Friday, August 7, 2015

Value of Feedback in Learning Placement of a Subclavian Central Venous Catheter

Francisco Fernandez, MD, MEd
University of Cincinnati / UC Health

Background: Simulation is typically structured as a simulated experience followed by a facilitated debriefing session. Debriefing is considered a critical component, but there is little literature to support its value in procedural education.

Aims: To test the hypothesis that students who receive a debriefing session after their first attempt at subclavian catheter insertion will perform better during a second attempt when compared to students who do not receive a debriefing.

Methods: Medical students rotating in emergency medicine were randomized using simple 1:1 randomization. The students then watched a central line training video and were asked to perform two attempts at central line placement using a simulator. After the first attempt, students in the debriefing group received a structured debriefing session from a single EM physician. Students in the control group received a break, but no feedback. Video recordings of the attempts were later viewed and scored on an 18 item checklist by two EM physicians who were blinded to the student’s randomization and to whether this was the first or second attempt. Repeated measures ANOVA was used to test for differences in scores between groups.

Results: We enrolled 68 medical students, 34 in each group. Most (87%) were fourth-years, and 91% had never attempted a central line placement. The mean score for the first placement in the debriefing group was 11 (SD 3) and in the control group was 12 (SD 4), p=0.938. The mean score for the second placement in the debriefing group was 16 (SD 2) and in the control group was 13 (SD 3). While both groups significantly improved their scores overall, debriefing had a greater effect (p<0.0001).

Conclusion: Students in both groups demonstrated improvement in scores at the second attempt. However, students who received a structured debriefing session had significantly higher scores than students in the control group. Structured debriefing should remain an important component of procedural simulation education.