Clinical skills
Instructional video for teaching venepuncture Michael Pan, Sara Harcharik, Adam Luber, Sebastian Bernardo and Jacob Levitt, Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, USA Marina Moskalenko, Department of Hematology/Oncology, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, USA
Safe venepuncture technique is a critical skill for health care professionals
SUMMARY Background: Safe venepuncture technique is a critical skill for health care professionals, to avoid accidental occupational injury. This study investigates whether watching an instructional video improves medical students’ ability to perform venepuncture safely. Methods: This was a randomised, controlled, assessor-blinded trial that evaluated the utility of an instructional video, with the primary outcome of the ability to perform venepuncture safely. Forty-two second-year medical students were recruited and randomised to receive either
video instruction (group A, n = 20) or no intervention (group B, n = 22). Prior to the study, all students attended an instructor-led workshop on venepuncture. During the study, students were paired and instructed to perform venepuncture on a partner. Performance was assessed using a points-based checklist. Pre- and post-study surveys were conducted to assess confidence with technique. Results: The mean total checklist score was higher in group A than in group B, with values of 14.15 and 9.18, respectively (p < 0.0001, maximum 18 points). Mean scores were also
higher in group A than in group B among students who performed first (p = 0.008) and students who performed second (p = 0.005) within the pair. From the post-procedure survey, only group A rated increased confidence in performing venepuncture after the study (p = 0.008). Discussion: Students who watched an instructional video performed venepuncture more effectively and reported greater confidence with the technique. Medical students can benefit from having access to an instructional video on venepuncture as an adjunct to the standard curriculum.
436 © 2014 John Wiley & Sons Ltd. THE CLINICAL TEACHER 2014; 11: 436–441
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9/5/2014 2:32:25 PM
INTRODUCTION
P
ercutaneous injuries from venepuncture and other sharps-related procedures constitute one of the most common occupational hazards to health care professionals, with approximately 385 000 injuries per year in the USA.1 The Association of American Medical Colleges recommends that all future doctors should be proficient in safe venepuncture technique prior to medical school graduation.2
The current literature shows that video instruction can enhance the acquisition of surgical and clinical skills, either as adjuvants to expert-led instruction,3,4 or as independent teaching modules for medical professionals across a variety of health care disciplines.5–7 No study has evaluated the utility of video instruction in teaching venepuncture. In this study, we explore whether medical students develop safer, a more effective venepuncture technique after watching an instructional video as an adjunct to attending an instructor-led workshop.
METHODS This was a randomised, controlled, assessor-blinded trial held at the Icahn School of Medicine at Mount Sinai (ISMMS) campus. The study underwent expedited review by the Institutional Review Board and was exempted from written consent. All second-year medical students at ISMMS were invited by e–mail and offered monetary compensation ($10) to participate in the study. Fortytwo students were recruited in December 2012. To ensure study groups were matched for baseline skill, students were stratified into four subsets according to the number of times they had performed venepuncture in the past (never, once, between two and five times, and between five and
Table 1. Demographic profile of study population, obtained from pre-study survey Characteristic
Group A (n = 20)* n (%)
Group B (n = 22)* n (%)
Gender Male
12 (60.0)
10 (45.5)
8 (40.0)
12 (54.5)
Female
Have you performed venepuncture before? Yes
13 (65.0)
16 (72.7)
No
7 (35.0)
6 (27.2)
We explore whether medical students develop safer, more effective venepuncture technique after watching an instructional video
If so, how many times have you performed venepuncture? Never
7 (35.0)
6 (27.3)
Once
6 (30.0)
7 (31.8)
2–5 times
6 (30.0)
8 (36.4)
5–10 times
1 (5.0)
1 (4.5)
Have you ever watched an instructional video about venepuncture in the past? No
20 (100)
22 (100)
Have you ever accidentally stuck yourself with a needle while performing venepuncture? No
20 (100)
22 (100)
How confident do you feel performing venepuncture on another person? (scale 1–5)**
1.75
1.73
How would you rate your knowledge of venepuncture safety? (scale 1–5)***
2.00
2.27
*Group A watched the instructional video; group B did not watch the instructional video. **Mean score scale: ranged from 1 (not confident at all) to 5 (extremely confident). ***Mean score scale: ranged from 1 (poor) to 5 (superior).
10 times), which was reported in a pre-study survey (Table 1). Blocked randomisation with a computer-generated random number list was performed within each subset to assign students to receive either video intervention (group A, n = 20) or no video intervention (group B, n = 22). A 12–minute high-definition audiovisual recording was produced by the authors in July 2012 to teach safe and effective venepuncture technique, and this was made available on
YouTube (http://youtu.be/16nATSEgCI). A comprehensive checklist containing 17 items involved in venepuncture technique was created and reviewed by multiple educators at ISMMS. Each correctly completed item earned one or two points, and each safety violation deducted three points, for a maximum score of 18 points (Table 2). Six assessors (five medical students with at least 1 year of clinical experience and one doctor) were recruited and familiarised with the checklist items.
© 2014 John Wiley & Sons Ltd. THE CLINICAL TEACHER 2014; 11: 436–441 437
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9/5/2014 2:32:50 PM
Table 2. Checklist used to assess venepuncture technique and safety Task
Points
Group A (n = 20) Group B (n = 22)
P value
Participant sanitises hands before carrying out procedure
1
18*
20*
1.0
Participant wears gloves throughout procedure
1
20
22
1.0
The participant correctly prepared workspace to include all items needed following needle stick: disposable apron, gauze, vacutainer adapter, vacutainer tubes, band-aids, alcohol swabs, butterfly needle, tourniquet
1
18
17
0.4
Participant asks if the patient has a tendency to faint while having his/her blood drawn
1
16
3
Instructional video for teaching venepuncture Michael Pan, Sara Harcharik, Adam Luber, Sebastian Bernardo and Jacob Levitt, Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, USA Marina Moskalenko, Department of Hematology/Oncology, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, USA
Safe venepuncture technique is a critical skill for health care professionals
SUMMARY Background: Safe venepuncture technique is a critical skill for health care professionals, to avoid accidental occupational injury. This study investigates whether watching an instructional video improves medical students’ ability to perform venepuncture safely. Methods: This was a randomised, controlled, assessor-blinded trial that evaluated the utility of an instructional video, with the primary outcome of the ability to perform venepuncture safely. Forty-two second-year medical students were recruited and randomised to receive either
video instruction (group A, n = 20) or no intervention (group B, n = 22). Prior to the study, all students attended an instructor-led workshop on venepuncture. During the study, students were paired and instructed to perform venepuncture on a partner. Performance was assessed using a points-based checklist. Pre- and post-study surveys were conducted to assess confidence with technique. Results: The mean total checklist score was higher in group A than in group B, with values of 14.15 and 9.18, respectively (p < 0.0001, maximum 18 points). Mean scores were also
higher in group A than in group B among students who performed first (p = 0.008) and students who performed second (p = 0.005) within the pair. From the post-procedure survey, only group A rated increased confidence in performing venepuncture after the study (p = 0.008). Discussion: Students who watched an instructional video performed venepuncture more effectively and reported greater confidence with the technique. Medical students can benefit from having access to an instructional video on venepuncture as an adjunct to the standard curriculum.
436 © 2014 John Wiley & Sons Ltd. THE CLINICAL TEACHER 2014; 11: 436–441
tct_12198.indd 436
9/5/2014 2:32:25 PM
INTRODUCTION
P
ercutaneous injuries from venepuncture and other sharps-related procedures constitute one of the most common occupational hazards to health care professionals, with approximately 385 000 injuries per year in the USA.1 The Association of American Medical Colleges recommends that all future doctors should be proficient in safe venepuncture technique prior to medical school graduation.2
The current literature shows that video instruction can enhance the acquisition of surgical and clinical skills, either as adjuvants to expert-led instruction,3,4 or as independent teaching modules for medical professionals across a variety of health care disciplines.5–7 No study has evaluated the utility of video instruction in teaching venepuncture. In this study, we explore whether medical students develop safer, a more effective venepuncture technique after watching an instructional video as an adjunct to attending an instructor-led workshop.
METHODS This was a randomised, controlled, assessor-blinded trial held at the Icahn School of Medicine at Mount Sinai (ISMMS) campus. The study underwent expedited review by the Institutional Review Board and was exempted from written consent. All second-year medical students at ISMMS were invited by e–mail and offered monetary compensation ($10) to participate in the study. Fortytwo students were recruited in December 2012. To ensure study groups were matched for baseline skill, students were stratified into four subsets according to the number of times they had performed venepuncture in the past (never, once, between two and five times, and between five and
Table 1. Demographic profile of study population, obtained from pre-study survey Characteristic
Group A (n = 20)* n (%)
Group B (n = 22)* n (%)
Gender Male
12 (60.0)
10 (45.5)
8 (40.0)
12 (54.5)
Female
Have you performed venepuncture before? Yes
13 (65.0)
16 (72.7)
No
7 (35.0)
6 (27.2)
We explore whether medical students develop safer, more effective venepuncture technique after watching an instructional video
If so, how many times have you performed venepuncture? Never
7 (35.0)
6 (27.3)
Once
6 (30.0)
7 (31.8)
2–5 times
6 (30.0)
8 (36.4)
5–10 times
1 (5.0)
1 (4.5)
Have you ever watched an instructional video about venepuncture in the past? No
20 (100)
22 (100)
Have you ever accidentally stuck yourself with a needle while performing venepuncture? No
20 (100)
22 (100)
How confident do you feel performing venepuncture on another person? (scale 1–5)**
1.75
1.73
How would you rate your knowledge of venepuncture safety? (scale 1–5)***
2.00
2.27
*Group A watched the instructional video; group B did not watch the instructional video. **Mean score scale: ranged from 1 (not confident at all) to 5 (extremely confident). ***Mean score scale: ranged from 1 (poor) to 5 (superior).
10 times), which was reported in a pre-study survey (Table 1). Blocked randomisation with a computer-generated random number list was performed within each subset to assign students to receive either video intervention (group A, n = 20) or no video intervention (group B, n = 22). A 12–minute high-definition audiovisual recording was produced by the authors in July 2012 to teach safe and effective venepuncture technique, and this was made available on
YouTube (http://youtu.be/16nATSEgCI). A comprehensive checklist containing 17 items involved in venepuncture technique was created and reviewed by multiple educators at ISMMS. Each correctly completed item earned one or two points, and each safety violation deducted three points, for a maximum score of 18 points (Table 2). Six assessors (five medical students with at least 1 year of clinical experience and one doctor) were recruited and familiarised with the checklist items.
© 2014 John Wiley & Sons Ltd. THE CLINICAL TEACHER 2014; 11: 436–441 437
tct_12198.indd 437
9/5/2014 2:32:50 PM
Table 2. Checklist used to assess venepuncture technique and safety Task
Points
Group A (n = 20) Group B (n = 22)
P value
Participant sanitises hands before carrying out procedure
1
18*
20*
1.0
Participant wears gloves throughout procedure
1
20
22
1.0
The participant correctly prepared workspace to include all items needed following needle stick: disposable apron, gauze, vacutainer adapter, vacutainer tubes, band-aids, alcohol swabs, butterfly needle, tourniquet
1
18
17
0.4
Participant asks if the patient has a tendency to faint while having his/her blood drawn
1
16
3
