results introduction methods objectives summary ...

Successful Cannulation by Medical Students: Does it Require Supervision? Adam M. Gwozdz*, Michael Klingenberg, and Deborah Gill University College London Medical School, Division of Medical Education, London, UK

INTRODUCTION • Cannulation is the second most common invasive procedure for hospital inpatients, surpassed only by venepuncture, and is often performed by junior doctors Medical students’ competency and preparedness for unsupervised cannulation has not previously been assessed The recent implementation of the European Working Time Directive has resulted in a reduction in the number of hours of supervised teaching for undergraduate medical students in clinical settings Student feedback has suggested that this lack of supervised teaching has resulted in inconsistencies between their learning experiences during standardised clinical skills sessions using rubber arm manikins and the teaching they receive during on-site clinical attachments Feedback from medical students also included requests for additional specialised teaching sessions, as well as more supervision from expert tutors whilst in clinical settings

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RESULTS CANNULATION PERFORMANCE WAS NOT IMPROVED BY SUPERVSION

R2=0.75

Example of 1st year clinical students participating in a cannulation teaching session on rubber arm manikins in a clinical skills laboratory

OBJECTIVES • To examine cannulation performance by medical students in their 1st clinical year to quantify the impact supervision has on their success

R2=0.84

METHODS CANNULATION TEACHING AT UCL MEDICAL SCHOOL

• Cannulation is initially taught to all 1st year clinical students in a single •

identical session over an eight week period as part of their competency in the practical skills curriculum The cannulation teaching session is scheduled for 150 minutes and consists of a theoretical and practical component:

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The theoretical component covers reasons for cannulation, catheter sizes, locating and identifying appropriate veins, and using the aseptic technique

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Teaching of the practical component consists of a four-stage approach on a rubber manikin arm

• All students cannulate a rubber arm manikin at least twice; once for initial •

practice and a second time as a mock exam which is peer-reviewed The cannulation teaching occurs in all Year 3 (1st year clinical) attachments, ie: General Medical Specialities, General Medicine, Surgery, Care of the Older Person/Orthopaedics and Rheumatology, so that all students have received their cannulation training in the clinical skills laboratory by the end of their first attachment

Linear regression analyses were used to compare the number of successful cannulation outcomes with the number of supervised attempts (A; slope=0.82; 95% confidence interval (CI)=0.76-0.87; P < 0.0001) and unsupervised attempts (B; slope=0.78; 95% CI = 0.74-0.82; P