Oral Themed Presentation
Background: : Umbilical line placement is an essential skill and one of the most common procedures practiced in neonatal intensive care units. The Royal College of Physicians and Surgeons of Canada (RCPSC) and other accrediting bodies require that trainees become proficient at inserting umbilical lines and demonstrate appropriate, safe and timely performance of this skill during their training. Clinical exposure to procedures can be variable among pediatric residents and its questionable whether they receive adequate training in these procedural skills. There is an urgent need to supplement curriculum to teach this life-saving skill using best practices.
Research Question: : 1) Create a realistic simulation model using human umbilical tissue and develop a competency-based curriculum utilizing just-in-time video teaching and deliberate practice.
2) Assess the feasibility and impact of developing, implementing, and evaluating this curriculum on both learners and teachers during a four week neonatology rotation.
Methodology: : Junior and Senior pediatric trainees will be identified a priori at the start of each 4 week block and approached for participation. Parents will be approached for permission to use residual umbilical cords. Residents will be exposed to an umbilical line insertion curriculum which will include: a structured introductory teaching session, followed by one or more attempts of umbilical line insertion (the skill) in a safe simulated environment. Opportunity for self-assessment, feedback, and reflection will be provided. The curriculum will be evaluated with pre and post testing, based on: trainee reaction, learning (knowledge, as well as behavior (performance evaluation using adapted OSATS/O-SCORE). Clinical implications will be sought from trainees at the end of their rotation and 6 months following rotation completion.
Results: : To date, 7 trainees have completed the curriculum (4 PGY3/4 & 3 PGY1s). We anticipate at least 18 more in the next six months. All the residents were highly engaged and appreciative of the curriculum.Obtaining umbilical cords from placentas was feasible with only 2/9 refusals to date. None of the junior trainees had prior experience inserting UVC lines. Senior residents had variable experience (# of insertions varied from 3-20) prior to the curriculum. Most junior (2/3) and senior (3/4) residents improved their pre/post knowledge scores.
Senior residents had good knowledge and skills to begin with, three out of four residents had an improvement in Ottawa Surgical Competency Operating Room Evaluation (O-SCORE). Senior residents required 2 or 3 attempts in order to be assessed as able to independently perform. For junior residents, all had a score of 2/5 prior to the curriculum. All improved performance to a4 or 5/5 on the O-SCORE. All junior residents were initially unable to perform UVC insertion independently. By the end of three simulations, they were all able to perform the task independently (teacher evaluation). Resident reaction to the study was extremely favorable. 2 of 7 residents reported that it contributed to improved confidence in actual UVC insertion during the rotation.
Discussion/Conclusions: : As medical education shifts towards competency based education, it becomes ever more important to develop a framework to teach and assess competence of skills. We hypothesize that by completing a curriculum utilizing simulation, deliberate practice and just-in-time teaching, residents will be able to achieve proficiency in umbilical line insertion, a potentially life-saving skill.