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Original Research: SIMULATION-BASED TRAINING |

Simulation-Based Objective Assessment Discerns Clinical Proficiency in Central Line Placement: A Construct Validation

Yue Dong, MD; Harpreet S. Suri, MBBS; David A. Cook, MD, MHPE; Kianoush B. Kashani, MD; John J. Mullon, MD; Felicity T. Enders, PhD; Orit Rubin, PhD; Amitai Ziv, MD; William F. Dunn, MD, FCCP
Author and Funding Information

From the Mayo Clinic Multidisciplinary Simulation Center (Drs Dong, Suri, Cook, Kashani, Mullon, and Dunn), the College of Medicine (Drs Dong, Suri, Cook, Kashani, Mullon, Ziv, and Dunn), and the Department of Health Sciences Research (Dr Enders), Mayo Clinic; the Office of Education Research (Dr Cook), Mayo Medical School, Rochester, MN; and the Israel Center for Medical Simulation (Drs Rubin and Ziv), Chaim Sheba Medical Center, Tel Hashomer, Israel.

Correspondence to: William F. Dunn, MD, FCCP, Division of Pulmonary and Critical Care Medicine, College of Medicine, Mayo Clinic, 200 1st St SW, Rochester, MN 55905; e-mail: dunn.william@mayo.edu


Funding/Support: Supported by the Mayo Foundation for Medical Education and Research and The Y&S Nazarian Family Foundation.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestpubs.org/site/misc/reprints.xhtml).

For editorial comment see page 1009


© 2010 American College of Chest Physicians


Chest. 2010;137(5):1050-1056. doi:10.1378/chest.09-1451
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Background:  Central venous catheterization (CVC) is associated with patient risks known to be inversely related to clinician experience. We developed and evaluated a performance assessment tool for use in a simulation-based central line workshop. We hypothesized that instrument scores would discriminate between less experienced and more experienced clinicians.

Methods:  Participants included trainees enrolled in an institutionally mandated CVC workshop and a convenience sample of faculty attending physicians. The workshop integrated several experiential learning techniques, including practice on cadavers and part-task trainers. A group of clinical and education experts developed a 15-point CVC Proficiency Scale using national and institutional guidelines. After the workshop, participants completed a certification exercise in which they independently performed a CVC in a part-task trainer. Two authors reviewed videotapes of the certification exercise to rate performance using the CVC Proficiency Scale. Participants were grouped by self-reported CVC experience.

Results:  One hundred and five participants (92 trainees and 13 attending physicians) participated. Interrater reliability on a subset of 40 videos was 0.71, and Cronbach a was 0.81. The CVC Proficiency Scale Composite score varied significantly by experience: mean of 85%, median of 87% (range 47%-100%) for low experience (0-1 CVCs in the last 2 years, n = 27); mean of 88%, median of 87% (range 60%-100%) for moderate experience (2-49 CVCs, n = 62); and mean of 94%, median of 93% (range 73%-100%) for high experience (> 49 CVCs, n = 16) (P = .02, comparing low and high experience).

Conclusions:  Evidence from multiple sources, including appropriate content, high interrater and internal consistency reliability, and confirmation of hypothesized relations to other variables, supports the validity of using scores from this 15-item scale for assessing trainee proficiency following a central line workshop.

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