Episode 10: Bedside Procedural Skills

In this episode Dr. Irene Ma discusses how education plays a critical role in promoting patient safety during invasive bedside procedures, which are commonly performed but can have a high rate of complication. Invasive bedside procedures are done for important diagnostic and therapeutic reasons but can cause complications that fall into two categories: infectious and non-infectious (bleeding, mechanical, and thrombotic complications). Some bedside procedures, such as insertion of a central line, have a risk of infectious complication rate as high as 26% and this procedure is performed approximately 5 million times a year in the United States.

Irene discusses four points that promote patient safety during invasive bedside procedures:
1.  Educational models need to be mindful of the ultimate goal of competency
2.  Simple measures can decrease the risk of complications
3.  Never events should never occur
4.  Technological advances have improved procedural safety.

After listening to this podcast listeners will be able to:
1.  Describe why invasive bedside procedures are necessary despite their relatively high risk of complications
3.  Compare the logbook method of teaching procedural skills with a competency based education model
4.  Define a never event and list some simple measures that can help promote patient safety by decreasing the complication rates and preventing never events
5.  Describe how technological advances such as the use of simulation in education can enhance procedural safety

Irene Ma, MD
Irene is a general internist at the Foothills Medical Centre and an Associate Professor in the Department of Medicine, University of Calgary. She received her Medical Degree from the University of British Columbia (UBC), where she also completed her training in Internal Medicine and Nephrology. This was followed by an MSc in Epidemiology from Stanford University. In addition to her clinical expertise, Irene is also formally trained in medical education and previously worked as the Associate Program Director for Internal Medicine at UBC before joining the Division of General Internal Medicine at the University of Calgary in 2009. She is author or co-author on various abstracts and peer-reviewed publications in medical education and holds a number of leadership roles focused on residency training of procedural skills within Alberta Health Services and the University of Calgary. Irene has also been invited to lecture at local, national, and international meetings, workshops, and conferences on how to teach medical procedures using simulation. A large element of her recruitment to Calgary was due to the research opportunities provided through the W21C. Now, as the Clinical Simulation Lead for the W21C team, her research focuses on initiatives related to human-based innovation and to new approaches to promoting safety through education and better teaching.

References:
Ma, I.W., Teteris, E., Roberts, J.M., Bacchus, M. (2011). Who is teaching and supervising our junior residents’ central venous catheterizations? BMC Med Educ, 11,16.
Barsuk, J.H., McGaghie, W.C., Cohen, E.R., O’Leary, K.J., Wayne, D.B. (2009). Simulation-based mastery learning reduces complications during central venous catheter insertion in a medical intensive care unit. Crit Care Med ,37, 2697-701.
Pronovost, P., Needham, D., Berenholtz, S., et al. (2006). An intervention to decrease catheter-related bloodstream infections in the ICU. NEJM 355, 2725-32.
Ma, I.W., Brindle, M., Ronskley, P., Lorenzetti, D., Sauve, R., Ghali, W. (2011). Use of simulation-based education to improve outcomes of central venous catheterization: a systematic review and meta-analysis. Acad Med, 86,1137-4.
National Health Service. The never events policy framework. An update to the never events policy. 2012