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Concise Critical Appraisal: Improving Training for Invasive Bedside Procedures

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Jessica M. Gibson, AGACNP-BC ; Katharine Thiemer, AGACNP-BC ; Jim H. Lantry III, MD
7/7/2021

Invasive bedside procedures (IBPs) require a high degree of familiarity and skillful expertise. Yet effective and thorough bedside training can be haphazard or unattainable. Chest published a systematic review and meta-analysis that highlights gaps in research on IBP training in critical care. The study included four focus groups of pulmonary and critical care medicine faculty and fellows from four U.S. medical centers. The focus groups identified traits, behaviors, and context as common themes of effective teachers. This Concise Critical Appraisal takes a deep dive into the study and the takeaways for experts and novices seeking to improve procedural knowledge and increase patient safety.

Invasive bedside procedures (IBPs) are frequently conducted for diagnostic or therapeutic purposes. In the intensive care unit (ICU), IBPs are performed by professionals credentialed in these procedures. A high degree of familiarity and skillful expertise make for a safer procedural environment. This is why training clinicians on how to perform these procedures is of the utmost importance. However, effective and thorough bedside training may be haphazard or unattainable because of the unpredictable nature of the ICU and the need for experienced proceduralists to stabilize patients. Encouraging novice providers to participate in IBPs builds procedural confidence and proficiency.
 
Kelm et al conducted a qualitative study exploring the characteristics of effective teachers of IBPs in the ICU.1 Four focus groups of pulmonary and critical care medicine faculty and fellows from four U.S. medical centers participated. The focus groups identified traits, behaviors, and context as common themes of effective teachers. Traits are inherent characteristics such as calmness, patience, and maintaining control of complex situations. Behaviors are learned qualities such as performing pre- and post-procedural briefs and administering feedback. Context refers to the environment, i.e., a milieu of severely ill patients and potentially chaotic situations. The study emphasized teachers’ interpersonal skills over technical knowledge and how this impacted students’ success in learning IBPs.
 
Limitations of this study include sample size and focus group populations. Similar studies should be performed to include a more comprehensive group of ICU clinicians—possibly residents, interns, nurse practitioners, and physician assistants. Both larger and smaller institutions from both urban and rural areas should also have an opportunity to participate to gain a deeper understanding on this topic.
 
Huang et al similarly researched teaching methods for bedside procedural instruction in a systematic review and meta-analysis.2 Although certain initiatives, in the form of checklists and care bundles, may aid in preventing IBP complications, a key determinant of patient outcomes remains attributed to clinician skill level. By developing goal-oriented, hands-on teaching methods, and with repetition of these teachings, novice clinicians were able to build skill sets. This study, which was nonspecific to the ICU setting, highlights the gap in research on IBP training in critical care. Thus, the themes identified by Kelm et al may be an impetus for formulating institution-wide standards of practice for procedural competency.
 
These study findings from Kelm et al apply to ICU clinicians who perform IBPs. Identified traits and behaviors should be distributed among expert and novice learners to improve procedural knowledge and increase patient safety.


References

  1. Kelm DJ, Ridgeway JL, Ratelle JT, et al. Characteristics of effective teachers of invasive bedside procedures: a multi-institutional qualitative study. Chest. 2020 Nov;158(5):2047-2057. https://doi.org/10.1016/j.chest.2020.04.060
  2. Huang GC, McSparron JI, Balk EM, et al. Procedural instruction in invasive bedside procedures: a systemic review and meta-analysis of effective teaching approaches. BMJ Qual Saf. 2016 Apr;25(4):281-294.


Author
Jessica M. Gibson, AGACNP-BC
Jessica M. Gibson, AGACNP-BC, is a critical care nurse practitioner at Inova Fairfax Hospital.
Author
Katharine Thiemer, AGACNP-BC
Katharine Thiemer, AGACNP-BC, is a critical care nurse practitioner at Inova Fairfax Hospital.
Jim H. Lantry III, MD
Author
Jim H. Lantry III, MD
Jim H. Lantry III, MD, is an assistant professor of emergency and critical care medicine and the associate program director of the critical care fellowship at the University of Maryland Medical Center in Baltimore, Maryland, USA. Dr. Lantry is an editor of Concise Critical Appraisal.
Author

Posted: 7/7/2021 | 0 comments


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