(1071) Lines, Tubes, and Trachs, Oh My! Improving Resident Confidence and Competence in Medical Technology

Tuesday, February 25, 2025

12:30pm – 1:30pm Eastern Time

Location: Connections Central - RST 01

First Author(s)

Courtney Alvis, MD

Nationwide Children's Hospital At Ohio State University, USA

Co-Author(s)

MD

Megan Daniel, MD

NCH PCCM Fellowship Program Director
Nationwide Children's Hospital, United States
Markita Suttle, MD

Associate Professor of Pediatrics Division of Critical Care Medicine
Nationwide Children's Hospital
Westerville, Ohio, United States
CS

Claire Stewart, MD, MEd

Associate Professor of Pediatrics; Associate Program Director, PCCM Fellowship
Nationwide Children's Hospital at The Ohio State University, United States

Introduction: Pediatric residents have little didactic time devoted to management of medical technology including invasive lines and tubes. Based on a previous needs assessment, we identified a lack of education and comfort with these devices, however when these technologies malfunction the same needs assessment identified residents as the first call to troubleshoot these devices. We hypothesized that initiation of a formalized curriculum using didactic education and simulation-based training increases resident confidence and competence in the management and troubleshooting of tracheostomy tubes, gastrostomy tubes, central venous lines (CVLs) and chest tubes.

Methods: We created a curriculum of monthly didactic and simulation sessions for categorical pediatric (CP) and internal medicine-pediatric (MP) residents during their PICU rotation. All residents underwent anonymous pre and post-session surveys, linked with a unique code, using an IRB-approved, Redcap© database to assess increases in confidence and competence. Confidence was assessed by survey questions adapted from the ACGME graduating resident survey. Competence was assessed based on responses to published, case-based clinical scenario questions. Central line removal procedural competency was assessed against a checklist.

Results: 33 of 50 (66%) residents completed both pre- and post-session surveys. Of the 33, 16 were PGY-2 (48%) and 17(52%) were PGY-3. 28(85%) were CP residents and 5 (15%) MP residents. All residents reported low agreement in confidently completing common ICU tasks before the didactic session but had improved agreement in confidently completing tasks such as removing a CVL (27% vs 97%), removing a chest tube (3% vs 64%), flushing a chest tube (24% vs 94%), changing a trach (15% vs 91%), or changing a gastrostomy tube (45% vs 97%) following the didactic session. 31/33 (94%) residents were able to complete a CVL check off without re-mediation after the session.

Conclusions: Residents had variable but limited experience with management of lines and tubes. Both CP and MP residents reported increased confidence and demonstrated increased competence in all procedures after the session. They also found the sessions applicable to their future careers. Our next step is a 6-month follow up survey to evaluate for retention of knowledge.