Limits...
The effect of simulation-based training on initial performance of ultrasound-guided axillary brachial plexus blockade in a clinical setting - a pilot study.

O'Sullivan O, Iohom G, O'Donnell BD, Shorten GD - BMC Anesthesiol (2014)

Bottom Line: This study was discontinued following a planned interim analysis, having recruited 10 trainees.This occurred because it became clear that the functionality of the available simulator was insufficient to meet our training requirements.There were no statistically significant difference in clinical performance, as assessed using the sum of a Global Rating Score and a checklist score, between simulation-based training [mean 32.9 (standard deviation 11.1)] and control trainees [31.5 (4.2)] (p = 0.885).

View Article: PubMed Central - PubMed

Affiliation: Department of Anaesthesia and Intensive Care Medicine, Cork University Hospital, Wilton, Cork Ireland ; Department of Anaesthesia and Intensive Care Medicine, University College Cork, Cork, Ireland ; ASSERT for Health Centre, University College Cork, Cork, Ireland.

ABSTRACT

Background: In preparing novice anesthesiologists to perform their first ultrasound-guided axillary brachial plexus blockade, we hypothesized that virtual reality simulation-based training offers an additional learning benefit over standard training. We carried out pilot testing of this hypothesis using a prospective, single blind, randomized controlled trial.

Methods: We planned to recruit 20 anesthesiologists who had no experience of performing ultrasound-guided regional anesthesia. Initial standardized training, reflecting current best available practice was provided to all participating trainees. Trainees were randomized into one of two groups; (i) to undertake additional simulation-based training or (ii) no further training. On completion of their assigned training, trainees attempted their first ultrasound-guided axillary brachial plexus blockade. Two experts, blinded to the trainees' group allocation, assessed the performance of trainees using validated tools.

Results: This study was discontinued following a planned interim analysis, having recruited 10 trainees. This occurred because it became clear that the functionality of the available simulator was insufficient to meet our training requirements. There were no statistically significant difference in clinical performance, as assessed using the sum of a Global Rating Score and a checklist score, between simulation-based training [mean 32.9 (standard deviation 11.1)] and control trainees [31.5 (4.2)] (p = 0.885).

Conclusions: We have described a methodology for assessing the effectiveness of a simulator, during its development, by means of a randomized controlled trial. We believe that the learning acquired will be useful if performing future trials on learning efficacy associated with simulation based training in procedural skills.

Trial registration: ClinicalTrials.gov identifier: NCT01965314. Registered October 17th 2013.

Show MeSH
Configuration of simulator similar to that during trial.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
getmorefigures.php?uid=PMC4384236&req=5

Fig1: Configuration of simulator similar to that during trial.

Mentions: Following initial familiarization with the simulator, lasting 50 – 60 minutes (duration partially due to the prototypal nature of the device), SG subjects were asked to complete 4 procedure specific tasks to a predefined proficiency level, 2 relating to ultrasound scanning (utilizing a single haptic device) and 2 relating to needle advancement under ultrasound guidance (concurrently controlling two haptic devices – see Figure 1). Computer generated feedback was given to the subject after each attempted performance of each task. Participants were required to meet proficiency levels on two consecutive attempts before passing each task. In order to complete simulation training the SG participants had to pass all 4 tasks. The tasks were specifically chosen to cover the pre-procedural scout scan and the needling component of USgABPB, while also permitting capture of behaviors likely to lead to significant clinical errors[15]. Table 1 outlines each task, the feedback given and the proficiency level which had to be met. There was no specified time limit to meet these requirements. Subjects were free to control the frequency and duration of use of the simulator. Following initial orientation, training on the simulator in this study was largely unsupervised. An investigator was immediately available to address any technical issues which may have arisen. A flow diagram of the study design is provided (Figure 2). Figures 3,4, and5 provide sample images, representative of (i) instructional material, (ii) automated feedback, and (iii) the automated login process.Figure 1


The effect of simulation-based training on initial performance of ultrasound-guided axillary brachial plexus blockade in a clinical setting - a pilot study.

O'Sullivan O, Iohom G, O'Donnell BD, Shorten GD - BMC Anesthesiol (2014)

Configuration of simulator similar to that during trial.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4384236&req=5

Fig1: Configuration of simulator similar to that during trial.
Mentions: Following initial familiarization with the simulator, lasting 50 – 60 minutes (duration partially due to the prototypal nature of the device), SG subjects were asked to complete 4 procedure specific tasks to a predefined proficiency level, 2 relating to ultrasound scanning (utilizing a single haptic device) and 2 relating to needle advancement under ultrasound guidance (concurrently controlling two haptic devices – see Figure 1). Computer generated feedback was given to the subject after each attempted performance of each task. Participants were required to meet proficiency levels on two consecutive attempts before passing each task. In order to complete simulation training the SG participants had to pass all 4 tasks. The tasks were specifically chosen to cover the pre-procedural scout scan and the needling component of USgABPB, while also permitting capture of behaviors likely to lead to significant clinical errors[15]. Table 1 outlines each task, the feedback given and the proficiency level which had to be met. There was no specified time limit to meet these requirements. Subjects were free to control the frequency and duration of use of the simulator. Following initial orientation, training on the simulator in this study was largely unsupervised. An investigator was immediately available to address any technical issues which may have arisen. A flow diagram of the study design is provided (Figure 2). Figures 3,4, and5 provide sample images, representative of (i) instructional material, (ii) automated feedback, and (iii) the automated login process.Figure 1

Bottom Line: This study was discontinued following a planned interim analysis, having recruited 10 trainees.This occurred because it became clear that the functionality of the available simulator was insufficient to meet our training requirements.There were no statistically significant difference in clinical performance, as assessed using the sum of a Global Rating Score and a checklist score, between simulation-based training [mean 32.9 (standard deviation 11.1)] and control trainees [31.5 (4.2)] (p = 0.885).

View Article: PubMed Central - PubMed

Affiliation: Department of Anaesthesia and Intensive Care Medicine, Cork University Hospital, Wilton, Cork Ireland ; Department of Anaesthesia and Intensive Care Medicine, University College Cork, Cork, Ireland ; ASSERT for Health Centre, University College Cork, Cork, Ireland.

ABSTRACT

Background: In preparing novice anesthesiologists to perform their first ultrasound-guided axillary brachial plexus blockade, we hypothesized that virtual reality simulation-based training offers an additional learning benefit over standard training. We carried out pilot testing of this hypothesis using a prospective, single blind, randomized controlled trial.

Methods: We planned to recruit 20 anesthesiologists who had no experience of performing ultrasound-guided regional anesthesia. Initial standardized training, reflecting current best available practice was provided to all participating trainees. Trainees were randomized into one of two groups; (i) to undertake additional simulation-based training or (ii) no further training. On completion of their assigned training, trainees attempted their first ultrasound-guided axillary brachial plexus blockade. Two experts, blinded to the trainees' group allocation, assessed the performance of trainees using validated tools.

Results: This study was discontinued following a planned interim analysis, having recruited 10 trainees. This occurred because it became clear that the functionality of the available simulator was insufficient to meet our training requirements. There were no statistically significant difference in clinical performance, as assessed using the sum of a Global Rating Score and a checklist score, between simulation-based training [mean 32.9 (standard deviation 11.1)] and control trainees [31.5 (4.2)] (p = 0.885).

Conclusions: We have described a methodology for assessing the effectiveness of a simulator, during its development, by means of a randomized controlled trial. We believe that the learning acquired will be useful if performing future trials on learning efficacy associated with simulation based training in procedural skills.

Trial registration: ClinicalTrials.gov identifier: NCT01965314. Registered October 17th 2013.

Show MeSH