Abstract
Background Central Venous Catheter (CVC) placement is a common critical care procedure. Simulated practice has been shown to reduce its iatrogenic complications. Video modeling (VM) is an instructional adjunct that improves the quality and success of CVC insertion. Immersive VM can improve recall and skill translation, but its role in teaching medical procedures is not established.Research question/hypothesisWe hypothesized that, relative to traditional VM, immersive VM would decrease cognitive load and enhance ultrasound-guided CVC insertion skill acquisition.MethodsThirty-two resident physicians from four specialties were randomized into traditional (control) or immersive VM (intervention) groups for three CVC training sessions. Cognitive load was quantified via NASA Task Load Index (TLX). Mean (± standard deviations) values were compared using two-tailed t-tests. Skill acquisition was quantified by procedural time and the average 5-point [EM1] [TB2] entrustment score of three expert raters.ResultsOverall entrustment scores improved from the first (3.44±0.98) to the third (4.06±1.23; p<0.002) session but were not significantly different between the control and intervention groups. There were no significant differences between NASA TLX scores or procedural time.ConclusionWe found no significant difference in entrustment, cognitive load, or procedural time. Immersive VM was not found to be superior to traditional VM for teaching CVC insertion.
Highlights
Central venous catheter (CVC) placement is a medical procedure that involves the insertion of a catheter into the venous system to facilitate the administration of medications, fluids, and blood products [1]
There were no significant differences between NASA Task Load Index (TLX) scores or procedural time
Building on recent literature suggesting that immersive Video modeling (VM) initially increases procedural cognitive load but that this cognitive load decreases with time [15], we hypothesized that incorporating immersive VM at the beginning of procedural training could decrease cognitive load during successive attempts at the procedure
Summary
Central venous catheter (CVC) placement is a medical procedure that involves the insertion of a catheter into the venous system to facilitate the administration of medications, fluids, and blood products [1]. It has been associated with serious mechanical (pneumothorax, bleeding, thrombus formation, occlusion, extravasation, catheter embolism or breakage, fistula formation, air embolism, pericardial tamponade, cardiac aneurysm, or vein stenosis) and infectious (cellulitis, phlebitis, intracardiac abscess, or sepsis) complications. CVC insertion training that utilizes both video modeling (VM) and task trainers for procedural simulation has been shown to decrease instructor time [5,6], training time [5], equipment spoilage [6], and adverse events [5,7]. Relative to traditional VM, immersive VM would decrease cognitive load and enhance ultrasound-guided CVC insertion skill acquisition.
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