54 The Development of a Simulated Umbilical Line Insertion Model and Curriculum in the Neonatal Intensive Care Unit

Umbilical line placement is an essential skill and it is one of the most common procedures practiced in neonatal intensive care units by pediatric trainees. The Royal College of Physicians and Surgeons of Canada (RCPSC) requires that pediatric residents become proficient at inserting umbilical lines and demonstrate effective, appropriate, safe and timely performance of this skill during their training. Clinical exposure to procedures can be variable among pediatric residents and its questionable whether residents receive adequate training in procedural skills during the residency. There is an urgent need to supplement curriculum to teach this life-saving skill using best practices. 1) Create a realistic simulation model using human umbilical tissue and develop a competency-based curriculum utilizing just-in-time video teaching and deliberate practice. 2) Assess the feasibility and impact of developing, implementing, and evaluating this curriculum on both learners and teachers during a four week neonatology rotation. Junior and Senior pediatric trainees will be identified a priori at the start of each 4 week block and approached for participation. Parents will be approached for permission to use residual umbilical cords prior to placental disposal. Residents will be exposed to umbilical line insertion curriculum during the first rotation. It will consist of: a structured introductory teaching session, followed by one or more attempts of umbilical line insertion (the skill) in a safe simulated environment. Opportunity for self-assessment, feedback from the supervisor, and reflection on a plan for improvement will be provided. We will evaluate the curriculum with pre and post testing, based on: trainee reaction, learning (knowledge (indication for UVC placement, steps needed, complications), as well as behavior (performance evaluation using adapted OSATS/O-SCORE). Clinical implications will be sought from trainees at the end of their rotation and 6 months following rotation completion. Institutional REB approval was secured. To date, 7 trainees have completed the curriculum (4 PGY3/4 and 3 PGY1s). We anticipate at least 18 more in the next six months. All the residents were highly engaged and appreciative of the curriculum.Obtaining umbilical cords from placentas was feasible with only 2/9 refusals to date. None of the junior trainees had prior experience inserting UVC lines. Senior residents had variable experience (# of insertions varied from 3–20) prior to the curriculum. Most junior (2/3) and senior (3/4) residents improved their pre/post knowledge scores. For senior residents, most had good knowledge and skills to begin with, three out of four residents had an improvement in Ottawa Surgical Competency Operating Room Evaluation (O-SCORE). Senior residents only required 2 or 3 attempts in order to be assessed as independently able to preform. For junior residents, all had a score of 2/5 prior to the video demonstration. All improved performance signaficantly O-SCORE to either 4 or 5/5. All three junior residents initially were not able to perform a UVC insertion independently. By the end of three simulations, they were all able to perform the task independently as per teacher assessment. Resident reaction to the study was favorable for all seven trainees. Two of seven residents reported that it contributed to improved confidence in actual UVC insertion during the rotation. As medical education shifts towards competency based education, it becomes ever more important to develop a methodology to ensure that we have a proven framework from which to teach and assess competence of skills. We hypothesize that by completing a curriculum utilizing simulation, deliberate practice and just-in-time teaching, residents at various levels will be able to achieve proficiency in umbilical line insertion, a potentially life-saving skill in neonatology.

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