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Do More With Less: A Surgery Directed Institutional Model for Resident Central Line Training

Do More With Less: A Surgery Directed Institutional Model for Resident Central Line Training. David Leshikar, M.D. Jonathan Pierce, M.D. Edgardo Salcedo , M.D. Gurpreet Bola, B.S. Joseph Galante , M.D. April 23, 2013. “See One, Do One, Teach One”. Apprenticeship model

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Do More With Less: A Surgery Directed Institutional Model for Resident Central Line Training

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  1. Do More With Less: A Surgery Directed Institutional Model for Resident Central Line Training David Leshikar, M.D. Jonathan Pierce, M.D. EdgardoSalcedo, M.D. Gurpreet Bola, B.S. Joseph Galante, M.D. April 23, 2013

  2. “See One, Do One, Teach One” • Apprenticeship model • Little to no supervision • Bedside teaching

  3. Simulation Training • Background • Uses • Procedural training • CPR/ACLS • Endoscopy • Laparoscopy • Endovascular • Fundamentals of Laparoscopic Surgery

  4. Central Venous Catheters (CVC) • Common bedside procedure • Performed by many specialties • Complications

  5. Central Line Simulation • CVC Simulation: • Decreases complications • Improves comfort level • Widespread adoption Barsuk, et al, Crit Care Med, 2009. Barsuk, et al, Arch Intern Med, 2009 Burden, et al, J Clin Anesth, 2012.

  6. Procedural Simulation • Expensive • Equipment costs • Faculty time • No standardized assessment metrics • Redundant within institutions Duncan, et al, J Grad Med Educ, 2010

  7. Hypothesis • A curriculum centralized in the department of surgery • Single faculty trainer • Maintain quality of training • Institution wide • Efficient resource utilization

  8. Curriculum • Web-based module • Covered all aspects of central line placement • Pre/Post testing • Hands-on simulation training • Technical training – all components • Video assessment

  9. Resource Utilization • Equipment costs • CVC simulator • Simulator supplies • Staff productivity • Number of faculty involved • Preparation time • Compared pre vs post implementation

  10. Pre-Implementation • Individual departments • Inconsistent simulator use • No standardization

  11. Post-Implementation • Study Period: July 2010-June 2012 • Departments involved: • Surgery • Internal Medicine • Emergency Medicine • Family Practice • Pediatrics • Anesthesia • Standardized evaluation • Single faculty trainer

  12. Online Module

  13. Video Assessments

  14. Central Line Infections • Mean before, 3.8 infections per 1000 catheter days • Mean after, 2.3 infections per 1000 catheter days

  15. Resource Utilization

  16. Estimated Program Costs

  17. Summary • Streamlined development • Effective instruction • Improved efficiency

  18. Conclusion • Standardization of simulation • Maintained quality of teaching • Decrease resource utilization

  19. Questions?

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