(1085) High-Risk, Low-Volume Critical Care Procedural Training Positively Impacts Perceived Proficiency

Introduction: Developing and maintaining proficiency in high risk, low volume (HRLV) procedures in critical care is of acknowledged difficulty and importance given their potential morbidity and mortality. HRLV procedural competency may be addressed by high fidelity training, with data indicating that training frequency correlates with perceived proficiency. As such, a procedural training needs assessment was used to develop a cadaver based HRLV course with the aim of improving self-perceived proficiency.

Methods: A procedural training needs assessment was conducted by surveying critical care medicine attending physicians and advance practice providers (APPs) and used to develop a 5-hour HRLV procedure course focused on hands-on training in cricothyrotomy, difficult airway management, lung isolation, Minnesota tube insertion, pericardiocentesis, temporary transvenous pacemaker insertion, and tube thoracostomy taught by expert faculty using a modified Peyton four-step approach. Identical pre and post training surveys were completed, where participants rated their self-perceived skill levels using a four-point Likert scale with the categories novice, competent, proficient, and expert. Data was coded from 1 (novice) to 4 (expert) and analyzed using paired T-test after excluding participants who considered themselves at the highest skill level in both surveys.

Results: Of 36 course participants, 10 completed both the pre- and post-course self-assessments. Survey comparison shows statistically significant increased self-perceived skill level for all evaluated procedures (p < 0.05) except for arterial line insertion and temporary transvenous pacemaker insertion. Among HRLV procedures, Minnesota tube insertion and temporary transvenous pacemaker insertion were associated with the lowest pre-course self-perceived skill level while the largest scale improvements were observed for difficult airway management and tube thoracostomy. Most participants considered the course useful and expressed interest in such training being offered on a recurring basis.

Conclusions: Cadaver based training in HRLV procedures in critical care medicine is feasible and associated with significantly increased self-assessed proficiency in critical care attending faculty and APPs.