An estimated 5 million central venous catheters are inserted into the large veins of patients in the United States yearly. While crucial for intravenous administration of fluids, blood products, and medications, or for diagnostic procedures, central venous cannulation (CVC) can be hazardous, potentially leading to serious infectious or mechanical complications. Medical students and housestaff physicians must learn how to properly perform this procedure, yet teaching tools are lacking. A VCU Health System task force for safe and effective CVC identified a need for instructional materials such as slides and procedure demonstration for students and housestaff physicians.
The overarching goals of the project are to develop a tool that would be useful for students and physicians by clearly discussing the risks, benefits, and process of CVC, to provide the opportunity for future self-directed learning, and to measure the impact of the tool. Specific objectives include:
- To produce an instructional video that clearly demonstrates the step-wise performance of CVC conducted in a safe and effective fashion, with an emphasis on prevention of infectious and mechanical complications.
- To produce a CD-ROM to be distributed to medical students that contains A) the instructional video, B) instructional powerpoint slides that provide additional information, and C) a 10 question self-assessment test.
- To incorporate these materials into the M-IV Update Course lecture, “Tubes, Lines, and Vents in the ICU”, given yearly by Dr. Sessler, and for self-study.
A set of 58 powerpoint slides that review the background, anatomy, latest clinical and research about process and potential complications, including recommendations made by the U.S. CDC and other agencies for safe CVC was updated. In a collaborative effort between CVC task force (including John Perry, MD, Matthew Williams, MD, and Renata Sampson, RN) and the VCU Creative Services Department we designed and created a series of videoclips that illustrate the process of CVC using a volunteer in the ICU setting. 13 selected video clips that depict key components of CVC were then imbedded into the powerpoint slides. The VCU Creative Services Department created a CD-ROM that contains the CVC slides with imbedded video. A 10 question quiz with annotated answers was created and added to the CD-ROM. The CD-ROM also contains the updated VCU Medical Center policy on infection control for CVC created by Dr. Edmond, an introductory letter, and 3 other sets of powerpoint slides of lectures given by Dr. Sessler on “Endotracheal Intubation”, “Mechanical Ventilation”, and “Arterial and Swan Ganz Catheterization”. The CD-ROM is entitled “Tubes, Lines, and Vents in the ICU” and 225 copies were burned. Copies were distributed to the members of the Medical School Class of 2004 as well as to various intensive care units and educational units throughout the VCU medical center.
In order to assess knowledge acquisition by M-IV students, the 10-question quiz was administered before and after giving the CVC powerpoint/video lecture. The M-IV students improved significantly (p < .001) from 50.3% correct pre- to 88.2% correct post-lecture. Improvement was noted for basic and advanced concepts for preventing mechanical and infectious complications. In addition to M-IV students, Dr. Sessler has given the lecture to various groups of housestaff physicians. A smaller group of Internal Medicine housestaff were also given the quiz and improved (p < .001) from 72.7% correct pre-lecture to 91.9% correct post-lecture.
There has been an enthusiastic response regarding the value of this innovative approach to teaching ICU procedures among students and housestaff as well as other medical educators. Based upon the pre- and post-lecture quiz results, there is an opportunity for improving the M-IV knowledge regarding this topic, and that the current approach is useful. It is anticipated that having a copy of the CD-ROM will provide each graduating student with the opportunity for future self-directed learning as well. Plans include refinement and updating of the materials, instruction of the class of 2005 medical students, and perhaps posting of the powerpoint slides, as well as quiz and answers on a VCU website. There is interest on behalf of the VCU Medical Center Chief of Staff in using this tool, either as CD-ROMs or in a web-based fashion for education of all housestaff physicians. Finally, Dr. Sessler has submitted an abstract that describes the development of this innovative program as well as the pre- and post-intervention quiz results for presentation at the annual meeting of the Society of Critical Care Medicine, in Phoenix, AZ in January 2005.
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