Improving Residents' Knowledge of Arterial and Central Line Placement with a Web-based Curriculum

Overview

Journal J Grad Med Educ

Date 2011 Dec 2

PMID 22132276

Citations 2

Authors

Shilpa Grover

Paul F Currier

Jason M Elinoff

Joel T Katz

Graham T McMahon

Affiliations

Soon will be listed here.

Abstract

Background: Procedural skill is predicated on knowledge. We used a previously validated test to evaluate the impact of a web-based education program on medical residents' knowledge of 2 advanced medical procedures.

Methods: We enrolled 210 internal medicine residents at 3 residency programs in a randomized, controlled, educational trial. Study participants completed a 20-item, validated online test of their knowledge of central venous and arterial line (CVL and AL, respectively) placement at baseline and after performing their next 2 procedures (test 1 and test 2). Between test 1 and test 2, participants were randomized to online educational material for CVL insertion, AL insertion, both, or neither. The primary outcome of the study was the difference in test scores between test 1 and test 2 by randomization group.

Results: Though residents in the baseline cohort were confident about their knowledge of procedural technique, their mean test scores were low (62% and 58% in the CVL and AL tests, respectively). Baseline test score correlated with the number of prior procedures performed. Sixty-five residents completed all 3 CVL tests, and 85 residents completed all 3 AL tests. Access to the web-based procedure education was associated with a significant improvement in scores for both the CVL test (effect size, d = 0.25, P = .01) and AL test (d = 0.52, P < .001).

Conclusions: Web-based procedure training improves knowledge of procedures to a significantly greater extent than performing the procedure alone. Web-based curricula can effectively supplement other methods of skill development.

Citing Articles

Online Digital Education for Postregistration Training of Medical Doctors: Systematic Review by the Digital Health Education Collaboration.

George P, Zhabenko O, Kyaw B, Antoniou P, Posadzki P, Saxena N J Med Internet Res. 2019; 21(2):e13269.

PMID: 30801252 PMC: 6410118. DOI: 10.2196/13269.

First do no harm: preserving patient safety without sacrificing procedural education.

Wayne D, Holmboe E J Grad Med Educ. 2011; 2(4):499-501.

PMID: 22132266 PMC: 3010928. DOI: 10.4300/JGME-D-10-00183.1.

References

Rivers E, Nguyen B, Havstad S, Ressler J, Muzzin A, Knoblich B . Early goal-directed therapy in the treatment of severe sepsis and septic shock. N Engl J Med. 2002; 345(19):1368-77. DOI: 10.1056/NEJMoa010307. View

Kerfoot B, Conlin P, McMahon G . Comparison of delivery modes for online medical education. Med Educ. 2006; 40(11):1137-8. DOI: 10.1111/j.1365-2929.2006.02588.x. View

Cook D, Beckman T . Reflections on experimental research in medical education. Adv Health Sci Educ Theory Pract. 2008; 15(3):455-64. DOI: 10.1007/s10459-008-9117-3. View

Brennan T, Leape L . Adverse events, negligence in hospitalized patients: results from the Harvard Medical Practice Study. Perspect Healthc Risk Manage. 1992; 11(2):2-8. DOI: 10.1002/jhrm.5600110202. View

Graham A, Ozment C, Tegtmeyer K, Lai S, Braner D . Videos in clinical medicine. Central venous catheterization. N Engl J Med. 2007; 356(21):e21. DOI: 10.1056/NEJMvcm055053. View

Hicks C, Gonzalez R, Morton M, Gibbons R, Wigton R, Anderson R . Procedural experience and comfort level in internal medicine trainees. J Gen Intern Med. 2000; 15(10):716-22. PMC: 1495602. DOI: 10.1046/j.1525-1497.2000.91104.x. View

Wigton R, Alguire P . The declining number and variety of procedures done by general internists: a resurvey of members of the American College of Physicians. Ann Intern Med. 2007; 146(5):355-60. DOI: 10.7326/0003-4819-146-5-200703060-00007. View

Smith C, Gordon C, Feller-Kopman D, Huang G, Weingart S, Davis R . Creation of an innovative inpatient medical procedure service and a method to evaluate house staff competency. J Gen Intern Med. 2004; 19(5 Pt 2):510-3. PMC: 1492327. DOI: 10.1111/j.1525-1497.2004.30161.x. View

Prystowsky J, Bordage G . An outcomes research perspective on medical education: the predominance of trainee assessment and satisfaction. Med Educ. 2001; 35(4):331-6. DOI: 10.1046/j.1365-2923.2001.00910.x. View

10.

Huang G, Smith C, Gordon C, Feller-Kopman D, Davis R, Phillips R . Beyond the comfort zone: residents assess their comfort performing inpatient medical procedures. Am J Med. 2006; 119(1):71.e17-24. DOI: 10.1016/j.amjmed.2005.08.007. View

11.

Lenhard A, Moallem M, Marrie R, Becker J, Garland A . An intervention to improve procedure education for internal medicine residents. J Gen Intern Med. 2008; 23(3):288-93. PMC: 2359479. DOI: 10.1007/s11606-008-0513-4. View

12.

Barsuk J, Cohen E, Feinglass J, McGaghie W, Wayne D . Use of simulation-based education to reduce catheter-related bloodstream infections. Arch Intern Med. 2009; 169(15):1420-3. DOI: 10.1001/archinternmed.2009.215. View

13.

Tegtmeyer K, Brady G, Lai S, Hodo R, Braner D . Videos in Clinical Medicine. Placement of an arterial line. N Engl J Med. 2006; 354(15):e13. DOI: 10.1056/NEJMvcm044149. View

14.

Sherertz R, Ely E, Westbrook D, Gledhill K, Streed S, Kiger B . Education of physicians-in-training can decrease the risk for vascular catheter infection. Ann Intern Med. 2000; 132(8):641-8. DOI: 10.7326/0003-4819-132-8-200004180-00007. View

15.

Gaies M, Morris S, Hafler J, Graham D, Capraro A, Zhou J . Reforming procedural skills training for pediatric residents: a randomized, interventional trial. Pediatrics. 2009; 124(2):610-9. DOI: 10.1542/peds.2008-2658. View

16.

Kerfoot B, Baker H, Jackson T, Hulbert W, Federman D, Oates R . A multi-institutional randomized controlled trial of adjuvant Web-based teaching to medical students. Acad Med. 2006; 81(3):224-30. DOI: 10.1097/00001888-200603000-00004. View

17.

Fincher R . Procedural competence of internal medicine residents: time to address the gap. J Gen Intern Med. 2000; 15(6):432-3. PMC: 1495461. DOI: 10.1046/j.1525-1497.2000.0004010.x. View

18.

Martin M, Scalabrini B, Rioux A, Xhignesse M . Training fourth-year medical students in critical invasive skills improves subsequent patient safety. Am Surg. 2003; 69(5):437-40. View

19.

Millington S, Wong R, Kassen B, Roberts J, Ma I . Improving internal medicine residents' performance, knowledge, and confidence in central venous catheterization using simulators. J Hosp Med. 2009; 4(7):410-6. DOI: 10.1002/jhm.570. View

20.

Grover S, Currier P, Elinoff J, Mouchantaf K, Katz J, McMahon G . Development of a test to evaluate residents' knowledge of medical procedures. J Hosp Med. 2009; 4(7):430-2. DOI: 10.1002/jhm.507. View