C. C. Sonntag1, M. A. Yovanoff3, D. F. Pepley2, R. S. Prabhu5, S. R. Miller4, J. Z. Moore2, D. C. Han1 1Penn State Hershey Medical Center,Department Of Surgery,Hershey, PA, USA 2Penn State University,Department Of Mechanical And Nuclear Engineerging,University Park, PA, USA 3Penn State University,Department Of Industrial Engineering,University Park, PA, USA 4Penn State University,Department Of Engineering Design And Industrial Engineering,University Park, PA, USA 5Penn State University,Department Of Engineering Design,University Park, PA, USA
Introduction: Ultrasound guided central venous catheterization (USCVC) training is typically performed using mannequin simulators that cannot simulate anatomic variations in vessel depth and position. Mannequin training also requires the presence of a preceptor to provide real time meaningful feedback to the learner. A virtual reality haptic robotic simulator that provides anatomic variation and immediate qualitative feedback has been previously validated. The goal of this study was to assess the effectiveness of the robotic simulator as a new intern training device using Verification of Proficiency (VOP) testing as the outcome measure.
Methods: Resident USCVC training curriculum currently consists of an introductory video, didactic instruction, procedure demonstration, and three simulation sessions prior to VOP testing. New surgical interns were randomly assigned to either robotic (n=13) or mannequin (n=13) training, and all 26 interns performed a pretest USCVC on the same mannequin that was used for training. Both the first and second simulation sessions consisted of ten ultrasound guided venous aspirations on their assigned training modality. Feedback was provided by either the robotic simulator (robotic group) or an experienced preceptor (mannequin group). The training mannequin was used in the third session by both groups. This session consisted of two USCVC with feedback by an experienced preceptor. VOP testing was performed on a mannequin with vessel depth and position that was dissimilar to the mannequin used for simulator training. A standardized rubric grading system was used by a single experienced educator to assess VOP performance. Two-way mixed ANOVA was used to evaluate results.
Results: Baseline demographics and pre-test time to insertion were not significantly different between groups. All robotic simulation residents (13 of 13) passed VOP testing on their first attempt, compared to 92% of residents trained on mannequin simulation. Reason for the exam failure in the mannequin group was unintentional arterial access. Average time to perform ultrasound guided venous aspiration for mannequin trained residents was 134 seconds, compared to 86 seconds for robotic trained residents training (p = 0.07).
Conclusion: The virtual reality haptic robotic simulator for USCVC demonstrated improved results compared to standard mannequin training with respect to first time pass rate on VOP testing. Interns who used the robotic simulator showed a faster time to perform USCVC compared to mannequin testing, although this did not quite reach statistical significance. In addition to the ability to simulate anatomic variations, another potential advantage of the robotic simulator for USCVC is the immediate
