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)