The Development of a Simulated Umbilical Line Insertion Model and Curriculum in the Neonatal Intensive Care Unit

Abstract

Background Insertion of an umbilical venous catheter (UVC) is a required skill for pediatric residents to learn and perform effectively. However, there is known variability in the ability of residents to perform this essential neonatal skill. Objective The objective of our study was to create a competency-based curriculum for umbilical vein catheter insertion using a human umbilical tissue simulated model, and to assess the feasibility of the curriculum on resident learners during their neonatology rotations. Methods We evaluated the curriculum by assessment of resident learning, reactions, and behaviours. Performance was assessed using the Ottawa Surgical Competency Operating Room Evaluation (O-SCORE). Results A total of 14 residents were included for analysis. The majority were 'senior' residents (postgraduate year (PGY)-3 and PGY-4 n = 10; PGY-1 n =4), and they reported a wide range of previous experience with UVC insertion prior to this curriculum implementation. The residents' reaction to the curriculum was overwhelmingly positive. All residents maintained or improved in their knowledge assessment. O-SCORE results showed improvement in UVC insertion before and after curriculum completion for both junior (2.5 +/- 0.71 to 4.5 +/- 0.41) and senior (3.55 +/- 0.42 to 4.95 +/- 0.15, p < 0.001) residents. The mean improvement in O-SCORE was greater for junior residents than senior residents. Conclusion The results of this study demonstrate the feasibility and emerging impact of a competency-based curriculum using simulation for procedural skills.

Keywords: competency-based assessment; neonatology; procedural skills; residency training; simulation; umbilical venous catheter.

Figure 1. Comparison of Teacher Evaluated Modified O-SCORES Pre and Post-Curriculum Implementation

The orange line represents the change in mean senior resident modified O-SCORES as assessed by the evaluators, and the blue line represents the change in mean junior resident modified O-SCORES assigned by the evaluators. Error bars represent standard deviation for each mean modified O-SCORE. O-SCORE: Ottawa Surgical Competency Operating Room Evaluation.

Figure 2. Umbilical Venous Catheter (UVC) Simulation Model Before and After UVC Insertion

UVC simulation model before and after UVC insertion. Pictured on the left is a simulated umbilical cord using human umbilical tissue. Pictured on the right is a completed simulated UVC insertion.

Figure 3. Modified Ottawa Surgical Competency Operating Room Evaluation (O-SCORE) for UVC Insertion Teacher Form

**Removed from evaluation because determined to be not applicable to this simulation exercise Adapted from [18]

Figure 4. Resident Reaction/Perception of Simulation Exercise

Adapted from [22]