Objective:

To evaluate the efficacy of a simulation-based skills station in enhancing junior neurology residents’ competence and confidence in performing plasma exchange (PLEX) catheter removal per institutional standardized protocol. 

Background:

PLEX catheter removal is a critical skill for junior neurology residents. Initial surveys revealed low self-reported confidence in this procedure, potentially compromising patient safety.  To address this gap, a simulation-based skills station utilizing a manikin-based approach was developed to provide safe, supervised practice. 

Design/Methods:

A skills station based on institutional standard operating procedure was integrated into a pre-neurology bootcamp for 14 junior residents (12 PGY-2 adult neurology, 2 PGY-3 child neurology). Residents and faculty observers completed pre- and post-training surveys assessing confidence and competence in performing PLEX removal independently. Confidence was rated on a 4-point Likert scale (1=could not perform, 2=may perform with assistance, 3=may perform independently, 4=easily perform independently). Results were analyzed using Wilcoxon-Signed Rank Tests with median and interquartile range (IQR) reported.  

Results:

All 14 residents completed the training.  Resident reported confidence increased significantly from a median of 1 (IQR 1-2) pre-training to 3 (IQR 1-4) post-training (V=0, p<0.001). Pre-training, 64% (9/14) residents rated themselves at the lowest confidence level, while post-training 93% (13/14) rated themselves as able to perform independently or easily (score 3-4). Faculty perceptions showed an even greater improvement, with median scores rising from 1 (IQR 0-1) to 4 IQR (1-4), (V= 0, p <0.001). Notably, faculty consistently rated trainee confidence higher than the trainee themselves.  

Conclusions:

The simulation-based skills station significantly improved both resident and faculty-perceived confidence in PLEX catheter removal. This study demonstrates manikin-based simulation training is an effective approach for teaching invasive procedures to junior residents.