Preparing interns for clinical practice through an institution-wide simulation-based mastery learning program for...

Area of Science:

• Medical Education
• Patient Safety
• Surgical Skills Training

Background:

• Central venous catheter (CVC) placement carries iatrogenic risks, yet standardized competency assessment for trainees is lacking.
• Existing literature on institution-wide CVC competency programs is limited.
• Competency-based education can reduce CVC-associated morbidity.

Purpose of the Study:

• To describe the implementation of an institutional-wide, simulation-based mastery curriculum for first-year residents.
• To assess initial competency in central venous catheter placement prior to supervised clinical practice.
• To verify trainee proficiency using a standardized checklist and defined competency standards.

Main Methods:

• A simulation-based mastery training curriculum was developed for first-year residents in 2021-2022.
• A multidisciplinary team created an internal checklist for CVC placement.
• The Mastery-Angoff technique determined minimum passing standards for competency.
• Faculty assessed intern performance using the checklist post-training.

Main Results:

• 229 interns from 20 specialties participated over two academic cycles.
• 83% achieved competency on the first attempt, 14% on the second, and 3% on the third.
• Significant improvement in scores from baseline to posttest was observed (P < .001).
• 10.5% of interns performed dangerous actions (e.g., malpositioning, retained guidewire).

Conclusions:

• Simulation-based mastery training is a feasible method for verifying preliminary procedural competency.
• This approach promotes patient safety by ensuring interns meet standards before clinical CVC placement.
• While all interns achieved competency, dangerous actions highlight the need for continued vigilance and training refinement.