Effectiveness of Implementing Simulation-based Education with Flipped Classroom in Ultrasound-guided Vascular Access

Purpose: Post-graduate trainees are expected to perform the clinical procedures of central venous catheter (CVC) insertion during their post-graduate year training (PGY). However, it is not one of the 81 minimal required clinical skills for medical graduates in Taiwan. Performing CVC insertion carries a certain level of risk of hemothorax, pneumothorax, and arterial puncture injuries. Studies have shown ultrasound-guided vascular access can minimize the number of punctures and the occurrence of complications. Therefore, it is somewhat important to utilize simulation-based education to introduce ultrasound-guided vascular access in general medicine training. Methods: This course used the flipped classroom model, included 18 PGY trainees during March 2020. Trainees were required to complete an online course and a written test before entering the practical session, which used the workshop model to deconstruct the four steps of ultrasound-guided vascular access. After completing the course, the trainee must finish the online written test and fill out a satisfaction survey. We used pair-t test to compare the pre-test and post-test to evaluate the effectiveness of this educational strategy. Results: The average trainees' satisfaction level towards the course is as high as 5.00. The mean test score improved from the pre-test, 52.2, to the post-test, 75.56, which is statistically significant. Especially the poke step after deliberate hand-on practice. Trainees have notably improved their learning effectiveness through high-fidelity simulation practices. Conclusions: Efficiency through simulation-based education for ultrasound-guided vascular access is excellent. The trainees can successfully perform ultrasound-guided central venous catheter insertion, and the level of improvement is also noticeable.