1. Grantcharov TP, Reznick RK. Teaching procedural skills. BMJ 2008;336:1129

2. De Gottardi A, Thevenot T, Spahr L, et al. Risk of complications after abdominal paracentesis in cirrhotic patients: a prospective study. Clin Gastroenterol Hepatol 2009;7:906-9.

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4. Grabau CM, Crago SF, Hoff LK. Performance standards for therapeutic abdominal paracentesis. Hepatology 2004;40(2):484-8.

5. Gines A, Fernandez-Esparrach G, Monescillo A, et al. Randomized trial comparing albumin, dextran 70, and polygeline in cirrhotic patients with ascites treated by

paracentesis. Gastroenterology 1996;111(4):1002-10. 6. Runyon BA. Paracentesis of ascetic fluid: a safe

procedure. Arch Intern Med 1986;146:2259-61. 7. Stephenson J, Gilbert J. The development of guidelines on

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A single 1:1 30-min practical paracentesis teaching session, using an existing Clinical Checklist and Equipment Kit, helped junior doctors gain knowledge, competence and confidence.

Future improvements to the module could include a repeat practical assessment, acquisition of a simulation model and increased attendance rates. Research is required to determine if patient outcomes are improved by adding the module to integrated procedural education programmes at Waitemata DHB.

Practical Paracentesis Teaching Improves Procedural Confidence and Competence

To assess if a 1:1 practical paracentesis teaching session improves the confidence, competence and knowledge of junior doctors, as part of a wider procedural teaching programme.

Step 3 – Pre-testJunior doctors completed a confidence / competency questionnaire and knowledge quiz before the sessions.

Step 2 – RecruitmentHouse officers and medical registrars invited to attend sessions from July to August 2017.

Step 5 – Anatomical landmarks Tutors demonstrated positions in the right-lower quadrant and right lower quadrant for paracentesis on a model

Step 1 - Reviewed literatureAuthors developed a teaching programme, curriculum, quiz and paracentesis models (fig 1&2).

30 Minutes Practical Paracentesis

Teaching Module

Step 7 – Post-test Junior doctors completed a confidence / competency questionnaire and knowledge quiz after the sessions.

1 2 3Stephanie Yung , S Y Sylvia Wu and Zoë RaosNorth Shore Hospital, Waitemata District Health Board, New Zealand

. � .General Medical Registrar Gastroenterology Advanced Trainee Gastroenterologist

INTRODUCTION

METHOD

SUMMARY & RESULTS

CONCLUSION REFERENCES

AIM

Step 8 – Ongoing Improvement Next step: Incorporate into the educational programme at WDHB, including funding application for a paracentesis simulation model.

26 junior doctors (out of 82 who were invited) attended an advertised teaching session. 46% of the participants were first year house officers.

There was an 83% and 80% increase in self-rated confidence post-teaching session in performing diagnostic and therapeutic paracentesis respectively.

There was a 13% increase in post-teaching quiz scores. 100% of participants found the sessions 'useful', with feedback that a

paracentesis simulation model would enhance the module further.

Junior Doctors at Waitemata District Health Board (Waitemata DHB) routinely perform bedside invasive Ÿprocedures, such as diagnostic and therapeutic paracentesis. A locally developed Procedure Checklist and standardised Equipment Kit have reduced local complication Ÿrates and improved procedural quality for patients undergoing paracentesis since 2013.Training for procedural skills is traditionally dependent on bedside teaching on patients with ascites to reach Ÿtechnical competence. There is little in the literature regarding ideal methods for teaching and assessment of diagnostic and therapeutic paracentesis, whilst similar procedures (such as thoracocentesis and lumbar puncture) have established teaching methods and utilisation of models.

Step 4 – Introduction SessionTutors provided 1:1 teaching on informed consent, indications and safety considerations + introduction of local Paracentesis Clinical Checklist and Equipment Kit.

Figure 1: USS model used to identify anatomical landmarks

Figure 2: Practical paracentesis model

4 bags of saline with a dressing sitting in a plastic bucket

Contents of the Equipment Kit

Step 6 – Hands-on teachingTutors assessed prior experience: Inexperienced proceduralist – focus on safe diagnostic paracentesis Prior experience – in depth teaching on therapeutic paracentesisUtilised standardised Equipment Kit and a practical paracentesis model that mimics an abdominal cavity filled with fluid (fig 2).

Figure 3: Self-rated Confidence to Perform Diagnostic Paracentesis without Supervision

Figure 4: Self-rated Confidence to Perform Therapeutic Paracentesis without Supervision