Assessing Skill Acquisition in Anesthesiology Interns Practicing Central Venous Catheter Placement Through Advancements in Motion Analysis.

ABSTRACT

OBJECTIVES: The study authors hypothesized that a combination of previously used (path length, translational motions, and time) and novel (rotational sum) motion metrics could be used to analyze learning curves of anesthesiology interns (postgraduate year 1) practicing central venous catheter placement in the simulation setting. They also explored the feasibility of using segmented motion recordings to inform deliberate practice. DESIGN: A prospective cohort study. SETTING: A single academic medical center. PARTICIPANTS: Anesthesiology interns (postgraduate year 1). INTERVENTIONS: Anesthesiology interns underwent a 2-day training course in which they performed 9 central venous catheter placements, while attached to motion sensors on the dorsum of their dominant hand and ultrasound probe. MEASUREMENTS AND MAIN RESULTS: Motion metrics were analyzed using generalized estimating equations for both the overall procedure and predefined segments. Five attending anesthesiologists performed 3 trials each for comparison. Overall, there was a negative trend in path length, translational motions, rotational sum, and time (p < 0.001), with the exception of translational motions of the ultrasound probe. Interns reached within 1 standard deviation of the attending anesthesiologists by trials 7-to-8 for most metrics. Segmentation identified specific components of the procedure that were either significantly improved upon or required deliberate practice. The novel metric of rotational sum exhibited a moderate-to-strong positive correlation with other metrics (p < 0.001). CONCLUSIONS: A comprehensive series of motion metrics was able to describe the learning curves of novices training to perform central venous catheter placement in the simulation setting. Furthermore, it was determined that segmentation may provide additional insight into skill acquisition and inform deliberate practice.