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J Pediatr Intensive Care
DOI: 10.1055/s-0043-1775567
Original Article

Central Venous Catheter Placement Skill Acquisition Through Apprenticeship Training in Clinical Context during Pediatric Critical Care Medicine Fellowship: A Longitudinal Study

Ryan J. Good 
1   Section of Critical Care Medicine, Department of Pediatrics, University of Colorado at Denver, Aurora, Colorado, United States
,
Kristen R. Miller
2   Department of Pediatrics, School of Medicine, University of Colorado, Aurora, Colorado, United States
,
John L. Kendall
3   Department of Emergency Medicine, Denver Health Medical Center, Aurora, Colorado, United States
,
Angela S. Czaja
1   Section of Critical Care Medicine, Department of Pediatrics, University of Colorado at Denver, Aurora, Colorado, United States
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Abstract

Pediatric critical care medicine (PCCM) fellows must develop competence in central venous catheter (CVC) placement. The impact of experiential learning opportunities in the clinical context on PCCM fellow CVC placement skill acquisition remains unknown. We sought to measure femoral CVC placement skill acquisition during fellowship and compare fellow to attending skill. We performed a prospective observational cohort study of PCCM fellows at the University of Colorado from 2019 to 2021. Femoral CVC placement skill was measured by attending evaluation of level of the supervision (LOS) required for the fellow, and hand motion analysis (HMA) on simulation task trainer. Competence in femoral CVC placement was defined as LOS ≥ 4 (can perform this skill independently) on a 5-point Likert scale. We compared fellow skill in femoral CVC placement to years of training and number of femoral CVCs placed. We also compared third-year fellow and attending HMA measurements. We recruited 13 fellows and 6 attendings. Fellows placed a median of 8 (interquartile range 7, 11) femoral CVCs during the study period. All fellows who reached third-year of fellowship during the study period achieved competence. Longitudinal analysis demonstrated improvement in CVC placement skill by both LOS and HMA as years of fellowship and number of femoral CVCs placed increased. Few third-year fellows achieved attending level skill in femoral CVC placement as measured by HMA. PCCM fellows acquired skill in CVC placement during fellowship and achieved competence in the procedure, but most did not reach attending level of skill.

Keywords

education - medical - central venous catheters

Supplementary Material



Publication History

Received: 20 July 2023

Accepted: 28 August 2023

Article published online:
19 September 2023

© 2023. Thieme. All rights reserved.

Georg Thieme Verlag KG
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