(Social) Distanced Medical Simulation: Lessons Learned in Virtualizing Resident Central Venous Catherization
TimeWednesday, April 143:30pm - 3:50pm EDT
LocationEducation and Simulation
DescriptionMedical education has traditionally been taught through in-person didactic lectures and "see-one, do-one, teach-one" methodologies. However, medical education has evolved throughout the last century, with the use of computer- and simulation-based training. While computer-based education provides a standardized and efficient method of educating students without geographic constraint, simulation-based education has been shown to aid in the development of hands-on experience for without patient risk. Using these two methods in tandem has been shown to be an impactful way to develop medical skills. While we have seen growth in the use of these technologies in medical education, the need for an evolution of how medical education is taught has become even more apparent through the COVID-19 pandemic.
One such area utilizing this education approach is residents undergoing Central Venous Catheterization (CVC) training. CVC is currently taught using high-fidelity manikins that only provide one specific patient anatomy and requires an in-person preceptor for performance feedback. As the COVID-19 pandemic hit, institutions around the world were left with the challenge of how to facilitate hands-on CVC learning while adhering to strict socially distancing guidelines. In order to overcome this obstacle, we integrated the Dynamic Haptic Robotic Trainer (DHRT) system tied with an online educational curriculum.
The DHRT serves as a social distancing medical simulator for CVC training allowing residents to complete a needle insertion for CVC while simulating different patient profiles and without the need of an in-person preceptor. The online educational curriculum was developed using human-factors principles to teach the theoretical CVC information while complying with social distance. In order to transition medical education through online environments while utilizing both computer- and simulation-based education, residents had to complete their online curriculum training to then practice their needle insertion using the DHRT. The development of the curriculum involved input from 5 medical experts from 2 different medical institutions. A series of virtual meetings were conducted to reach an agreement on the learning objectives, learning material, and main goals of the curriculum. Improvements based on the meetings' discussions were made.
The experts agreed to 8 training modules on CVC information, overview, access sites, central line bundle, RaCeVA protocol and ultrasound, mechanical procedures, complications, and catheter removal. Experts were assigned training modules and were asked to pre-record them. These recordings ranged from a minimum of 2.30 minutes to a maximum of 15.38 minutes. Medical experts also agreed to have inside each training module a 2 multiple-choice question embedded quiz to test the short-term knowledge gained. Nonetheless, experts also agreed on having a pre and post-assessment to test students' knowledge gained. Experts also provided feedback on the pre- and post-assessment developed. These assessments included a total of 14 questions of multiple-choice questions, picture identification, and ordering of CVC steps. The learning objectives, training modules, and assessments compiling the online curriculum was designed in CANVAS learning management system. Kaltura MediaSpace was used for the embedded quizzes in each training module. Settings in Kaltura were modified to not allow residents to skip through the videos. While settings in Canvas were changed for residents to unlock the next step of the curriculum only after they observed the whole video and submitted the Kaltura quizzes. Therefore, residents were not able to jump through the curriculum without completing the previous requirement. With the integration of this online curriculum and the DHRT system we virtualize medical education during COVID-19 pandemic times.
Despite the socially distancing guidelines, we were able to provide CVC medical education to 14 medical residents. Medical residents that underwent this virtual medical education, initially took a Pre-Test with a one-time attempt and no required passing grade. Residents then completed the 8 training modules with the embedded quizzes and then took a Post-Test with an unlimited number of attempts and a required passing grade of 80%. Residents were asked to complete a satisfaction survey, including Likert-scale and open-ended questions and observe a video introducing the DHRT system. After completing this online curriculum, residents applied their knowledge gained to their CVC needle insertion with the DHRT and manikin training. With the integration of this educational online curriculum and DHRT system, medical education was delivered to residents even with COVID-19 and socially distancing guidelines. Lessons learned include that computer- and simulation-based learning are tools available to improve medical education. There is a need to continue improving medical education so that our doctors and residents are well trained and informed even in these difficult pandemic times. Based on the feedback survey, future work should be dedicated to improve the online curriculum by reducing the overall time taken to complete the curriculum, modify the ordering question in the pre- and post-assessments, providing direct feedback with the assessment submission, and test this educational approach in other hospital settings.