Methods
The concepts of a two-phase training program was created by consensus between key teaching faculty, APPs and the residents in our department of cardiothoracic surgery. The specific procedures were determined by the local Graduate Medical Education office and our department. The specific curriculum was developed by a working group of trainees, advance practice providers and faculty. The course was divided into an online session followed by a hands-on simulation course. The online curriculum was a requirement to participate in the live course. The online curriculum contained the didactic information for each of procedures and was accompanied by videos, instruction guides and departmental policies created by the teaching faculty(Supplement). During the four-hour interactive session, trainees broke up into several groups and were instructed on and observed doing several high-risk bedside procedures. The stations were precepted by cardiothoracic faculty, senior APPs, critical care faculty and certified registered nurse anesthetists (CRNA). The defined procedures were central venous cannulation, radial and femoral arterial line placement, thoracentesis and pigtail catheter insertion, nasogastric and DUO tube placement (Cortrak 2 Avanos Medical Devices, Alpharetta, Georgia) and endotracheal tube intubation. The course faculty instructed and demonstrated the procedures to the trainees on high fidelity simulation models, after which they were evaluated and if competent, received a pass by the attending. Successful credentialing required attending approval of all high-risk procedures on a binary scale.
Each procedure had a set of criteria established by the working group that represented a combination of both safety and competency. Trainees were required to meet all these criteria before being approved on a procedure. In addition to this metric, pre and post tests were administered to assess trainee knowledge base for each procedure. Furthermore, pre and post surveys were also administered to gauge the trainees’ attitude and response on the creation and execution of the credentialing course. All subjective responses were graded on a Likert scale from 1 to 5, which 1 being strongly disagree, 3 being neutral, and 5 being strongly agree. Surveys were administered on local computers and were proctored by the local staff at the simulation facility. by Paired student’s T tests were done to evaluate the pre and post-test and survey results. Approval was granted by the University of Pittsburgh IRB (PRO19040405)