The goal of this project is to reduce the high mechanical and infectious complication rates of Central Venous Catheter (CVC) placement through the development and implementation of enhanced training methods; specifically, through the innovative concepts of Dynamic Haptic Robotic Training (DHRT) and the advanced DHRT (DHRT+). Building on the progress of the PIs original R01 the proposed goal will be accomplished through the completion of the three specific aims.
Specific Aim 1 Develop and implement whole procedure training through the integration of a mixed reality smart tray, advanced testing surface, and high functional fidelity virtual ultrasound imaging. In this aim, the novel concept of whole procedure training will be pursued, where all 4 key steps of the CVC procedure are automatically trained. In addition optimized high fidelity real time virtual ultrasound images will be developed through advanced modeling. The fidelity of these advancements will be assessed through quantitative measurements and expert panel evaluation.
Specific Aim 2 Develop, implement, and evaluate the impact of adaptive feedback and assessment on resident learning and surgical performance. In this aim, the development of optimal performance metrics and assessment strategies will be investigated through expert and resident testing. In addition the impact of the structure, type, components, and timing of adaptive feedback will be explored.
Specific Aim 3 Assess the wide-spread integration impact of the DHRT+ system on patient outcomes and surgical performance through its incorporation into the residency curricula at Hershey Medical Center (Hershey, PA) and Cedars-Sinai Medical Center (Los Angeles, CA). In the final aim, long-term skill transfer and the impact of patient safety from DHRT and DHRT+ training will be assessed. Specifically, 625 residents will be monitored as they progress through their first year at their respective institutions, Hershey Medical Center and Cedars-Sinai Medical Center. The mechanical and procedural complications they encounter on their first 5 supervised CVC procedures in the clinic will be assessed. In addition, mechanical and infectious complication rates will be recorded for the residents' first CVC patient.

Public Health Relevance

The goal of this study is to develop, implement, and explore the effectiveness of advanced dynamic haptic robotic training (DHRT+) for central venous catheterization (CVC) through a multi-institutional study with Cedars-Sinai Medical Center and Hershey Medical Center. The novel DHRT+ innovations allow for whole procedure training on a diversity of simulated patients, advanced adaptive feedback and assessment, and a global learning system which allows for communication between DHRT+ systems for the implementation of continual improvements. The proposed project will explore the effectiveness of training at reducing the high mechanical complications and infection rates that occur from CVC procedures.

National Institute of Health (NIH)
National Heart, Lung, and Blood Institute (NHLBI)
Research Project (R01)
Project #
Application #
Study Section
Biomedical Computing and Health Informatics Study Section (BCHI)
Program Officer
Lee, Albert
Project Start
Project End
Budget Start
Budget End
Support Year
Fiscal Year
Total Cost
Indirect Cost
Pennsylvania State University
Schools of Medicine
United States
Zip Code
Pepley, David F; Yovanoff, Mary A; Mirkin, Katelin A et al. (2018) Integrating Cadaver Needle Forces Into a Haptic Robotic Simulator. J Med Device 12:0145011-145015
Chen, Hong-En; Yovanoff, Mary A; Pepley, David F et al. (2018) Can Haptic Simulators Distinguish Expert Performance? A Case Study in Central Venous Catheterization in Surgical Education. Simul Healthc :
Yovanoff, Mary A; Chen, Hong-En; Pepley, David F et al. (2018) Investigating the Effect of Simulator Functional Fidelity and Personalized Feedback on Central Venous Catheterization Training. J Surg Educ 75:1410-1421
Pepley, David Frederick; Sonntag, Cheyenne Cassel; Prabhu, Rohan Sunil et al. (2018) Building Ultrasound Phantoms With Modified Polyvinyl Chloride: A Comparison of Needle Insertion Forces and Sonographic Appearance With Commercial and Traditional Simulation Materials. Simul Healthc 13:149-153
Yovanoff, Mary; Pepley, David; Mirkin, Katelin et al. (2017) Personalized Learning in Medical Education: Designing a User Interface for a Dynamic Haptic Robotic Trainer for Central Venous Catheterization. Proc Hum Factors Ergon Soc Annu Meet 61:615-619
Pepley, David F; Gordon, Adam B; Yovanoff, Mary A et al. (2017) Training Surgical Residents With a Haptic Robotic Central Venous Catheterization Simulator. J Surg Educ 74:1066-1073
Pepley, David; Yovanoff, Mary; Mirkin, Katelin et al. (2016) A Virtual Reality Haptic Robotic Simulator for Central Venous Catheterization Training. J Med Device 10:0309371-309372
Yovanoff, Mary; Pepley, David; Mirkin, Katelin et al. (2016) IMPROVING MEDICAL EDUCATION: SIMULATING CHANGES IN PATIENT ANATOMY USING DYNAMIC HAPTIC FEEDBACK. Proc Hum Factors Ergon Soc Annu Meet 60:603-607