Date of Award

January 2022

Document Type

Thesis

Degree Name

Medical Doctor (MD)

Department

Medicine

First Advisor

Leigh Evans

Abstract

In the past two decades, simulation has emerged as a modality to standardize teaching of invasive procedures, allowing physicians in training to practice without risk of harm to patients and potentially reducing medical errors associated with inexperienced clinicians. This work seeks to describe a hospital-wide deliberate practice simulation training program for central venous catheter (CVC) insertion, present information about maintaining such a program, and analyze the association between trainee demographic characteristics and both performance and learner outcomes.The qualitative portion of this study consists of two semi-structured interviews focused on important aspects of program administration. The quantitative portion examines previously collected performance data from all resident trainees who completed the program in 2021. The relationship between trainee characteristics and outcome variables was analyzed using descriptive statistics and linear regressions. Outcome variables included a global assessment instrument encompassing number of restarts, number of cannulation attempts, and change in confidence level. Two major qualitative themes emerged: the importance of personnel resources and the advantages of a just-in-time approach to scheduling. The total sample size for the quantitative portion of the study was 158 residents over a one-year period. There were no significant associations between trainee characteristics and number of restarts or number of cannulation attempts in the linear regression models. Male trainees had a statistically significant higher rating of their confidence before beginning the program (1.62 versus 1.32, p-value 0.0183) and in post-training and testing (4.11 versus 3.73, p=0.0067). In the regression model for confidence difference pre- and post- program completion, status as a surgical/procedural resident was significantly associated with a greater increase in confidence (partial η2 0.067). While there was no significant association between the trainee characteristics and our primary outcome variables (number of restarts and number of cannulation attempts), there was a significant association with surgical/procedural specialties and a larger increase in confidence after completing the program. Additionally, the qualitative data regarding program logistics and administration, including personnel and resource requirements, may be a valuable resource for other institutions considering the initiation of a hospital-wide CVC training program.

Comments

This thesis is restricted to Yale network users only. It will be made publicly available on 06/29/2024

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