What was known Performing bedside procedures is a common element of residency, yet there is no universal standard for determining competency.;What is new Criteria for defining central venous catheter insertion competency, which combines assessments of knowledge, skill, and attitudes, is validated using data for procedural outcomes.;Limitations Participants were evaluated during a 4-week procedure team rotation; short study period, small sample, and single-site administration limit generalizability.;Bottom line One-third of the residents attained competence after 4 weeks of focused experience. A performance checklist can be used to assess competency for performing bedside procedures.;Editor's Note: The online version of this article contains the performance checklist used in the study.;Introduction In an effort to improve patient safety, residency programs are seeking new methods of teaching invasive bedside procedures.1–3 Studies confirm that simulation-based training,4,5 use of ultrasound,6,7 adherence to a checklist,8 team training,9 and direct observation10 decrease complication rates, thereby improving safe practices. In 2007, the American Board of Internal Medicine (ABIM) ceased to mandate technical competency for some procedures, while it recommended active participation in a predetermined number of procedures subsequent to simulation-based learning.11 Despite the relative infrequency of internists performing procedures posttraining,12 some academic programs may continue to rely on residents to do so as a component of their training. In the absence of endorsed criteria for measuring competency, some training programs devised their own systems. Smith et al3 created a medical procedure service and evaluated patient outcomes but did not specifically define a competency threshold. Dong et al2 and Huang et al8 provided validity evidence for a central line checklist by using a task trainer but did not link the learner's skill to patient outcomes. Studies suggest that to provide a comprehensive assessment of trainees' abilities, a range of tools should be used.13 The purpose of our study was to build on the work of others in developing and evaluating new criteria for procedural competency that included knowledge, skill, and attitude coupled with the assessment of procedural outcome measures.;Results A total of 171 residents participated in the procedure team rotation. Under direct attending physician supervision, residents inserted CVCs by using real-time ultrasound guidance for a variety of clinical indications. Reported information reflects only those residents with complete data, defined as postintervention written test, checklist scores, and attitude ratings needed to evaluate at least 1 CVC attempt. Excluding the 18 participants with incomplete records and the 5 who did not perform an insertion, we assessed a total of 148 residents during 639 procedures. Fifty percent of the patients were referred by medical teaching teams, and the majority were located on the general medical wards. The greatest number of CVCs (416 [65%]) were inserted into the internal jugular vein, followed by 173 (27%) in the femoral and 49 (8%) in the subclavian veins. Insertion site was missing for 1 procedure. Each site was chosen based on the clinical indication for the procedure as well as patient-specific characteristics (eg, patency of the selected vein). The sample population of trainees is described in table 1a. Applying our criteria to the first procedure in a patient, only 4 residents began the training with established competency. Of the 148 residents who completed all assessments, 53 (36%) ultimately achieved the primary outcome of competency, 40 residents (27%) were judged to be borderline competent, and the remaining 55 (37%) were deemed not competent. View larger version (20K) TABLE 1AProcedure Team Resident Characteristics During Central Venous Catheterization at Jackson Memorial Hospital (2007–2011);Discussion To date, there has been n
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