Impact of simulation‐based learning on immediate outcomes of temporary haemodialysis catheter placements by nephrology fellows

Autor:	Hui Boon Tay, Riece Koniman, Chee Yong Ng, Lina Hui Lin Choong, Swee Ping Teh, Htay Htay, Hui Hua Li, Shien Wen Sheryl Gan, Chieh Suai Tan, Marjorie Foo, Ru Yu Tan, Cheng Boon Poh, Su Hooi Teo, Wenxiang Yeon, Jia Liang Kwek, Peiyun Liu, Pei Loo Tok, Kian Guan Lee, Suh Chien Pang
Rok vydání:	2018
Předmět:	Adult Male Nephrology Catheterization Central Venous medicine.medical_specialty 030232 urology & nephrology Simulation training Teaching hospital Nephrologists 03 medical and health sciences 0302 clinical medicine Renal Dialysis Risk Factors Internal medicine Central Venous Catheters Humans Medicine 030212 general & internal medicine Simulation Training Aged Retrospective Studies Simulation based learning business.industry Retrospective cohort study General Medicine Middle Aged Surgery Education Medical Graduate Haemodialysis catheter Female Clinical Competence Curriculum Historical control business Body mass index Learning Curve
Zdroj:	Nephrology. 23:933-939
ISSN:	1440-1797 1320-5358
Popis:	Aim Traditional apprenticeship model (AM) of teaching in invasive procedures such as temporary haemodialysis catheter (THDC) insertion can result in propagation of errors and complications. Simulation-based learning (SBL) offers standardization of skills and allows trainees to repeatedly practice invasive procedures prior to performing them on actual patient. Methods Retrospective cohort study of first-, second- and third-year Nephrology Fellows from a tertiary teaching hospital from September 2008 to September 2015. The intervention group (n = 9) received simulation training in ultrasound-guided THDC placement. The historical control group (n = 12) received training through traditional AM. The primary and secondary outcomes were the immediate complications and success rates of THDC insertion. Results A total of 2481 THDCs were placed in 1787 patients. Success rate of internal jugular THDC placement for AM vs. SBL Fellow was 99.8% versus 100% (P = 0.90), while the success rate for femoral THDC placement was 99.6% versus 99.2% (P = 0.53). SBL Fellows reported fewer overall peri-procedure complications (8.3% vs. 11.2%, P = 0.02) and mechanical complications (1% vs. 2.4%, P = 0.02) compared to AM Fellows. The rate of reported technical difficulty was similar (7.5% vs. 9.2%, P = 0.17). After adjusting for side and site of THDC placement, body mass index and laboratory indices, THDC inserted by AM Fellows were independently associated with increased overall peri-procedure complications (OR = 1.396, 95% CI: 1.052-1.854, P = 0.02) and mechanical complications (OR = 2.481, 95% CI: 1.178-4.810, P = 0.02). Conclusions Simulation-based learning was associated with lower procedure related complications and should be an integral component in the teaching of procedural skills in Nephrology.
Databáze:	OpenAIRE
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