(1110) Self-Directed Simulated Peripheral IV Task Training for Pediatric Residents: A Pilot Project

Introduction: Pediatric residents have variable pre-residency clinical experience and exposure to procedures with either manikin task training or procedures performed in human patient encounters. Peripheral intravenous catheter insertion (PIV) may be a life-saving procedure and remains one of the ACGME recommended procedures for pediatric residency graduation competency. To better understand the potential experiences and skills with PIV in pediatric residents we evaluated baseline self-assessment and pilot project data using simulated task trainer with trained rater and directly observed scoring tool.

Methods: We developed a low-fidelity PIV forearm task trainer and observer scoring tool of 18-observable steps. Pediatric residents entering PGY-2 level at our university-affiliated children’s hospital rotated through two stations. First, demonstration of 24G, 22G, 20G, and 18G to review needle size and common usages. Second, a single rater evaluated each resident’s IV insertion on a simulated 12yo trauma victim with 3-minute time limit. No interaction between rater and resident occurred.

Results: Of 15 PGY-2 residents, 11 (73.3%) completed the baseline survey and 9/15 (60%) completed the simulation station. 9/11 (81.8%) had more than 1 year of clinical experience since medical school graduation (observerships or prior residency years), 2/11 (18.2%) EMT, 0 phlebotomy, and 7/11 (63.6%) prior life-saving specialty training. Reported experience in PIV insertions with manikins range 2 to >10; mode 2; mean 6 and on human patients range 5 to >100; mode 10; mean 30 insertions. Self-reported confidence was higher than observer scoring. Observer scores of PIV insertion steps completed were range 6 to 15, mode 15, mean 11. Hand-washing occurred in all insertions; not wearing gloves in 2; not releasing the tourniquet in 4 simulated PIV insertions.

Conclusions: Our Pediatric residents have pre-residency clinical experience from EMT and prior residency years completed. Our residents report more PIV insertion in human than in simulated encounters. This self-directed simulated PIV task trainer and observer scoring tool may promote our program’s ACGME competency assessment in directly observed pediatric peripheral PIV insertion in both simulated and human PIV insertions.