Assessing Skill Acquisition in Anesthesiology Interns Practicing Central Venous Catheter Placement Through Advancements in Motion Analysis

Published:February 01, 2022DOI:


      The study authors hypothesized that a combination of previously used (path length, translational motions, and time) and novel (rotational sum) motion metrics could be used to analyze learning curves of anesthesiology interns (postgraduate year 1) practicing central venous catheter placement in the simulation setting. They also explored the feasibility of using segmented motion recordings to inform deliberate practice.


      A prospective cohort study.


      A single academic medical center.


      Anesthesiology interns (postgraduate year 1).


      Anesthesiology interns underwent a 2-day training course in which they performed 9 central venous catheter placements, while attached to motion sensors on the dorsum of their dominant hand and ultrasound probe.

      Measurements and Main Results

      Motion metrics were analyzed using generalized estimating equations for both the overall procedure and predefined segments. Five attending anesthesiologists performed 3 trials each for comparison. Overall, there was a negative trend in path length, translational motions, rotational sum, and time (p < 0.001), with the exception of translational motions of the ultrasound probe. Interns reached within 1 standard deviation of the attending anesthesiologists by trials 7-to-8 for most metrics. Segmentation identified specific components of the procedure that were either significantly improved upon or required deliberate practice. The novel metric of rotational sum exhibited a moderate-to-strong positive correlation with other metrics (p < 0.001).


      A comprehensive series of motion metrics was able to describe the learning curves of novices training to perform central venous catheter placement in the simulation setting. Furthermore, it was determined that segmentation may provide additional insight into skill acquisition and inform deliberate practice.

      Key Words

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        • Saugel B
        • Scheeren TWL
        • Teboul J-L.
        Ultrasound-guided central venous catheter placement: a structured review and recommendations for clinical practice.
        Crit Care. 2017; 21: 225
        • Barsuk JH
        • McGaghie WC
        • Cohen ER
        • et al.
        Simulation-based mastery learning reduces complications during central venous catheter insertion in a medical intensive care unit.
        Crit Care Med. 2009; 37: 2697-2701
        • Barsuk JH
        • McGaghie WC
        • Cohen ER
        • et al.
        Use of simulation-based mastery learning to improve the quality of central venous catheter placement in a medical intensive care unit.
        J Hosp Med. 2009; 4: 397-403
        • Barsuk JH
        • Cohen ER
        • Feinglass J
        • et al.
        Use of simulation-based education to reduce catheter-related bloodstream infections.
        Arch Intern Med. 2009; 169: 1420-1423
        • Cohen ER
        • Feinglass J
        • Barsuk JH
        • et al.
        Cost savings from reduced catheter-related bloodstream infection after simulation-based education for residents in a medical intensive care unit.
        Simul Healthc. 2010; 5: 98-102
        • Soffler MI
        • Hayes MM
        • Smith CC.
        Central venous catheterization training: Current perspectives on the role of simulation.
        Adv Med Educ Pract. 2018; 9: 395-403
        • Barsuk JH
        • Cohen ER
        • Wayne DB
        • et al.
        A comparison of approaches for mastery learning standard setting.
        Acad Med. 2018; 93: 1079-1084
        • Musits AN
        • Phrampus PE
        • Lutz JW
        • et al.
        Physician versus nonphysician instruction: evaluating an expert curriculum-competent facilitator model for simulation-based central venous catheter training.
        Simul Healthc. 2019; 14: 228-234
        • Chin KJ
        • Tse C
        • Chan V
        • et al.
        Hand motion analysis using the imperial college surgical assessment device: Validation of a novel and objective performance measure in ultrasound-guided peripheral nerve blockade.
        Reg Anesth Pain Med. 2011; 36: 213-219
        • Corvetto MA
        • Fuentes C
        • Araneda A
        • et al.
        Validation of the imperial college surgical assessment device for spinal anesthesia.
        BMC Anesthesiol. 2017; 17: 131
        • Corvetto MA
        • Pedemonte JC
        • Varas D
        • et al.
        Simulation-based training program with deliberate practice for ultrasound-guided jugular central venous catheter placement.
        Acta Anaesthesiol Scand. 2017; 61: 1184-1191
        • Corvetto MA
        • Altermatt FR.
        Tracking motion devices as assessment tools in anesthesia procedures: Have we been using them well?.
        CJEM. 2017; 19: 412-413
        • Farcas MA
        • Trudeau MO
        • Nasr A
        • et al.
        Analysis of motion in laparoscopy: The deconstruction of an intra-corporeal suturing task.
        Surg Endosc. 2017; 31: 3130-3139
        • Belvroy VM
        • Murali B
        • Sheahan MG
        • et al.
        In the Fundamentals of Endovascular and Vascular Surgery model motion metrics reliably differentiate competency.
        J Vasc Surg. 2020; 72: 2161-2165
        • Baribeau V
        • Weinstein J
        • Wong VT
        • et al.
        Motion-tracking machines and sensors: Advancing education technology.
        J Cardiothorac Vasc Anesth. 2022; 36: 303-308
        • Clinkard D
        • Holden M
        • Ungi T
        • et al.
        The development and validation of hand motion analysis to evaluate competency in central line catheterization.
        Acad Emerg Med. 2015; 22: 212-218
        • Matyal R
        • Montealegre-Gallegos M
        • Mitchell JD
        • et al.
        Manual skill acquisition during transesophageal echocardiography simulator training of cardiology fellows: A kinematic assessment.
        J Cardiothorac Vasc Anesth. 2015; 29: 1504-1510
        • Matyal R
        • Mahmood F
        • Knio ZO
        • et al.
        Evaluation of the quality of transesophageal echocardiography images and verification of proficiency.
        Echo Res Pract. 2018; 5: 89-95
        • Ebina K
        • Abe T
        • Higuchi M
        • et al.
        Motion analysis for better understanding of psychomotor skills in laparoscopy: Objective assessment-based simulation training using animal organs.
        Surg Endosc. 2021; 35: 4399-4416
        • Riggle JD
        • Wadman MC
        • McCrory B
        • et al.
        Task analysis method for procedural training curriculum development.
        Perspect Med Educ. 2014; 3: 204-218
        • Varas J
        • Achurra P
        • León F
        • et al.
        Assessment of central venous catheterization in a simulated model using a motion-tracking device: An experimental validation study.
        Ann Surg Innov Res. 2016; 10
        • Taffinder N
        • Smith S
        • Mair J
        • et al.
        Can a computer measure surgical precision? Reliability, validity and feasibility of the ICSAD.
        Surg Endosc. 1999; 13: 81
        • Hayter MA
        • Friedman Z
        • Bould MD
        • et al.
        Validation of the Imperial College Surgical Assessment Device (ICSAD) for labour epidural placement.
        Can J Anaesth. 2009; 56: 419-426
        • Shaharan S
        • Nugent E
        • Ryan DM
        • et al.
        Basic surgical skill retention: Can patriot motion tracking system provide an objective measurement for it?.
        J Surg Educ. 2016; 73: 245-249
        • Ahmed OMA
        • Niessen T
        • O'Donnell BD
        • et al.
        The effect of metrics-based feedback on acquisition of sonographic skills relevant to performance of ultrasound-guided axillary brachial plexus block.
        Anaesthesia. 2017; 72: 1117-1124