PS8-01: FROM THE SIMULATION CENTER TO THE BEDSIDE: VALIDATING THE EFFICACY OF A DYNAMIC HAPTIC ROBOTIC TRAINER IN INTERNAL JUGULAR CENTRAL VENOUS CATHETER PLACEMENT.
Hong-En Chen1, Cheyenne C Sonntag2, David Pepley1, Katelin Mirkin2, David Han2, Jason Moore1, Scarlett R Miller, Associate Professor of Engineering Design1; 1The Pennsylvania State University, 2Penn State Health
Introduction: Medical education has seen a wide-spread integration of patient simulators to provide a low-stress and no-risk learning environment. However, many simulation-based training systems lack validation of training efficacy and skill transfer into clinical environments. Two cohorts of first-year surgical residents were trained to place internal jugular central venous catheter (IJCVC) on the dynamic haptic robotic training (DHRT) system, which presents multiple patient profiles and personalized learning feedback after each needle insertion. The purpose of this study was to compare resident IJCVC placement on patients in the intensive care unit (ICU) completed by robot-trained residents to traditional manikin-trained residents in order to validate the efficacy of training on the DHRT system.
Methods: Robot-trained (n=9) and manikin-trained (n=43) residents were evaluated in IJCVC placement on patients in the ICU. All residents had passed a standardized verification of proficiency in IJCVC. Evaluation was completed by expert observers on a 23-item IJCVC placement skills checklist, with additional errors and comments reported. The 23-item checklist evaluates successful completion of procedural (e.g. maintaining sterile technique) and technical (e.g. locating the needle position on the ultrasound image) skills, and tracks areas for improvement such as inadvertent arterial puncture or an inability to complete the procedure without assistance. Unpaired t-tests were used to compare group differences.
Results: Eleven out of 43 manikin-trained residents experienced procedural or technical complications; no robot-trained residents experienced any complications. Manikin-trained residents experienced significantly more procedural and technical (80/989) complications than robot-trained residents (0/207), t(50) = 2.9839, p = 0.0044. On average, successful catheterization was completed by 86.0% of the manikin- trained residents and 100% of the robot-trained residents. Manikin-trained residents completed 91.9% of the full procedure, required 1.59±0.94 needle insertion attempts, and experienced 7.0% inadvertent arterial puncture. Robot-trained residents completed 100% of the procedure, required 1.22±0.54 needle insertion attempts, and experienced 0 arterial punctures.
Conclusion: Assessment of IJCVC placement showed that robot-trained residents performed as well or better than manikin-trained residents in the clinical environment. This study confirms the translation of these skills from the simulator to the bedside using the DHRT system to efficiently and effectively train IJCVC placement.