K. Ji1, K. Nolan2, A. Stolfi1, A. Cardosi2, M. Verbillion1, Y. Wong1 1Wright State University, Boonshoft School Of Medicine, Dayton, OH, USA 2Premier Health, Dayton, OH, USA
Introduction: Preparation of interns presents significant challenges given the rapid acquisition of medical knowledge and procedural skills. Interns enter residency with varying levels of clinical proficiency, resulting in a lack of preparedness as they assume the responsibilities of patient care. This study investigates the effectiveness of simulation and cadaveric training on confidence and ability in placing chest tubes, central lines, and arterial lines.
Methods: During orientation, general surgery and emergency medicine interns participate in a training series including Advanced Trauma Life Support, Intern Boot Camp, and cadaveric procedure class. Pre and post training surveys assessed confidence in these procedures and knowledge of surgical anatomy, surgical technique and skill, and management of surgical complications. Confidence and knowledge were measured on a Likert scale, where 4 is extremely knowledgeable or completely confident. A complimentary chart review evaluated complication rates, using procedure notes and post-procedural blood tests, lab results, and chest x-ray. This approach differentiated complications due to patient morbidity from those related to procedural errors.
Results: Training significantly improved intern’s confidence in placing chest tubes (mean 2.08 to 3.00, p=0.005) and arterial lines (1.67 to 2.00, p=0.002). Central line placement showed no significant improvement (2.08 to 2.58, p=0.124), suggesting a potential area for training enhancement. Pre-training, knowledge of surgical anatomy averaged 2.33 for chest tubes and central lines and 1.92 for arterial lines. Interns’ confidence in surgical technique and skills averaged 1.83, and 1.92 in the management of surgical complications. Post-training, interns rated the training’s helpfulness as 2.83 for improving knowledge of surgical anatomy, 3.50 for improving surgical technique and skills, and 2.50 for improving management of surgical complications. Statistical analysis revealed significant variation in complication rates among the different procedures (p<0.001). Radial arterial lines had the highest rate of complications (23.26%), followed by right lateral chest tubes (22%) and subclavian central lines (20.94%). Common complications included bleeding, hematoma formation, chest tube repositioning, multiple placement attempts, and pneumothorax.
Conclusion: The study highlights that simulation and cadaveric training significantly enhance intern confidence in chest tube and arterial line placement, though central line training needs further improvement. While confidence in surgical techniques increased post-training, variable complication rates suggest persistent challenges, especially with radial arterial lines. Observed complications underscore the need for continuous refinement of training methods. Future research should focus on improving intern orientation protocols and assessing their impact on patient outcomes to better prepare residents.