Clinics in Medical Education

Design, Implementation and Evaluation of Just-in-Time Training Simulated Videos for Central Venous Catheter Insertion and Epidural Placement

Megan Clancy, DNP, CRNA, Sarah Hayden, DNP, CRNA, Jennifer Phelan, DNP, CRNA, Susan Emery, PhD, CRNA, Caitlin Vitale, PhD, CRNA, Patricia Reid Ponte, DNSc, CRNA

Published January 23, 2025 | Clinics in Medical Education 

Issue 5 | Volume 1 | January 2025

The time that elapses between didactic and simulation training experiences of SRNAs and actual clinical interventions in the patient care setting often contributes to the erosion of knowledge and confidence in completing a technical intervention. This is known as skill decay. To mitigate this phenomenon, Just-in-Time (JIT) simulated training videos were designed based on Cognitive Load Theory (CLT) which, emphasizes the importance of minimizing extraneous cognitive load and enhancing knowledge retention.

The project team designed, administered, and evaluated JIT training videos for two procedural competencies. Participants were second- and third-year Boston College student registered nurse anesthetists (SRNAs).

Participants viewed the simulation video and completed pre- and post-knowledge assessment surveys that also included items to assess perceived confidence levels related to performing the technical procedure; demographic information and participants’ opinion about the video quality, learning experience and likelihood of using JIT simulation videos in the future.

Participants’ knowledge of verbalization of procedural steps, awareness of patient anatomy, proper use of equipment, skillset and confidence level improved after the JIT videos were watched. Additionally, participants’ likelihood of using JIT training videos in the future increased.

Limitations

Several limitations of this project included the small participant sample size, the amateur quality of the video production and limited simulation equipment. However, the JIT simulated videos will continue to be used, evaluated and improved based on feedback by students and faculty.

Key Points

  • Skill decay in student registered nurse anesthetists (SRNA) is predictable and can be reduced with knowledge refreshers.
  • Video aids and cognitive load theory (CLT) in educational design have proven effective in enhancing learning outcomes.
  • Developing just in time (JIT) training videos with CLT methodology for procedural competencies enhances confidence in SRNAs.

Scan here to view detailed description of the project.

Results and Findings

  • Confidence levels increased for the responding SRNAs in all areas examined: clinical skills performance, verbalization of steps, anatomy, equipment and likelihood to use similar videos in the future. 
  • Confidence increased most significantly related to anatomy and equipment associated with the procedure
  • 91% of responding SRNAs would be likely to use JIT training videos in the future to enhance learning.

Conclusions

Viewing JIT training videos developed with CLT may enhance confidence in the SRNA when performing procedural competencies. This project provides the first known example of JIT training videos developed specifically for SRNAs with the incorporation of CLT.

Impacts and Dissemination

  • Findings support the design and production of additional JIT training videos developed with CLT for SRNAs while enhancing coordination with clinical and didactic curriculum.
  • With 68% of the sample preferring hands on simulation review formats , future training videos will be used in parallel with hands-on workshops and simulated procedural review.

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