Cognitive load theory as a framework for simulation-based, ultrasound-guided internal jugular catheterization training: Once is not enough.

Abstract

The main objective of this study was to use the principles of cognitive load theory to design a curriculum that incorporates a progressive part practice approach to teaching ultrasound-guided (USG) internal jugular catheterization (IJC) to novices. A secondary objective was to compare the technical proficiency of residents trained using this curriculum with the technical proficiency of residents trained with the current local standard of a single simulation session. The experimental group included 16 residents who attended three 2-hour sessions of progressive part practice in a simulation lab. The control group included 46 residents who attended the current local standard of a single 2-hour simulation session just prior to their intensive care unit rotation. Technical proficiency was assessed using hand motion analysis and time to procedure completion. After three sessions, median scores for right hand motion (RHM) (34.5; [27.0-49.0]), left hand motion (LHM) (35.5; [20.0-45.0]), and total time (TT) (117.0 s; [82.7-140.0]) in the experimental group were significantly better than the control group (p<0.001). Results for eight experimental group residents who were assessed for retention at a later date revealed median scores for RHM (45.0; [32.0-58.0]), LHM (33.5; [20.0-63.0]), and TT (150.0 s; [103.0-399.6]), which were significantly better than those of the control group (p=0.01, p<0.01, and p=0.02, respectively). These results support multiple sessions of progressive part practice in a simulation lab as an effective competency-based approach to teaching USG IJC in preparation for the clinical setting.