Enhancing cardiology trainee competence through simulation-based pericardiocentesis training: a pilot programme evaluation
Authors: Sabu S , Byrne C , Gibson G , Leung L , Behar J M 
Published: October 2024

Abstract

Introduction
Cardiology training requires trainees to manage clinical duties whilst developing practical skills. Changes to the UK curriculum have resulted in reduced time available for procedural teaching. Pericardiocentesis is one of many required competencies. The Joint Royal College of Physicians Training Board cardiology curriculum cites the importance of simulation-based education to teach procedures.
Procedural training encompasses the development of clinical reasoning alongside motor skills. Gange (1962) and Carless (2010) emphasized the importance of expert-guided practice, interactive teaching, and instant feedback in motor skills teaching to maximize the educational experience.

Aim
Develop a simulation teaching programme to enhance trainees' confidence and competency in pericardiocentesis. Procedures form part of a summative Direct Observation of Procedural Skills, enabling trainees to learn in a safe environment and use as evidence at their Annual Review of Competence Progression (ARCP).

Method
We developed a pilot programme for pericardiocentesis facilitated through high-fidelity equipment between February 2023 and February 2024. Participants were recruited through medical education departments.
The sessions were delivered on a one-to-one basis by a cardiology consultant to facilitate discussion and interactivity. The teaching involved a core knowledge presentation, discussion of trainee experiences, case studies as examples, including review of echocardiography features. This was followed by clinical skills teaching of pericardiocentesis, utilizing a model, and transthoracic echocardiography. Trainees were sent anonymous feedback forms after the session.

Results
46 cardiology registrars participated; 48% were within their first few years of training. 87% reported difficulty in practicing this skill in clinical practice due to: lack of exposure, other clinical responsibilities taking priority, and the need for consultant-delivered care on patients requiring an urgent or emergency procedure.
Mean trainee confidence before teaching was 3.24 out of 5 (SD = 1.14), with a significant improvement to 4.48 (SD = 0.59 p&lt;0.001). 52% improved in confidence by 1 unit and, 31% improved in confidence by 2 or more units. Trainees reported the following themes regarding the session: knowledgeable trainer, high fidelity equipment, instant feedback to predict, prevent, and overcome challenges, and a multi-modal approach to teaching, incorporating presentation and discussion on pericardial effusion, tamponade, and drainage.

Conclusion
Our programme offers a unique multi-modal teaching approach, with dedicated time with an expert. We supported the progress of 46 trainees and enhanced their training competencies. We aim to expand the programme to incorporate more procedures in line with growing curriculum requirements. Tracking trainee progress until ARCP outcomes will reveal the impact of simulation teaching on their experience and professional development.