephrology fellows to mastery standards in THDC insertion. This program illustrates a feasible and reliable mechanism to achieve and document procedural competency.

Index Words: Central venous catheterization, clinical competence, mastery learning, medical education, nephrology, simulation-based education, temporary hemodialysis catheter, ultrasound