'Post factum'-What of you could change the terms? Initial experiences of U/S guided lines

Authors

Mema
Harris

Theme

Simulation

INSTITUTION

Hospital for Sick Children

Background

Ultrasound  (U/S) guided Central Venous Line (CVL) insertion is the standard of care, in many centers, for placement of central line catheters. Data from Randomized Controlled Trials (RCTs) and systematic reviews of the literature show that simulation training is superior to apprenticeship training for procedural learning. Reviews in simulation and medical education call for more studies that explore transfer of skills learned in simulation to practice settings and the factors that influence the transfer. The purpose of this study is to explore, from the perspectives of participants in a simulation-training program, the factors that help or hinder the transfer of skills from simulation to practice.

 

Summary of Work

Purposeful sampling was used to investigate the experience of novice fellows after they had completed simulation training and then performed U/S guided CVL in practice. Seven eligible novices each participated in a semi-structured interview. The data was analyzed qualitatively to identify themes. To validate the data from trainees regarding performance at the bedside, we interviewed six faculty members who had closely supervised these fellows in these “real life” procedures. Member checking was done with both groups of faculty and trainees by presenting the results in a slide presentation format and eliciting their perspectives about the results.

Summary of Results

The trainees had no prior knowledge or skills related to U/S guided CVL insertion. After the simulation training they went on to have real-life experiences with U/S guided CVL insertion. Both curricular and real-life factors influence the transfer of skills from simulation to real-life settings and the overall performance of trainees. Clear instructions, the opportunity to practice to mastery and one-on-one observation with feedback were perceived as curricular factors that facilitated the transfer of skills. Timing of simulation training in relation to bedside experience, the degree to which real-life events were replicated, the possibility of practicing with different scenarios and the possibility of practicing with models of varying difficulty were perceived as curricular factors that might have helped or hindered the transfer of skills. Real-life factors that facilitated the transfer of skills were supervision and further real-life experiences. Concern for patient welfare, live troubleshooting, complexity of the ICU environment and the procedure itself were perceived as real-life factors that hindered the transfer of skills.

 

Conclusion

As more studies confirm the superiority of simulation training versus apprenticeship training for initial student learning, learner performance and patients' outcome, the curriculum developer can gain insight into factors that facilitate and hinder the transfer of skills from simulation to bedside settings and impact learning performance. As simulation further augments clinical learning, efforts should be made to modify the curricular and bedside factors that facilitate transfer of skills from simulation to bedside settings.

Acknowledgement

Sick Kids Paediatric Consultant’s Education Innovation and Development Grant 

References

Fraenkel, J., Wallen, N., & Hyun, H. (2011). How to Design and Evaluate Research in Education: McGraw-Hill Companies,Incorporated.

 Greeno, Moore, Smith. (1996). Transfer of situated learning: Ablex Publishing Corporation.

Background
Summary of Work
Summary of Results
Conclusion
Acknowledgement
References
Send ePoster Link