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Impact of Simulation-based Learning on Immediate Outcomes of Temporary Haemodialysis Catheter Placements by Nephrology Fellows.

Nephrology 2017 August 19
AIM: Traditional apprenticeship model (AM) of teaching in invasive procedures such as temporary haemodialysis catheter (THDC) insertion can result in propagation of errors and complications. Simulation-based learning (SBL) offers standardization of skills and allows trainees to repeatedly practice invasive procedures prior to performing them on actual patient.

METHODS: Retrospective cohort study of first-, second- and third-year Nephrology Fellows from a tertiary teaching hospital from September 2008 to September 2015. The intervention group (n=9) received simulation training in ultrasound-guided THDC placement. The historical control group (n=12) received training through traditional AM. The primary and secondary outcomes were the immediate complications and success rates of THDC insertion.

RESULTS: A total of 2481 THDCs were placed in 1787 patients. Success rate of internal jugular THDC placement for AM vs. SBL Fellow was 99.8% vs 100% (p=0.90), while the success rate for femoral THDC placement was 99.6% vs. 99.2% (p=0.53). SBL Fellows reported fewer overall peri-procedure complications (8.3% vs. 11.2%, p=0.02) and mechanical complications (1% vs. 2.4%, p=0.02) compared to AM Fellows. The rate of reported technical difficulty was similar (7.5% vs. 9.2%, p=0.17). After adjusting for side and site of THDC placement, body mass index and laboratory indices, THDC inserted by AM Fellows were independently associated with increased overall peri-procedure complications (OR=1.396, 95% CI: 1.052-1.854, p=0.02) and mechanical complications (OR=2.481, 95% CI: 1.178-4.810, p=0.02) CONCLUSIONS: Simulation-based learning was associated with lower procedure related complications and should be an integral component in the teaching of procedural skills in Nephrology.

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