Simulation-based teaching of aseptic technique for labor epidurals
Abstract Number: S-6
Abstract Type: Original Research
Background: Anesthesiology trainees have been shown to improve their technical skills more than they improve their observance of strict sterile technique during insertion of labor epidurals. This may reflect lack of appropriate teaching, and the development of teaching models for such task is warranted. We have developed an educational model that includes simulation of the actual procedure. The objective of this study was to determine the number of simulation sessions required by anesthesia trainees to learn the ‘aseptic technique’ as part of their epidural insertions. We also wanted to study how this knowledge is retained over time in clinical practice.
Methods: After obtaining informed consent, anesthesia trainees were scored on their baseline skills of maintaining sterility during simulated epidural insertions using a previously validated 15-item checklist. They were then given didactic teaching, a focused workshop, and a video demonstration of the correct and incorrect steps of the sterile technique. This was followed by simulations of the epidural technique on a Styrofoam epidural model. Each trainee had individual successive simulation and debriefing sessions until they achieved competency (100% score on the checklist). All sessions were observed and evaluated by the investigators. Upon completion of the teaching phase, the retention of competence was evaluated in real time practice, every 2 weeks for a total of 4 assessments.
Results: 21 anesthesia trainees (12 residents and 9 fellows) participated in the study. Out of a total of 15 points on the checklist, the baseline average score for the residents and the fellows were 6 and 7.9 respectively. After the initial teaching, there was a significant improvement in both groups to 10.8 and 11.2 respectively (p<0.001). During the simulation training, overall it took 5 attempts for the residents and 3 attempts for the fellows to achieve 100% competence. After the simulation sessions, which by definition brought all participants to a 15-point mark, the 4 subsequent assessments on actual patients over time consistently showed scores in the range of 13-15.
Conclusion: This study demonstrates that a comprehensive model of didactic teaching, focused workshop and simulation significantly improves the performance of anesthesia trainees as it relates to the aseptic technique for epidural insertion.
Reference: 1) Anesthesiology 2006; 105:381–93; 2) Anesth Analg 2007; 104: 965–74; 3) Anaesthesia 2002; 57: 593–6