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Teaching the Lumbar Epidural Technique to Millennial Learners: The Impact of an Educational Video
Abstract Number: T 27
Abstract Type: Original Research
BACKGROUND: A resident’s first rotation in obstetric anesthesia provides an intensive learning opportunity for the epidural technique. Current instruction of residents at our institution involves didactic sessions, demonstration of epidural technique by senior staff, and staff supervision during epidural placements. A recent audit reported that only 33% of trainees felt that they received adequate training before their first attempt(1). The use of multimedia such as point-of-view video has been advocated for enhancing curriculum among millennial learners(2). Video has been used to evaluate resident performance of the epidural technique(3), but the use of an institution-specific video to teach lumbar epidural placement has not been validated.
METHODS: We created an institution-specific video demonstrating the lumbar epidural technique. After IRB approval, anesthesia residents in their first obstetric anesthesia rotation were randomized to either routine orientation (control group) or routine orientation and video exposure (video group). All residents completed a pre-test to assess their baseline knowledge and a post-test to assess change in knowledge at the end of the rotation. Participants also logged epidural placements throughout the month detailing the number of attempts, whether assistance was required, and if the patient had adequate analgesia (VAS<3) 30-60 minutes after placement. Learning curves were calculated based on placements over time against success rate, with success defined as no assistance required, <3 attempts, or VAS<3. All residents completed a post-study questionnaire about the quality of education received and which educational tools were most beneficial.
RESULTS: Three of 25 subjects per group have been recruited to date; enrollment is ongoing. Interim analysis showed no significant differences in pre- and post-test scores between groups. While not significant (p ≥ 0.05), learning curve comparison suggested a higher incidence of success in initial epidural placement in the video group (70% video group, 30% control group) and a trend toward higher success rates beyond the fifth lumbar epidural placement in the video group. Survey of which educational tool was most helpful demonstrated that those in the control group valued direct observation of an attending, while those in the video group preferred the video.
CONCLUSION: Multimedia is increasingly favored among residents, who have been termed “millennial learners” for their facility with electronic devices and desire for interactive education. Our preliminary results suggest that an educational video of the lumbar epidural technique is a valuable learning tool. Further analysis will determine whether the suggested trend toward earlier success in performing the technique is a real effect.
1. Watterson LM et al. Anesth Intensive Care 2007;35(1):38-45.
2. Chu LF et al. Best Prac Res Clin Anaesth 2012;26:33-53.
3. Birnbach DJ et al. Anesthesiology 2002;96(1)5-9.